HomeMy WebLinkAbout2745 DESOTO AVE - Building Permitsri
AD�AESSOFBUILpNG: 2•]�}S DESOTO AV
OWNERSNRMEIFpqWN:ZUHKO, JOHN A
� ADDflE55:Q%4S DE SOTO DR
COSTA MESA,CA
�vc�. yuuxc �oonEss:
92626
UNT:
ARCHRECTOPENdNEEN:CORRIA CONSULTTtJG uc.r+o.: S2132
AIiCX.OPFNG.'SAUDNESS:Z(91'� BOLSA CHICA ST uxr:
C.M, CA 92649
cori,n�cransruxe:WESTERN PIERING ( 714 ) 974-1113
CONf11ACT0A5M411NG 6505 SERRANO AV �
�,00ness:ANAHEIM 92807 CF' uCNO 6997�7
UNT:
UCENSED COMflPCTOXS DECLANRTION: I hereby anirm under peneXy ol peyury the� I am Icensed uMer provispna W Cheplm 9
(cwnmenang wilA Sec�ion ]000) d Oi�iaion � ol the Buainsas entl Professiona Cade, ard m licenae ia in lull l«ce end eHad.
cmuc.No.: uc.cuss:B uc.r,o.:6997"�7 EXP:
o�, 3� 9G �o�„`�I.�.�i�
"^'�WNEH BUILOEN OECIARATION: I Mreby etfirm uMer penely d parNrY �� I em ezemq imm iM CaNratlon L'xero Lew la Me
�lxinp reavon(Sedion ]031.5 Bus'vross enA Proiesaions Cotle:Riry cGy a counly xfiidireQuiree e permil�o conaVuct,allel.imOrove.
holkh, or repeir eny s�mclure, prbr lo ib veuance, eko raquirea iha epplicenl lor such perma m file e eigned ateiemen� Me� he or nhe
�I'remed oureueni m tha Orwisiom oi Ihe Gomrenore ���se lnw jGheplx 9(mmmencino ��h Sad'on ]000) oi Div'sion 3 W Ihe
- Businasa eM Mdessiwo Cotle� or ihei M a she is exemq �haehom eiM ihe bsvs far ihe elbpeE exemqun. My vidatun d Seqon
)O�t.S b/ anY eVW�� fa a permil wbpds Ilie epdKent �o a avil penetly d m� mpe ihan iva huMrad Eollen (550011.
� I, ea owner W �ha vropeny or my employeea wnh wngae es �hei eole mmpenaation, xill do tha wod, end Ihe ewCure b �wl imenCeE
or ottered for xle (Seciion )044. Buairrosa entl PrMe, aiona Code: The Contreclors License Lew Eoes rol epply lo en ownerol propery
who buJEa or YnO�ovea �Mreon, end who Eoas such woA hunaeX or MnaX a thraph he a her own employeae, prvvked thm euch
impro.emmU era mt imaMed or aflered lor sab. M. �wever. �Ae buiNnq w vnparemenl is sdtl wnhin ma yeer d ooenplation, tM
wmrbuilder Mill have �M buNm d povirg M ar aM d'M � Wik w im0� �a iM puryose d aeb�.
❑ I, es owner M iha propaM. � exduuvey mnlreding ��h licenaed convecio�e lo connrud Iha Drol� (Sedion ]01<, Busir�e end
Profesiona Coda: Tha Contredon Lkense law Aoes nM epply m en avmer d Oroperly who buika w impraves t�ereon eM who
convecis la wtli prqects v.i�h e mnvmar�sl Icenaed w9wm b ine Conumon limnae Lewl.
� I em examq under Sec�ion�. B. b P.C., br Nis reeaon: ' '
Oela�. O'�ec ti
I do nereby cenAy Nel l em ewere d eM uMerstarM iM �e9�����s d te1lwnu HeaM eM sefery code Seaiom u5o5, a553J, eM
2553a, end ihm I or eny Mure Wilding mwpent xill / will �b (ci'cb one) riaed io campty w�h eeid atete wdes eiM Ihe requiremeMs br
epermillormneWClionormodAe�ationhomihaAk uaTy��eBememDietnd.ReaiEenlieleonst�udionepplrationaereexemqiromtheae
plOV1510119.
Dele� ADdceM'.
WOqKEN'S COMPENSATION OECLAFITION: I Mroby etfi�m unEer peneM1y W pe�jury me W the lallawiip Eederelbne:
� I heve eM xiY meimen e canAi�aa d mnsenl lo eeRinwre br xakan' compenelion, es prwideE lor by SeUbn �)00 d tha lebor
Gatla, lw iM peAamenca ol Ne wak Iw wkch t�i9 parmX ie iaued.
.• 11 I M1eve eM vril msinlen workeis' mmpenae�on inaure��e. es rpuired by $apim �]00 d IM lebor Coda. M IM parlormenca d Ihe
X woM fa whiM ihia parmil is iuuad. My warken' mm naetion insur ce rertier end poliry number are:
c,,,;,,: CAL'� COM� EXPIRES
� Pdicy Number: � 1 o i � 0 3/ 0 3/ 9 7
V�� �ThissMionneedrrot6erompleteC/thepermrtislwM�ndredGolkrs/JI00/ab.vJ
❑ I cenM �hn in �ha perlormenca ol tM work for whi thia permd ia iaeueE, I ahell na amploy eny peraon in eny manmr w m ta
becwne wbjeo ta tM wrlrore' compeneation lewe d Cdilwmie, anE epree �hat il I ehouN become wbjed to Ihe workers
compa /wp pwisiona Seawn �]00 ot IM latia �e. I Mell fonhx/nn�y� p xith Ihme qoNaiau.
oae:� / ?i ,gL nowKa���.l�; /— �
S q
W�minp: Fellun ro a�cun workri rompxwtlon covxep� b un/awNl, mtl �MII �uDpcf an smp/opr ro ctlMlul p�neltlu nM
clvll Ilnu �q ro on� h�ndrM tMuurM Joll�n lSt00,0�JA In eCd/tlon ro tln cwf ol rompsiwtbr5 G�m�q� u proWOM ror In
3rotlm 3]O6 0l Ms Lebor COM, /nfawf, entl attomey�o /ns.
tONSTFUC110N LEN�INO AOENCY: I hareby elfirm unEar penelry N perjury ihet ihero ia e mnelmdion lentlinp egenry /or iM
p,no�� a in. wo� ra wn�a, ina ve�� �a o�aa ls�a, aos�. cw. c�.
LENDEH'S NAME:
lENOEN'S ADDRE%:
I cenity ihat I hew rced �hia epd'K�� �d ¢�ele Inel ihe Pbove In�ame�ion ia cortq. I pree lo compty wilh ell tily enE oounry oMinencm
eM swe lexs rolvnB �o WiMvp mmvuaion enE hereby eu�Mixe rapraeentmives d iho tllyto enler upon tM ebove-mentuned propeM
�°� �°'0e�p� °�`P�B9 TALLAS ' MARGEAV.E
_/�.�2�'!/P� �e
� i— — -—� o�e: ��% !v
_ _ _ _. . __.,,._ _ �—
(StStdfi.WP) . Wh'ile-BuiW'vp 8 Selery; Greem-Fle; Cenery-Appifanl: Pink-fiavenue: Gakenro�Asxamr
_ CITY OF COSTA MESA — HUILDING PERMIT
PERM NO: B 077458
PERMIT NO: B 077458 PLAN CHECR NO: 01528-96 L GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: REP
SOB DESCRIPTION : UNDERPIN FOUNDATIONS DUE�TO WATER DAMAGE SQ FT: 7.0,000
CLAIM VALUE: 10,000.00 CALC—VALUE: 10,000.00 GROUP OCC: R-3 /
COMMENTS: UNDERPIN FOUNDATIONS DUE TO WATER DAMAGE
if iE iE�I' 1EiE 1f 1E IE'IF9E 1E 1E 1E 1E if iFlE i['iE 1f IE 1E if iE 1E 1f'If'lE1E iElf 1E ik IF i4'If �f # IFif� if 1F 9F if iF IF 1E1E1E'Ih iE # 1E 1f 16iE # iE 1E'k if IE 1E 7F iE iE i(' ff 1f 1E 1f 1i #!f d(' 1f if� #
Z O N I N G_ R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN RfiAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARKING RE(J: PROV: PARCEL: 14164206 ZNE: REF NO:
PLANNING NOTES>
i
li' if # It iF 1E iE iE'if �E iF iE if' iE 1E if iE if 1f iE ik 1E IE IE if iF 1E iF iF if iE iE if 1f 1Flf iF IE if 1f iF 1E'Ih 1Eif iE iE 1f lkif 1E iE�h 1FlElE 1E 1f 1f !E iE 1E iE 1("1I� iF iF if #'lE-IFik'lE'If i@ 1f �k 1E 1f
D E V E L O P M E N T S E R V 2 C E S R E Q U I R E M E N T S
ZONING APPROVED BY , DATE;
BUILDING APPRdVED BY
APPLICATION ISSUED BY
LEGALIZATION:N
BLDG PMT
IPERMIT 162.25
F E E S U M M A R Y
PLUMBING ELECTRIC MECHANIC FIRE
PLAN 105.46
ISSUE FEE
HUILDING—DIV—> PEAMIT ISSUE PLAN—CHECK
TOTALS----> 163.25 0.00 105.46
REVENUE DIVISION T6TALS--> COLLECTED:
BLDG PMT PLUMHING ELECTRIC MECHANIC
162.25
DATE:
DATE: �(% �I
1f1E'IfifiFif�lFi@' #'!f
STRUCTURAL SEGMENT:Y
SMZP/RES GRADING
1 . 0 0
SMIPlNON—RES
TOTAL PAID DUE
268.71 268.72 .00
263.25 OVEA/SHORT: 00
FIRE SMIP/TOT GRADING PLAN—CHECK
1.00
1E 1E1f'IF 1E iE'lE'IF iF 1E iE 1f' 1E 1E iE iE # 1f if �lE 1f'16 # iE ik ih iElf if')f 1Edf If 1k iE if')f' if i! 1E iEikif if 1E # df 1E 1f'If ik il' 1E fE iE 1f 1E �1E iE1E iE 1E iE'IE iE'IE'lE'Iflf 3F if if iP if lkif 1F #�lf�
I N D I V I D U A L F E E H R E A K D O W N
TYPE QTY D E 5 C R I P T I O N UNIT COST TOTAL COST
SFR 10000 ALTER HY VALUE RESIDENTIAL NOZONE 1,00 10,000.00
END OF FEES
D1 ��2�5603—Ofl2f15b09 T CeT ib3.2`
6ATE- 04/30/9S TiME: 16:43
�
monEssaem�ouw: 2�q5 DESOTO AV
ONNE?SN.WEIFpqWN:ZUBKO, JOHN A
� �ODNE55:2%�}S DE SOTO DR
COSTA MESA,CA
APPL. NAlI1NG ROOflESS:
92525
UNT:
ARCXRECTOPFN(iNFEN:CORRIA CONSULTING ucr�o.: $z132
�ncx.onu+c:s�oonca:16912 BOLSA CHICA ST UNT:
C.M. CA 92649
cwimncrarsx�Me:WESTERN PIERING (714)974-1113
CONfPACTOH5MY11NG 6505 SERRANO AV
�nnnEss:ANAHEIM CA ��.�, 699777
92807 uxr: C
LICENSED CONTflACTOHS OECLAFATION: I Mroby eflim umbr perie�y d perjury �hal 1 em IicemeE uMx qrniaona M Cheqx 9
(mmmenaig wit� Section )OOq d prviaun 3 d the Buei� aM PMesaona GOCe, eM m licen» is in hll brce arM eHed.
cmuc.No.: uc.cuss:B uc.No.:6997'�7 EXP:
o�, 3o y� ��,u`����
OWNEF BUILDEP UECLANATION: I hareby elfirm uMer parety d perjury Ihel I em exemq Irom iha Camreqon licena Law fa Iha
Idbwiq resson I�an ]W 1.5 Busiesa eM Prolesebns Coda: Riry ciY a oounry whidi requires e pa�mX to corebun. el�ar. impwe.
demdah, w repv eny svuclura, priar io in evieMe, elso requirm iM eppliran Im euch permn to file a sipmC statemenl Ihet M a aM
u IicenseE W��� io ihe prwieiona d iM Conlredon License law �Chepier 9(mmmmiip wilh Sedion 1000) d Oveion 3 d the
e�sma� a,d aro�ea.,�,s coeel or me� ne o. sne b e.emp �n«eimm ene ine n�s� r« ma �ia.d a.emm�, a�y voie�on a smo,
]0'J1.5 Ey enY aDdicent la e permil wbpda iM epd�t to e rivil penelry d mt mare �han live �unEreE dollera �55001).
il ❑ i, es o�a, d ina a.oaanv a, mv amniw� wnn weees � me�� aoia �mro�w�oo, w�n ao ma woM. �e ma swn�« � �m m�a�aed
or oMereE iw eele (Seclion ]044. Buaimu end Prolessiona Coda: The Conlredors License Lew doea nrn eppty io en Bwner M propeM
wha builds or im0�'� �hereon, end who tloae euch wak Mmaell or heneX or thraugh hu a har own amdW�. C�tleE Ihel euc�
improvemaMa ere � imeMeE or oflered lor eele. H, however, �ha buiNirq a vnqwemem ie edd wnhin wre yeer d mmpletion, Un
I ownerbuiNar xill heve �he burden d pro+inp M or sM d'M � buik w improva iw Ihe W m�a d eale�.
�� I. av ovmar d tM propaM. � e*dimMy mntrediq wnh liceneed conVactaa lo arMrua Ns qopa (�� ]014. Bwiroea erM
Proimsiom Coda: The COMredas Lcenae Lew dme mi epply to en ovmer af popMy wM Wikh a improvea �henon erM xfw
convena br urA prqxte wnh e mMredoNa) licensed punuent to Ihe Canveqon Umnaa lewl.
❑ I em ezamq uMer Secliort, B. 8 P.C., br �hia reevon:
Dela: Owner.
I do Mreby unity thet I em ewera of enE uMemtend ihe raQuirementa d Celfoma Heellh end &dery Code Sedime 25505. 255�3, and
2553a, enE Uel I a eny fulun Euildi�q aocupeni will / wYl nd (tlrcla om) neeC b compty wIh eeiC elele ooEee eM tM ispuinmeme far
epelmnlorwnsvuctionamodifimlionhwn�MAr ue�ty enapemeniDipiid.qpidenlieloonnivaioneppfutiomeneiemqhomlheae
�IOVISM119.
Dete: APd'cenc
WONKEWS COMPENSATION OECLAXATION: I hareby elfirtn undar penetly d peQury aw W Ihe IOlbxin0 ��mona:
❑ I �eve vd xiN meinlein e cetltlimle d mnwnt io veH-inaure br vrorken' companmlion, m O�a+ded br by 3eaion 3)00 d Ihe Lebor
Cade, for �M pe�ormerica d tha wA lor wtich thie peimn ie Iaued.
x❑ i n�. �d �� �m.� .�o�w�e mmwmmu� mw�p�,.. r.o�h.a M sw�o�, a�oo d m. �, cme, ror m. wnwm.�w a mo
work tw whic� I�h pemiM1 o 6eued. MY �k° C�L���� ��'d� ��m� ��: E X P I R E S
Certier:
Pdky NumEx: � 3� Q 3� 9 7
�This eeYion nesE rrof bs canpleteC / tM pemid is lor one hundro! EWkrs /510p) a bseJ
� I cerlRy ihet in Ihe ps�lormence ol iM work la whch ihie permit ie ieeued, I ehdl � emdW enY pe�� �� �Y mennar eo es lo
bacoma eubjed b Iha worken' campaneeiion lawa M Celilanla, and eprae Il�et il I ehoulE bacome wbjeq �o tM worlmre'
mmpen ii Dro�cone Sed'an �]00 0l ��e Lebor Code, I Mall lo hwilh pg wnh Ihoee provieiona.
o�,: ��?i� 9L A�w�t3 �, i
Wem/np: Fe/lun ro��cun xrorkwi roI11pMOtl0�l COVI/ly1IJYOlIWN( �/IJlMl111b/Kf l/1 N11p/OYN f0 Cl/MM/ pM/lBNlM!
clvll nroa up ro on. nundrW rMuunE tlolbn (5100.0001, In .Wltlon ro M. cosr ol comprw0on, aamipa u proHtlM ror In
S�cHm J105 0l fh� L�bor COW, /nbm( �ntl ettarnsY�� fso.
CONSTFUCTION LENUINO AOENCY: I hereby e/frm under penely M perlury �hat iMre ie e mruvuabn IeMinp epency br Ne
peAamance ol Iha vroM for wfiich �he peim4 ie owed (Sed'pn 30g1, Civ. C�.
LENOEN'S NAME:
LENOEN'S RDOflE55:
I cerlAy IM1at I heve med ihia epplcmian eM aele ilal IM ebove inlormmbn is cariea. l prea to camply with dl ary ud munry wtliwicee
end etete levrs relaiinp io builEig canavud'an eM hereEy author¢e rapreaemetivae d Ihie dry to anim upon ihe ebwe-memioned prtperty
�°`�°'°°"�°°v°`0°'°'TALLAS MARGEAVE
��i:?�l�����--�� i9 oma. �0�1�
(5i5b<B.WP) Whno-BailEip85afe�y;OreemFle;Cenery-ApOficen�;%nk-Revenue:OoldenroJ-Asseuw
1r
CITY OF COSTA MESA — BUII�AING PERMIT
PERM NO: B 07'7458�
PERMIT NO: B 077458 PLAN CIiECK NO; 01528-96 L GOVT: N SUPP: Id
CONSTRtJCTION TYPE: C'—N PERMIT TYPE: STR PURPOSE: REF
JOB DESCRIPTION : UNDERPIN FOUNDATIONS DUE TO WATER DAMAGE SQ FT: 10,000
CLAIM VALUE: 10,000,00 CALC—VALUE: 10,000.00 GROUP OCC: R-3 /
COMMENTS: UNDERPIN FOUNDATIONS DUE TO WATER DAMAGE
**�***3t*it***�***+c-**at****�at**i�******x�****at*�t�tx��-*it*****+�*+�*ie+�********�*at�***+�it**+�
Z O N I N GS ERTEB�AUCIKRSE M E N T S
------------ MAIN BUILDING ---------- ------ -- ACCESSORY BUILDING ---------
FRNT: PT' IN REAR: FT IN FRNT; FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 14164206 ZNE: REF NO:
PLANNING NOTES>
i
iF ik iE 3E iE iE iE iE iE iE 7E IE IE 9E iE fE iE 1E iE 1E if �f iE if iE iF ik iE iF 3E 3E 3E 3E �E fE iElF iE 1E iE iE iE 3F iE 1E if 9E iElE 1F 9E iE iE iE iE 9E 9E IElE 3E �F if 1f iE �E iE 3E iE iE if �F dE �E aE dE �E iE 1E i4
D E CT E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVEG BY DATE:
HUILDING APPROVED BY ; DATE:
APPLICATION ISSUED BY: DATE: 3� {
iEiE�(-iEiEiE'IfiElE9EIEiEiF9F3E3ElEifiFiEiEiE !E 1EiE3FlEikiklfiEjEiE !f �ifiE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECAANIC FIRE SMIP/RES GRADING
PERMIT 162.25 1.00
' SMIP/NON—RES
PLAN 105.96
ISSUE FEE -
BUILDING—DIC�—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 163.25 0.00 1,05.46 268,71 268.71 ,00
REVENUE DIVISION TOTALS--> COLiECTED: 163.25 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
162.25 1.00
iFlE 3E 1f ib if if dE if !E 3E �ElElE 9E df 3E dE fE iElE jE iE iE iF �F �f 1E iE iE 3E if vf 1E jf 1ElElE �)F iE iE 1E �E IE IE iE 1E jE 3E iE iE 1E 1f ik iE iE iE iE dE iE iE IE �E 9E �E �f 1f 3f 3E 1E �E IE df iF jE iE 9E iE 3E
I N D I V I D U A L "E E E B R E A K D O W N
TYPE QTY D E S C R I P T I O�N UNIT COST TOTAL COST
SFR 10000 ALTER BY VALUE RESIDENTIAL NOZONE 1.00 10,000.00
END •"OF FEES
EXPI �-�-�w ' , ;
DATE
�:(��_ �G_°:-,, i -' .
• i
��,ii-� s .' -. i_r;. 1. ,.�!
- �
CONSTRUCTION AND PLANNING POOI _ dPR
�APPROVAIS Permit # Date Inspector APPROVALS Permit # Date Inspector
7. Temporary Electricai Service or Pole 52. Pool & Equipment L.ocation �
2. Soil Pipe�Undrgrnd. 53. Steei Reinforcemeni '
3. Electrical Conduit Utility-Undrgmd. 54. Forms �'
4. Eiectricai Conduit-Undrgmd. 55. Electricai Bonding '. '
5. Steei Reinforcement 56. Rough Ptumbing & Pressure Test �
6. Electricai UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings . 58. Electrical Conduit�Undrgrnd. �
� 8. Foundation 59. Gas Pipe, �7 Undrgrnd., Test '
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�7rap, � Updrgrr.d.
10. Structural Floor Svscem � 67. APPROVAL TO DECK � �
11. Property Sewer Line & House Cdnnectlon 62. Backwash & Receptor�Final��
12. Sewer Cap � 63. Heater & Vent-Final � �
13. Roof Drains - 64. Plumbing System - Final �
74, Rough Plumbing .l� 65. Electrical-Final � "
15. Rou9h Electrica6Conduit ., 66. Solar SYstem�Final ��
7
76. Rough Electric Wfring �' 67. Fencing & Access Approval .
17. Rough 4Niring Slgn � 68. APPROVED FOR PLASTERyfUG '
18. Rough Electrica��T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVAIS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. OuMs, Ventilating 71. Product Piping � Gas v'^i Oil
23. Gas Pipe-Rough & Test 72. Underground Flush �� � -
24. Roof Framing 73. Undergrnd. Storaye Tank u Gas ❑ Oil .-:¢;
25. Roof Sheathing 74. Overhead Hydro �
26. T-Baa Celling (St«+ccvral) & Monotoa2 75. Dry Chemical -,•; �
27, Frame and Flashing 76. Dry Standpipe j
28. Lathing&Siding 77. FIXEDSYSTEMFINAL �,�' �
29. Insulation 78. FIRE PREV. FINAL
30. Dryevall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION �
32. Electrical Power Meter-Finai 80. FOOD CEftTIFICATE ISSUED
33. Final Electric Notes: S�`/y'/ �CKS /�f ����
34. Final Heatin & Air Conditionin �'� n� �/
9 9 �� / �O ✓/� (�oyG/�Zi�
35. Final Gas Pipe�7est
36. Hood or Canopy
37. Finai Pactory Fireplace
38. Finei Plumbing �
39. Water Service�F�nai ��
40. Gas Service-Final
41. Solar �omestic-Finai
42. Backfiow Preventer �
43. Backfiow Irrigation
44. Landscape Irrigation System � �
45. Sou�d Attenuation
46. Handicap Regulations .
47. FINAL STRUCTUFiE & BUIIDING �
48. FINAL P�ANN�NG
49. Electrlc Release to Edison _
50. Gas ReleaSe to 5outhern California Gas Co
51. CERTIFlCATE OF OCCUPANCY
No. Date
. . 18876
COSTA MESA BUILDING•SAFETY DEPARTMENT
P. O. BOX 9f7 COHTA MEBA. CALIRORNIA
For Applicani fo Fill In Complefely
TYPE OR PRINT
COSTA MESA. CALIFORNIA
' CITY C
STATE _
Ie:�"e ne'"�e"�." �,�1
Coast Hwy.
"+R-h-f`Pflcosrn17ys AkAO��J.QO
APPLICATION FOR PERMIT
sua�iN�
For Offiee Use Only
REGEIPT NO. PERMIT NO.
COSTA MESA. CALIFORNIA .
APPROVED
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NO. OP [� I llb6 OF NEW
PLANB 1 BUILDINO �
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NO, OR 6LDGBaT �
NOW ON LOT lY0]le p p, NO.
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APPROVED
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OF WORK
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NAL L`StUCCO I ROOFWOOCI Sr13ICE
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EVES
I NEREBY ACKNOWLEDGE TXAT 1 MAV6 RGD THI9 MPLIGTION {NE AMOUNT BHOWN UNOER V�LUATION 19 FOR TXe
ANU BTATE THAT THE ABOVE IB CORR6GT AND AOREE TO COM-
PUitP086 OP EBTABLIBHING A PERMIT FE8 ONLY.
PLV WITH ALL CIIY OqDiNAHCEB AND BTATE lAWB fiEOULATNG
eu�LolNa caNBTRUGTION. VALUATION //
SIGNATURE OF D � M D e t'C PERMIT FEE $ G(O !
PERMITTE
By:� ���� s 20,288.�� PLAN CHECK $�� �
AUTHORIZED AGENT ,«q„� �
TOTAL FEE ��