HomeMy WebLinkAbout3105 DONNYBROOK LN - Building PermitsPflOJECTA�OflESS: 31OS DONNYBROOH LN
OWNEP'SNRME: Y��I yAEKO
. aooeess: 3105 DONNYBROOK LN
COSTA MESA.CA 92626
719) 546-7758
AflCH/ENGINEEfl:
nooness:
HEC.NO.:
UNIT:
uxir:
eexminee: DAUGLASYAMAMI ( 714 ) 596-7758
aooeess: 3105 DONNYHROOK LN
C.M CA 92626
❑CENSED CONTNACTOP UECLIBATION: I hereDy affirm ��ai I am licensea un0er provtsions ol Chapter 9(cammencinp wi�� S¢ction
7000) ol Omsion 3 of ihe Business an0 Protessions GoOe. ana my license is in full force antl effect.
CITY LIC.: STFTE LIC.: CLASS:
Daie: Signaiure:
wOFKENS' COMPENSATION oECIANAiION: 1 nereby attirm ihat I have a certifitate ol consent to sell�insure or a certilicate of workers'
Campensation Insurance. ar a certifiea covY thereot (Section 3800. Lab. C).
POLICY NO.: E%P. DFTE:
uomenxr:
� Cetlifietl capy is �ereAy lumishee. ❑ Cenifietl copy is filed wit� ihe city Builtling �ivision.
oate: Aooi�canC
EXEMPfION FHOM WOHKEflS' fAMPEN5RTI0N DELUflRTION: (ihis section neeG no�
I ceriily iha� in ihe pehormance o� t�e work lor w�ich t�is permit is i5sue0. I hall
su�led �he VJOBert Com0en5aiion Laws of Cali�ornu.
ate: 7'2 �y Siqnature:
NOiICE: II, al�er making Ihis tleclaration. you should ome su b �
Cotle. you must lorthwil� com0ly wi�h such pmvisions or t�is rmi� Shall
CONSTHULTION LENOING FGENCY: I heteby allirm �hat there is a constmclio
w�i[� this permil is issuea (Sttiion d097. Civ. C).
LENOEN:
ADOflESS:
be ComDletM if the ce��� is ta ane hunared (51001 m less�.
not employ any persgn in any manner so as �o become
nsalion provisions oi Ihe Lahor
a0.
for 1he performance of t�e vrork for
OWNEF BUILOEfl DECLANATION: I hereby attirm Ihat I am exempi Irom ihe ConVaclors' State License law br ihe �ollowing reason
�Section 7031.5 Business an0 Pmlessional Code: Any city o� counry whic� requires a permit ro con5�mct, al�er, improve, tlemolish, or
repair any s�mclure. prior to its issuance, aim repuires lhe applicant �ar suc� permii Io lite a signetl s�atement Ihat he/sAe i5licen5e0
punuam to ihe pmvislons ol ihe Contractors' S�ate License Law �COapier 9(cammencing wi1A Seclion 7000) of Oivisian 3 0� Ihe Busines5
antl Professions Code) or �hal �e/she is ezempi therefmm and Ihe basis lor IAe allege0 e�emption. Any violaiion o� Seciion 7031.5 by
any apPlicam lor a Dermit subjects the aDPlicant to a civil penalry of not more Ihan live �untlretl Gollars (E500).
I. as awner of ihe pmpeny or my employees witn wages as tAeir sale compensalion, will ao ihe wOrk, antl ine
❑ simcmre is noi in�entle0 or o��erea �or sale (SetliOn 7044, Busine5s anU Pro�e55ional Cade: The Contrattors' Staie Li[lnse Law
aoes not apvly to an owner ol a property who ouilAs or improves Ihereon, and who Ooes such work himsell/nersell ar thmugh
�is or her own employees. prOvidetl ��at suc� impmvem¢n�5 are not intendeJ or oflere0 �or Sale. Ii, hOw¢ver the Euilding Or
impmvement is sold wi[hin one year o� comple�ion. Ihe owner will have ��e huraen o� pmving he/she tli0 not builG Or impmve
for ine purpose of sale�.
I, as owner of �he pmpeny, am exclusively conVac�ing wi�h licensed con�mc�ors �o consimct Ihe pmleci �Seclion 7044, Business
� antl Pm�essions Cotle: The Conlrac�ors' S�a�e License Law does not aDPty �o an owner a� pm0arty who build5 or improves ��ereon
antl who contracis br such pwlecls wi�� a conVactoqs�license pursuani to the Contrac�ors' S�ate License Law),I am aware
Iha� proof ol their WOBer'S ComOensation insuranre 5houl� 6e pmviaed lo me.
� I am exempt untler Seaion'. e. 8 P. C. /%
for�his reason: �� � _ . � _
va�e: '��—�._�— — r a uwner'
ereby cetli�y I�a� I am aware ol antl un0erstantl ��e requirements o C dorr
2553d antl �hal I or any �ulure �uiiding occupan� wilVwill nol �circle one) neeG to c
permii b� con5lmciion or modilicaiion irom ��e Air Ouabry Managemenl �islrict.
��ese pmvisians.
: Sec�ions 25505, 25533, and
es ana ihe requirtments lar a
aODlicalion5 are ¢Mempi �mm
�ate: Npp�icanl:
I M1ereGy cerlilylhai I have reatl this application ana slate thal ihe a�ove iniormalionis correcL IaA�ee �o comply vnlh all ci�y antl couniy
ortlinancesanaslatelawsrelalingloOudUmgconslmclionantlherebyaut erepresentalivesoflhisciry�oenlerupanlheabove�mentione0
Iy farinspection purposes. �// /
1 �// /�/ J�
'6/. _l _!—� � Signa�ure: — � / / 7 d�'L st....,.�Y
Oriver�s License oi Social Security p:
i6aLa6 W�ite—Builtlmg: Green—CoOe Enlorcemem; Ganary—Applicant: Pink—Revenue; Goldenro0—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 066120
PERMIT NO: B OG6120 PLAN CHECK NO: 00613-94 5 GOVT: N SUPP: N
CONSTRUCTION TYPE: V-5 PERMIT TYPE: STR PURPOSE: OTH
JOH DESCRIPTION : CONSTRUCT 6'X60' BLOCK WALL SQ FT; 60
CLAIM VALUE: 1,500.00 CALC—VALUE: 1,200.00 GROUP OCC: R-3 /
COMMENTS: CONSTRUCT 60LF OF HLOCK WALL ON THE REAR SZDE
*�*x*�*���+�+r�**���*+��*x��r*******�r**�*x*�+�+�***�***+�**�**+�***�**�***�*+�****�*r*;�*+�
Z O N I N GS ERTEBQAUCjKRSE M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT; 101 FT IN REAR; FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: 10 FT IN I
1PARKING REQ • PROV; PARCEL: 14104216 ZNE: R1 REF NO: �i
�PLANNING NZSTES> 60 LF, 6' HIGH BLOCK WALL TO BE CONSTRUCTED ALONG THE REAR I
� > PROPERTY LINE.
�ritx�**�r�r+rx�e**�t�ri��rfrf�ir*�r*�t�r�ri�*�rx�r**x�t*�r*�t*�t*+�ic�*****+�*�r�***+�**�ri���r�t*+�+t****#*�***�c* �i
D E V E L O P M E N T S E A V I C E S R E Q II I R E M E N T 5 I
ZONING APPROVED BY _ �f..��V� DATE: Z Z ��I
BUILDING APPROVED BY : C/�� DATE; � Z —�1
l
APPLICATION ISSUED BY: � DATE: ZZ, q� I
�r**�it**�titit*if*�t�r�r**�k�r�riF�3F��3FiF�r3F'3F�f±F ��r�riF�F'iF '�F'��F�*iF:FiF3F�3F�r+r�tx���.**ic�* * *�t �
±ritx*itx*it�ritititit�;r*�r*�r***�t�rit*it**«*�r*at*itx��r***�r***w�t**x�rit**rt*�r*x�*�r*itat**it*itx� *�*+t+�r-, I
LEGALZZATION:N F E E S U M M A R Y STRUCTURAL S.:GMENT:Y i
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 29.00
PLAN 18.85
ISSUE FEE
FIRE SMIP/RES GRADING
.50
SMIP/NON—RES
BUILDING—DIV—> PERMIT ISSUE PLAN—CFIECK TOTAL PAID DUE
TOTALS----> 29,50 0,00 18,85 48,35 98,35 .00
REVENUE DIVISION TOTALS--> COLLECTED: 48.35 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
29.00 .50 18.85
iE 1E ft 1E iE iE 1E if if k if if if if 1E 1F if 1! iE 1f ik 1E k iE k iE k M iF iE if k if #t iF iF fE 1f 1Elf 1f i! �f ff �f it iE fE 1E M 1E �f if iE iElE if 1E �f !f 1E iE 1f iE ff iE iE 1E if iElf if if if if iE �f iE if
I N D I V I D U A L F 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 60 RES—CONCAETE HLOCK WALL / FT, 20,00 1,200.00
END OF FEES
DS OO�JS%S�R—OQSJS%,�IO T Lt T 43,3`
DATE� 02/2�/94 TINE: 10:21
i:ONSTRUCTION AND PLANNWG - POC SPA
APPROVALS Permit � Oate Inspector pppROVAIS Permit � - Date Inspector
� L TemPocary Elecirical Service or Po4e 52. Poof & Equipmeni Location
2. Soii Pipe�Undrgrnd. 53, Steel Reinforcement .
3, Etectrical Conduit Utility-Undrgrnd. 54. Porms
4. Eleciric5� Conduit-Und�gmd. 55. Etectrical Bonding
5. Steel Reinforcemenc �..Ll _G� �{ �W� 56. flough Pium6�ing & Pressure Tzst
6. Electricai UPER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings �_y_ qy �p,.� 58. ElecVical Conduit�Undrgrnd.
8. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Plpe-Undr�rnd. 60. Sackwash Lines, P�Trap, d Undrgmd. � �'
10. Structurai Floor Svstem 61. APPfiOVAL TO DECK
11. Property Sewer �ine & House Connection 62. Backwash & Recepta��Final ,' ' .' '
12. Sewer Cap 63. Heater & Vent•Final .
13. Roaf Drains 64. Pfumbing System - FinaV - � ,'
14. Rough Plumbing 65. Electricai�Final �� �' �
15. Rough Electriul-Conduit 66. Soiar SVstem•Final '
16. Rough Elearic Wiring 67. Fencing & Access Approval
t7. Rough Wi�ing Si9� '� 68. APPROVED FOR PLASTERtNG
78. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL '
19. Rough Heating & Air Conditioning PIRE DEPT. REQUIREMENT
20. Rou9h Factory Fireplace APPROVALS Permit #
21. Duccs,in Siructure 70. Underg�ound Nydro
22. Ducts, Ventilating 71. Product Piping OGas OOiI
23. Gas PIpe�Rough & Ten 72. Underground Fiush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Ronf Sheathin9 74. Overhead Hydro
26. T�Bar Ce�ling (Structural) & Anonocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insu!ation 78. FIRE PREV. FINAL
30. Dryavall Nailing HEALTH DEPT. REQUIREMENT
37. Plaster 0ro�tm Coat 79. FINAL INSPECTION
32. Electric9l Power Meter�Final 80. FOOD CERTIFICATE ISSUED
33. Fina1 Electric Notes:
34. Final H¢ating & Air Cond�tioning �
35. Finai Gas Pipe-Test " � ��
36. Hood or Canopy �
37. Finat factory F'irepiace
38. Final Plumbing
39. Water Service�Final
40. Gas Serv�ce�Final
45. SoVar DOmesuc�Finat
42. Backflow Preventer -"
43. 8ackflow Irrigation
44. landscaaelrrigationSystem 7-10.. (/- � ���._yvL.. //'�
pwu�
45. Sound Attenuation .
46. HandicaP Regulations
47. PINAL STRUCTURE & BUILDWG 2J'^�-d( �w,�,
46. FINAL PLANNING
49. Electr�ic Reiease to Edison ' i, .
50. Gas Release to Southern Caltfornia Gas Co -� '
51. CERTIFICATE OF OCCUPANCY
No. Date -
-j--
.i�r
b ���
- - �� ���$ �� q ,COMPANY
-- - r
- - - NUMBER_MUST
;_,: � -�1��y - - - - TH� ALL INSPECTiON F�FQ�EST� - -
... �,.;i�PJ$ `..
Ap�lTIONS, D�LFT��;;� ;,' ;�LPF�,T:. : DIVISION OF BUILDING SAFETY
B€�4'?Rii�iEC Cif T's',c CITYOFCOSTAMESA
__.._-.-- � � APPROVFD �
r
�6Y
�
�$�iZ187�
n
qT/ OF COSTA MESA
p�p,NIvING CS'T.
au�[t► m ouc� o�r. Q[�. '.
02/ , 7 � CiL'
OP
RE5IDEMCE
■q N Is unlavrtW ro make aro/-W
psmission irom Ihe oivsbn d Bu
11N s�nDm9 of tlds Plan m�d e�
ar Io be an ePPrmal ot M�e v�t'
N�ts Ordnance anNa Slate tar.
nM'i! D� Blld D� � �^7•
fis p�9 m aa�k is nW tw�n�
(� w�in 180 days ol issuance.
IIE61D[MC[
---A"-�
pe kept an Ods�Oe � i
lerafa� m er�NAa
8afery, �d Coe�M
�
Cv �� L tit
I��
_ � i
� , , :1
r
0�
R[f10[MC[
F.
�I OS W
f
N
�
STREET � I �U � DO _
Cement Coping Outional 1'
Channel Block With 13/S�i
Horizontal Top of all
Fences
For Fences 5' or Less
Vert. Bars 3/8"¢ at 4' -0" O.C.
For Fences Higher Than 5'
Vert. Bars 3/S"� at 32" O.C. �
Fill Cells Solid With Grout
Where Steel Occurs
Reinforcing Steel Shall
Conform to Sec.A-1539
A.S.T.M.
AllSteelto be Lapped
24" or to Code
NATURALGRADE
TWO 3/8"¢ BARS '�
CONTINUOUSTOP
& BO7TOM�-.:.:.;; �„_
HOR7ZSTEEI MUST BE TIED IN
PLACE AT TIME OF TRENCH ,
INSPEC710N. ` r
� � �L� � '
TYPICAL 6�� CONCRETE BLOCK FENCE
i
0
s
�
x
on �p D .
� � F�—WIDTH
� p � SEE CHl+
���9 � BELOW
°L
��
�- : . _
�. 9 i
� ;
� . . .� -. �a e
o . . . . �
c! ^.� r t�l C'�.-`_"..�� �s:� t
�i��:—':1�'3 �,iA+.�yn,s,EC.�-u
l�^�' 2�%,�l C{?.'^� 4'9t4'
r�� �����;e�� �:���,�.�
3s � �;� e,s:, ��a �-��:�a
�"aa�"=�x"est:."s��'�
I NG_
WIOTH 14' Y/�
THICKN�SS p0�� . Ci.1n�Z'a
DEPTH OF EARTHTOOTH . 24� �jjy�;`. �� �.�
SPACING OF EQRTHTOOTH �I�2' __�,._
City of Costa Mesa, Cali.fornia
Building Department
4:EV15ED NOV. b2
G�Z;d
.
� e
a2Z3YZ •.-:;��
f� 12" .
8 ��
{r�iG� . . . .
i<Is� � �:i�e,:� . 16„
GENERAL- NOTES
MORTAR: p�e Part Plasfic Cement, and
Three Paris Sand
GROUT: One Part Cement Three and
One Halt Parts S�ond
COPING: One Part Cement, Three
Parts Sand
CONCRETE: Wel I M�xed 1:2- I/2: 3- I/2
Maz. of 7- I/2 Gallens of
YVater Per Sack of Cement
GROUT MAV BE POURED FROM THE TOP
OF THE FENCE IN CELLS WHERE STEEL
OCCURS.
CELLSAND AREASOF HORIZONTAL REIN-
FORCEMEN7 SHALL BE CLEAR, CLEAN &
FREE OF ALL MORTAR DEBRIS, ETC.
GF E4RTHTCOTH
�� TNE HEIGTH OF fENCE
_OW BOTTOM OF FOGTiNG.
SCALE: I/2��= 1�
12..
8„
12,�
16'
, State of � l
�
County of .�—�
On � � ! � before me,_
D E
personally appeared
NRME, TRLE OF OFFICER - E,G.. "UNE DOE, NOTAHV
NAME�S) OF SIGNER�S�
❑ personally known to me - OR -❑ proved to me on the basis of satisfactory evidence
to be the person(s) whose name(s) is/are
subscribed to the within instrument and ac-
knowledged to me that he/she/they executed
the same in his/her/iheir authorized
capacity(ies), and that by his/her/their
signature(s) on the instrument the person(s),
orthe entity upon behalf of which.the person(s)
acted, executed the instrument.
Witness my hand and official seal.
SIGNATURE OF NOTARY
NO2�
CAPACITY CLAIMED BY SIGNER
[�}'RJDIVIDUAL(S)
❑ CORPORATE
OFFICER(S) _
rme�s�
❑ PARTNER(S)
❑ ATTORNEY-IN-FACT
❑ TRUSTEE(S)
❑ SUBSCRIBING WITNESS
❑ GUARDIANICONSERVATOR
❑ OTHER:
SIGNER IS REPRESENTING:
NAME OF PERSON�S) OR ENTITV�IES)
ATTENTION NOTARV:.All�ough the information requested Delow is OPTIONAL, it could Qrevent tra,utlule�n�� a/lta_c'h/me�nt of /this� certificate to unauthorizetl tlocument.
THIS CERTIFICATE Title or Type of Document 7���/ G�a"�` (� 4��/ ��
�' MUST BE ATTACHED �
TO THE DOCUMENT Number of Pages / Date of Docume t
,� DESCRIBED AT RIGHT: Signer(s) Other Than Named Above
O 1991 NATIONAL NOTFRV ASSOCIATtUrv • 6236 Rammet Ava. � P.O. Boe 1t8< •
,
�
�I
PARTY WALL AGREEMENT
THIS AGREEMENT, made and entered into this ��� � `� day of
, by and between _,l1C�t:��-f �//,�i�d_.r��-
hereinafter referred to as "LANDOWNER;' and ��+ •��
hereinafter referred to as "ADJACENT PROPERTY OWNER"
It is hereby agreed that a party wall will be constructed on the property line
between
- � ' a�'✓ �%' .ii � .. '�.•
in the City of Costa Mesa, County of Orange, State of California, as per map recorded
- in Book , Page of Miscellaneous Maps, in the office of the County Recorder
•� of said County. The party wall shall be permitted to encroach � '
�� , � . .
�
IN WITNESS WHEREOF, the parties have entered into this Agreement the day and
year first above written.
LANDOWN�R , �
ADJACENT PROPERTY OWNER
(Signature
�o�12,v-{ L . .S'�ute.�
Name (Typed or Printed)
�.��//�✓w /_/_�?/�'yG%a.t--�- �ld� Gt.��,�2 Lal
(Address) ~ (Address) �
t90Ga6
NOTARIZATION. REQUIRED
�
ALL-PURPOSE ACKNOWLEDGMENT
State of �L' � FU�Z�� �
County of ���'�G� }
On �� /� 7 before me, `���'" y�'���'� s���'`�-
DATE NAME,� ITLE OF OFFICER � E.G.,'JANE DOE. N TARY PUBLIC" �—
personally appeared �'J'
131�1 /
❑ personally known to me - OR -,1iJ proved to me on the basis of satisfactory evidence
to be the er (s) whose �Es) t�/are
subscribed to the within instrument and ac-
-------------^----•--�--� �� knowledged to me�S�at I�e%she/they executed
�,�.,,�,_, , the same in 14'r�/heNtheir authorized
..;;.�;.;�^ UrFlCIAISEAL C��1.�y i@5), and that by�l+�sl�e�/their
SALLY G. A,RhriSiRC�NG �y��s) on the instrument the per��r�(s),
�, Notr.:/Pub;lc-Catlfomla
�=•"��� ��• ca�,Nc�:cau:Rv or the entity upon behalf of which the
�e Ny �ommision Cxoires � s) acted, executed the instrument.
ea �' Apni29, i9:-i
.c�Q:�,.,r:,u�,�,�. ... _
THIS CERTIFICATE MUST BE ATTACHED TO
THE DOCUMENT DESCRIBED AT RIGHT:
Though Iha data requested �ere is not required by law,
it rnuld prevent trautlulem reanachment of Ihis lorm.
VJITNESS my hand and ofiiciai seal.
No.5193
� OPTIONAL SECTION �
CAPACITY CLAIMED BY SIGNER
Though statme tloes not require �he Nmary to
fill in the data Delow. doing so may prove
invaluable to parsons relyirg on the dowmem.
� NDIVIDUAL
� CORPORATE OFFICER(S)
TITLE�S)
� PARTNER(S) � LIMITED
� GENERAL
� ATTORNEY-IN-FACT
� TRUSTEE(S)
� GUARDIAN/CONSERVATOR
� OTHER:
SIGNER IS REPRESENTING:
NAME OF PERSON�S) OR ENTITY�IES)
� OPTIONAL SECTION �
TITLE OR TYPE OF DOCUMENT �� C � �C'�'
NUMBER OF PAGES � DATE OF DOCUMENT
SIGNER(S) OTHER THAN NAMED ABOVE
7_/
-C-¢ _
07993 NATIONAL NOTARY ASSOCIATION • 8236 Remmet Ave., P.O. Boz 7184 • Canoga Park. CA 97309-77Be
NT
� ' /
State of �a �i �Ci ilid l/I l
JCounry of_�s�T
i \
On ��ZU %( `( k before me, ,
DATE� NAME, TIRE OF OFFICER � E.G.,'JANE OOE, NOT�RV PUBLIC'
personally appeared
NAME�S) OF SIGNER�S)
❑ personally known to me - OR - p proved to me on the basis o( satisfactory evidence
to be the person(s) whose name(s) is/are
subscribed to the within instrument and ac-
knowledged to me that he/she/they executed
the same in his/heNtheir authorized
capacity(ies), and that by his/her/their
signature(s) on the instrument the person(s),
or the entity upon behalf of wh ich the person (s)
acted, executed the instrument.
Witness my hand and official seal.
SIGNATURE OF NOTARY
NO 209
CAPACITY CLAIMED BY SIGNER
❑ INDIVIDUAL(S)
❑ CORPOAATE
OFFICER�S)
TITLE�S)
❑ PAR7NER(S)
❑ ATTORNEV-IN-FACT
❑ TRUSTEE(S)
❑ SUBSCRIBING WITNESS
❑ GUARDIAN/CONSERVATOR
❑ OTHER:
SIGNER IS REPRESENTING:
NAME OF PERSON�S) OR ENTITY�1ES)
AITENTION NOTARY: Although ;he information requestetl �elow is OPTIONAL, it could prevent Iraudulent attachment ot this cenificate ro unauthorizetl tlocumant.
THIS CERTIFICATE
MUST BE ATTACHED
�'�O THE DOCUMENT
DESCRIBED AT RIGHT:
Title or Type of Document
Number of Pages
Signer(s) Other Than Named Above
Date oi Document
� 1991 NATIONAL NOTARV
PARTY WALL AGREEMENT
THIS AGREEMENT, made and entered into this -�_�ii 2- � day of
� , by and between _ �e��� %�J _�'!_h1_g.ti� �
hereinafter referred to as "LANDOWNER," and �� t' L �w�✓�- �
w
hereinafter referred to as "ADJACENT PROPERTY OWNER"
It is hereby agreed that a party wall will be constructed on the property line
between
_ � 1 O 6 (,J�-✓�� �h) _
in the City of Costa Mesa, County of Orange, State of California, as per map recorded
in Book , Page of Miscellaneous Maps, in the office of the County Recorder
of said County. The party wall shall be permitted to encroach
IN WITNESS WHEREOF, the parties have entered into this Agreement the day and
year first above written.
-:►���►�
�`�Qlj �C �/� �0�•<9,GC �
Name (Typed�7Printedj
_ �/0,� ��� � �, �.
(Add����. �,� sy �
�90G46
ADJACENT PROPERTY OWNER
(sig�� �-'�-V
� •
_/�-1 e.l � s s a� t,��.e-
Name (Typed or Printed)
31 o b l,J a r r�,n I..►, . C� 5 td Me sa
(Address)
NOTARIZATION RE�UIRED
IA ALL•PURPOSE ACKNOWLEDGMENT
State of �� � �����
County of d/�f*%/�''�v �
On Z�� y� betore me, �"��' �� /��Z�Gt��/u'��
OATE NAME. RE OP OFFICER - E.G.,'JANE DOE. OTARY PU
personally appeared � v �� � 1�'�� �
NAME�S) OF SIGNER�S)
❑ personaily known to me - OR -�ved to me on the basis of satisfactory evidence
to be the rs n(s) whose �e(s) f�/are
subscribed o the within instrument and ac-
knowledged to me that �/she/they executed
" ' "' "' """""" =""""'"'�''""`""'the same in �js'/heNtheir�thorized
f y(ies), and that by her/their
! � �;,,,,J pfFlCIALSEAL A2tt�fe(s) on the instrument the 1so (s),
�'''i SALLY E. ARMSTRONG
i°r�':�r;��� N�C ANGECOUNN'� ��sert('s) actedue� cuedthe IflfS uhmentthe
��� My Commission E�olres �
� �,i Aprii 29, 1994
o�w-z�-�=���.�:.1 VJITNESS my hand and oHicial seal.
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SIGNATURE OF NOTARV
No.5193
� OPTIONAL SECTION �
CAPACITY CLAIMED BY SIGNER
Tl�ough statute tices not raquire Ihe Notary to
lill in ihe data below, doing so may prove
invaluable to parsons relyirg on the document.
�IVIDUAL
� CORPORATE OFFICER(S)
TITLE�S)
� PARTNER(S) � LIMITED
� GENERAL
� ATTORNEY-IN-FACT
� TRUSTEE(S)
� GUARDIAN/CONSERVATOR
� OTHER:
SIGNER IS REPRESENTING:
NAME OF PERSON(S) OR ENTITY(IES)
OPTIONAL SECTIO �` ��
THIS CERTIFICATE MUST BE ATTACHED TO TITLE OR TYPE OF DOCUMENT
THE DOCUMENT DESCRIBED AT RIGHT:
NUMBER OF PAGES � DATE OF DOCUMENT � �
T�oug� the data requestetl here is noi raquiretl by law, /� /���l� G..G��
ii could prevenl irautlulent reanachmern of this lorm. SIGNER(S) OTHER THAN NAMED ABOVE �� � <>^'y
m1993 NATIONAL NOTARV ASSOCIATION • 8236 Femme� Ave., P.O. 8ox 7784 • Canoga Park, CA 97309�77Ba
-OWNER
DATE
GENERAL CONTRACTOR ' VALUE$ »�qp
AP. No. LOT (�� TRACT �h�� FIRE ZONE DESCRIPTION OF WORR S1CIc12 Dw lli nmw�at'.t._var,
R iCTIONS I DATE I SUBCONTRACTOR I DATE PERM�TgNUMBER
�' �' ''7��2
COSTA MESA BUILDING DEPARTMENT
P.O. BOX 31�
' COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
aooRE�s"s 3105 Donnybrook Lane
COSTA MESA. CALIFORNIA
OWNER COLLEGE MESA COMPANY
r.�. ao
Anaheim
... u.. Y � v V a.� �� ��/
� ���5�
FIP!^,":CL �EPT.
nr nnn'� � � " r
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIPT NO.
0 c�1 _;L
IECEIVE I �`\p�i`CE� SEPTEISSU±
���r� � �
NQ: [(�' 3-3161 qDD EI55 /
ARCHITECT BUlOL� Ul ley uc. COSTA MESA. CALIFORNIA
OR ENGINEER No. RE 7191
no� �s 1102 W.-17th St., Santa Ana io e
CITV LIC. ���E v��NS TYPE / �
CONTRACTOR The Hale Com an No. 7350 //
AD�RE55 1777 . incoln 3tlQj.IAO. BYPROVE DATE
"`"` CORRECTIONS
oEs�A�P,�o� No 63 e�ocK TRACT2671
an o. -
A.P. NO.
SIZE �
OF LOT
USE OF
E%ISTING BLDG.
SETO/.CK LINE iROM SO, F
CENTEN OF SiFEET
1 �
SIDE YARD RIGHT lO �
NO.OF a�o�s.None
NOW ON LOT
AR YARD J1� '
13'
DESCRIPTION OF WORK
NEW X ALTERATION ADDITION
REPAIr. MOVING DEMOLISH
BUILDING 1ZS3�—L1V. NO.OF
SIZE � ROOMS 5� STORIES
COVERIINGWALL SCUCCO COVERING C01IlP0
USE OF NEW
BUILDING Single Dwelling w/att. gar
STaTE THAT TNE /.BOVE IS CORRER aN0 AGNEE TO [OMPLY WITH .�LL
CITY OROIN.�NCES AND STATE L�WS PEGVLiTING BVILDING CONSTflVC-
"°" COL EGE MESA COMPANY �ALU4TION
SIGNATtJRE OF
PERM,rrEE anv,Gen.�Partn r
S 12,890
AUTHOR
PERMiT FEE S3O.00
PLANCHEGK rDIS.00
TOTAL FEE S 4S .00
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