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Home My WebLink About3019 FILLMORE WAY - Building PermitsN IOJE� +ooness: 3019 FILLMORE WY UWN! 'NRME: SEALS, JAMES R . =�ss: EDLER, FAC7L 19411 DEVRY 4)' IRVINE CA 755-05�5 FflCHIENGINEEH: ..' AOOflESS: lIN1T: 92715 flEG.NO.: UNIT: PEPMITTEE: P�UI, F.I,DER ( 71 A) 755-0555 , - ADONESS: S9�II1 DEVRY IRVZNE CA 92715 LICENSEO CONTflPCTOH OECUIBATION: I hereby allirm that I am IicenseA untler provisions o� CAap�er 9(commencinA wiih Sec�ion 7000) al �ivreion 3 al Ihe Business entl Pmiqssions Catle. antl my license Is In lull lorca and eileci. CITY LIC.: STFTE LIC.: CIASS: Dam: Signature: WOflNEPS' COMPENSRTION oECIAflRTION: I hereby allirm inal I have a cenilicale al consenl to se0-insure or a cehilicate ol warkers' Fompensalion Insurance. ot a cerl�lietl copy t�ereal (Seclion 3800. Lab. C�. oOLICV NO.: E%P. OPTE: COMPANY: � ❑ Ceriilietl topy i5 hereby WmiSheA. ❑ C¢tliiiee copY i5 liled wiih �he Cily BUiltling Oivision. Oaie: Applican��. EMEMPTION FROM WOflHEPS' COMPENSAiION OECLABATION: (This section need noi be complele0 if �he permil is lor one huntlred (5100) or less�. I certily tha� in Ihe pedormance ol Ihe work lor whic� Ihis permi� is issued. I shall not emplay any person in any manner so a5 io become sublecl Io tne Workers' Compensa�ion Laws 01 Cali�omia. Oalel SignaNre: NO7ICE: II, aller making inis aeclaration, you snoultl become suUject to tne workerS' Compensation Drovisions of tne Labor Code. you musl �onhwith cam0ly with suc� provisions or tAis Dermit s�all be Eeemea revokeU. CONSTPUCTION 1EN01NG AGENCY: I AereGy allitm Ihal Ihere is a mn5imtlion lentling agency lor Ih¢ DeAOrmanCe ai Ihe work for whicb I�is Oermi� is issued �$¢ttion 3097. Civ. C�. LENOEfl: ADDNESS: OWNEB BIIILDEB OECIAPPTION: I herehy allirm that I am eKempt Imm the Conlraclors' Stale License Law lor ihe IollowinA �easan (Seclion 7031.5 Business an0 Pmlessional Catle'. Any ciiy ol coun�y which requires a permit �o conslmc�, alter, improve, tlemolish, or repair any slmciure. prior to ils issuance, dlso repuires ihe applicant �ar such permi� Io lile a signeE slatemeni Ihal he/she is Iicense0 pursuant to ��e pmvisions ol ihe Caniractars' S�a�e License Law (C�aO�er 9(cammencing with Section 7000� ol Division 3 0l t�e 9usiness ane Pmlessions Codel or �nai ne/sne is exemp� Iherelrom and the basis lor t�e alleAed e�emption. Any violatian oi Section 7031.5 by any/applitani lOr a De�mii Subletl5 1�¢ aDPlitani �0 a tivil p¢natly 01 no� more Ihan live �Unared tlollars �5500�. �1 I, as owner af Ihe pmpeny or my employees wit� waqes as tAeir sote compensation, will do ihe woAc, anA the �� simcWre is nat imentletl or otferee lor sale �Seciion 7044, Business ana Pmlessional Catle: The Coniractors' State License Law does nol apply lo an owner ol a propeny who builJs or imo�oves Ihereon, ana who Aoes such work himself/hersell or ihrough � his or her own employees, O�o��detl I�ai Sur,,,ppp impmvemems are no� imended or aitered for sale. II, �owever the Ouilding or impmvement is soltl within one year ol co�tio�'+ner ill h ve I�e burden o� pmving helshe Uitl no� �uilU or improve lor Ihe purpose o� sale). • ,p,� I, as owner oi �he pwperty, am e�clusively nlracUng wit lice u oniractors to consiruct ihe pmlect (Seclion 7044, Business �W and Pmlessions Cotle�, The Comracmrs' State License law tloes not apDly ro an owner of property who bmlas or impmves ihereon antl who con�mCis lOr Suth pmlet�s wii� a Contrat�or�s)litense pur5uanl�o Ihe COn(ratlors' S�ale license Law�.l am aware Ihai OrOoi ol �heir Worker'S Compen5alion insurante ShoWd �e proviA� me. � I am eremp� unGer Sec�ion: B. 8 P. C. / lar Inis reason: Oaic: � � � \ Ownec _ . I ao here�y cetlily thal I am aware ol antl unaerslanA tM1e requiremenls ol Calibmia Neallh ana Salery COAe Sec�ions 25505, 25533, and 2553A ana Ihai I or any fuWre builtling occupant will/will not (circle one) neetl lo comply wiih said 5�aie cotles an0 ihe requiremen�s �or a permil lar conslmction ar mo0ilication Imm Ihe Pir Ouality Managemenl DiSiricl. ReSideniial conSUuction applicalions are exempt �mm Ihese provisions. Oate: pOPlicanL 1 h¢reGy ceiidy I�al I have rea0 Ihis applicalio�.antl Stalel�allAe aboveinlOrmation is cOrret�. lagr¢eio tomply wilh all city antl tOUnty ominancesandslalelawsrelalingto0uilding�nslmc�iona ie� �yaut�or¢ere�y�sentativesoithi��tleahove-menti�neA pm0erty lor inSpCclion pur ses. � I\ /I Dale: � � Signaiure: _ _I,7(,/�.�- _ J oriver's ucense or 5ocial Secwiiy n: 1641�46 WOite—Bmlding', Green—Coao Enlo¢emen�: Canary—Applicant: Plnk—Revenue: GolOenrOC—Assvssor CITY Or COSTA MESA — iiliILDinG PLRMIT PcRM NO; H 05073" PERMIT Nd: R OS0733 PLAN CHECK NO; 00]?5-91 S f.;QVT; N;tiPP; N CONSTRUCTION TYPE: I�ERMIT TYf�H: S'1R PUit1`'OSEc OTii JOB DESCRIPTION ; CONS'I' 485F WOOD TRASH ENCLuSt7RE S�1 F7; .'.S CLAIM VALUE; SOO,UO CALC—VALC1Ec 500,OU GrtUUP Gt�C; R-1 ! COMMENTS; WOOD ENCLOSURE AS APPROVED BY FLANNING iE iE !E �Y� ii� If iF iE iF i(� %� tE it� it 1( �IF 11� �7F ik i4 if iE 3E 3(� it� iEiF it?f k iE li� iF iE ih iF ii� 1E ik ih �it iE 1F if �F i"r if ?f 3'r Y i'r ?f i'r ii 3E it� #f #e if i'r iE i'r ie 1E K� fi- ii� :•: IE ii• #?f ti� ie k�l� !F K� fF Z O 13 I N GS E�TEbQAiJCIKRSE M E N T S ------------ MAIN HUILDING ---------- --------- ACCESSOAY HJILDING ---------- FRNT: I'T IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT ZN LEFT: FT IT: ftGAT; rT IN PARKING REq: PROV; PARCEL: 14113448 ZNE: Ri REF NO: PLANNII3G N6TES> PROPOSED INSTALLATION OF A TRASA ENCLOSURE FOR AN > EXISTING TRIPLEX. %�X� �lE �%iF �N� if �lE if if if- iE �K- If iF If 3f iE IF iF iF �If� �lE if 1F 1(� if �7(� if 1f # if �1k �f ?4 3E iF if �l( if if if i! iE �1E If iE IE-0f !f if 9F x if� If iF 3F% IFlf IF jf �l( if if� )f� )f 141F �1f K;,ie 1f 1E 3f !E 3F 1f �f D E V E L O P M E N T S E R V I C E S R E Q U T R E M E N�T S ZONING APPROVED BY -T � DATE: �2J_� BU.ILD3NG APPROVED HY ; DATE: APPLICATION ISSUED BY: S A— DATE: ��-� � IEiFiE1EiE�lEififlfifififlEi6�l(�i(�#IFif#Fik tr �r 3f�}Eif1E7Eil3E3f)E1f i4?E iF 3F 3E 3F * ib iE N� IF ifl4 it 1F IE K-af i(• N� IF iF if If If �IE IE iE if iE !E iE �!E iF 1F %� )f 3E if IE 7(� IE �1E jt iE iE iE 3E �]E if 1E IE 3E af iF I(� % 3f X� �F iF %iE �E K� iE 3E �E iF+f IE jf if lf if �1( ±E fE ff iE jE LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLUG PMT PLUMBING ELECTRIC MECHANiC FIRE SMIP/RES GRADING PERMIT 15.00 ,SU SMZP/NON—r�ES ZSSUE FEE 9.75 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID D'UE TOTALS----> 15,50 0.00 9.75 25.25 25.25 .00 REVENUE DIVISION TOTALS--> COLLECTED: 25,?S OVER/SHORT; 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECR 15.00 .SO 9.'75 if -0E iE ih ih �E IE 3f i(- if if fF If IE 1c iE iF ii�lE ik i(� iE iE if �1f� i't IE % if 3E iF * if 1F 1f i(� �Ik �1F if iFif iE IE iE i(� iE !E if iE:f� IE iE iF i4 iE 1E 1E if it iF�1f iE 3'r 3F IF 7f iF if if It �� iF iE i(- if if if ii� it 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 5 C R I F� T I O N UNZT COST TOTAL COST SFR 25 RES—TRASH ENCLOSURE / rT. 20,00 500.00 END OF FEES oi �oo,�asc-coa?zcs: ��p� _�, DATE: G1(2l./9i 7ICc: 14�4v CQNSTRUCTION,4ND PLANNW� ' �` & SPA APPROVAI,S Permit # Date Inspector AppROVALS Permit # Date Inspector 1. �mporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms -4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7. Footings 58. Electrical Conduit-Ur+drgrnd. 8. Foundation 59. Gas Pipe, O Undrg�od., Test � 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Tra�, O Undrgrnd. �� t 10. Structural Floor System 61. APPROVAL TO DECK �___ _ 11. Property Sewer Line & Hause Conneaion 62. Backwash & Receptor-Final�- ,�� `) 12. Sewer Cap 63. Heater & Vent-Final 7 ;....,', "-'`s'� 13. Roof Dreins 64. Plumbing System - Final f 14. Rough Plumbing 65. Electrical-Final � � ''� � 75. Rough Electrical-Conduit 66. Solar SYstem-Final '. f 16. Rough Electric Wiring 67. Fencing & Access Approval � 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 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.StoregeTank OGas ❑Oil - ' 25. Roof Sheathing . 74. Overhead Hydro 26. T-Bar Cei�ing (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Sidinq - 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 � i 80. F000 CERTIFICATE ISSUED 33. Final Electric � � Notes: 34. Final Heating & Air Conditioning � 35. Final Gas Pipe�Tes[ � 36. Hood or Canopy 37. Final Factory Fireplace ' 38. Final Plumbinq 39. Water Service�Final 40. Gas Service-Final 41. Solar pomesticFinal � . 42. Backflow Preventer � � , 43. Backflow Irrigation 44. Landscape Irriqation System ' 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & 9UILDING � 48. FINALPLANNING ' 49. Electric Release to Edison ( 50. Gas Release to Southern California Gas Cn ' � 51. CERTIFICATEOFOCCUPANCY No. Date AVD�ieant to flll In a11 soaces except those within heavy bortler Iines anE sign all apvroprlate tleclarations. CITY OF.COSTA MESA C NSTR UCTION PE IT PEqpIT O.� TRACT NO. LOT NO. UNIT NO. A P# n/ 1� Project Address aV S Main Buildi AppliCant'S Mailing A dre55 � � TYPE OF CONSTRUCTION NEW A�D ALTERATION REPAIR E ,/�,c � ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' T Front Owner's Name �USf� /N ��%n Phone��t�i� DESCRIPTION OF WORK/USE OF BLDG. A Rear Atldress Arch/Eng. License No. TVPE OF PERMIT ❑ GRADING_ fOUNDATION STRUCTVRAL I K Right ❑ TENANT ❑ ELECTRICAL L��PLUMBING ❑ MECHANICAL i S' Left Address /� ❑ ,OTHER Pln Flef. # Contrecro�'� Na e -� ��% �� Pho e �� 9' Address (ma �'�9� �� PROJECT DESCRIPTION SQ. FT. OCGUPANCV Planning Notes: q C O N ST RUCTI ON TV PE V ALUATI O N$ City Licen<r Nn � 2 ZONE G G V LICENSED CONTRACTOR DECLARATION 1 hereby aifirm that 1 am licensetl untler provisions of Charte� 9(comm¢nCing with section 7000) of Division 3 of the Business antl Protesslons Cotle, antl my Iic�� s in tu❑ rca��ntl effect. � � /� �n Licen CI s �•S l/ L}'�ens N. �JV 7 Date� 5�9 t L�C� J%A/YIQ.QJ WORKERS' COMPENSATION DECLARATION � �eby aHi�m tnat I have a c¢rtiTitat¢ Of Consent to self-insure o� a certiticate Vorkers' C�jo�mpe(n�s/at/i/o'n� Insurance, or a certlff'�etl copY thereof (Section ��JO, Lzb. CL/�fT Y�V .CJ �E� V�.'� � Policy No. Company rcifietl copy is hereby furnishetl. � Cerlif,'qtl cp g,y iyf�I5tl with the city Buil iyisioJ! �, Date y-/d -XY ApPlicant ��/� �� EXEMPTION Ff20M WORKERS' COMPENSATION DECLARATION (Thissection neetl not De completetl it the permit I5 to/ One huntl�etl (E300) o� less). I certify that in the pertormance of the work tor which this perm�t is issuetl, I snall not employ any person in any manner so as to become subject to the Workers' Compensation Laws ot California. Date Si9nature NOTICE: If, af[er makinq this tleclaration, you shOultl become subject to the Workers' Compen5ation provisions ot the Labor Coae, you must Porthwith comply with such provi5ion5 or tnis pe�mii� shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV I hereby atflrm that there is a construction lentling agency for the performance of Ihe work tor which this permit is issued (Section 3097 Civ. C.) lsnGer's Name Lentler's Atltlress OWNERBUILDEa DECIARATION I hereby affirm that I am exempt trom the Contractor's License Law tor the following reason (Section 7031.5 Business antl Professional Cotle: Any citY or county wnich requires a pe�mit to const�uGt, alte�, imprave, tlemoli5h o� �epai� any structure, prior to its issuance, also requires the applicant for such permit to tile a signetl statement [hat he/she is licensetl pursuant to the provisions of the ContractOr's Licens¢ law (Chapter 9(commencing with Sectlon 7000) of livision 3 of the Business antl Professions Cotle) or that he/5he is exempt aerefrom antl tne basis for the allegetl exemption. Any violation of Section _ 2,J31'.5 by any applican[ for a permit subjects the applicant to a civll \ enalty of not more than tive huntlretl tlollars ($500). '� I, as owne� of tM1e property or my emplOy¢¢s with wa9¢5 as their Sole compensation, will tlo the work, antl the structure Is not intentletl or offeretl for sale (Section ]046, Business antl Protessional Cotle: The Contractor'S License law tloes not appty [o an owner of a property who builtls or improves thereon, antl who tloez sucb wo/k M1imSelf/he�self or through his or he� own employee5, providetl [ha[ sucn improvemenfs are not infentletl or ofteretl for wle. If, hOweveq the building or improvement i55oltl within one year ot com- pietion, the owner will have tne burtlen of proving he/she tlitl mt buila or im- prove forthe purpose of sale). ❑ I, as owner ot the pro0erry, am exclusively contracting witn licensetl mn- tractors to construct the project (Section 7044, Business antl Professlons Cotle: I The ContractoYs License lTw does not apply to an owner ot property who builtls or impwves thereon. antl who conVactS �or suth'oroiect5 with a ron- [ractor(51 Imense pursuam co me ConVacror•5 License Law). I am aware that proof of tneir Worker's Compensation insurance shoultl be provitletl to me. ❑ 1 am exempt untler Sectlon B. & P. C. for this reason Oate Owner I nereby certify tnat I have reatl tnis apP�ication antl state tnat the above information is correct. I agree to compry with all city antl county ortlinances antl sta[e laws relatin9 to builtlin9 con5truction, antl hereby authorize repre- Sentatives of th'S cj-��PPn the above-mentiOnetl roper(y�for inspection purp e / /�Jy Si9nature I Dat¢ �` �+ Drivers' license or 55 � - RADIN CU. D5. ACRES_ Remarks: /afSTK�CQ �.(/!�%� � I � Sink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Servic.e Outlets Interceptors Kitchen Sink Lavatories P-Trap Roof Drains Reinspection Fee UnderGround $15 Duct - Ventilating Exhaust System ❑ Multiple FirepUFact. Blt. �C60 # Heating System & Ducting ❑ o-100,000 BTU � 100,000 Reinspec[ion Fee � $75 0865-46, rev. 5/88 White - Builtling; Canary - Applicant; Pink - Accounting: Goltlenrod - Assessor $FIOWClS Servite Sink Sewer Cap Sewer Connection $O�dI C0112CtOf5 Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Issue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeretion System ❑O�t00,0006TU ❑100,00067 System Repair/Alteration Fire Dampers Registers Issue Fee ES P.utomatic Washer Construction Pole Sub. Cooking Unit Dishwasher Oryers OGas i�Elec Fan . F.A.U. Fixtures Device Boxes OUtI¢t5 $ 3 FEES $ 3 � , Garhage Disposal i Gene�ator �0.5 KW 5 w Zone ry Building: 2 O N I N G R Req./Provided E Q M T S. ELECTRICAL Tronstormer ❑ iS50KW ❑ 50+KW Meter LJup to 100 amps Meter ❑over100amps Suh Panel Momrs OO-1 HP �1 %- 8 Inc. Soiar �9-15 HP �16-15+ Microwave Pole Light Range Standing Sections Tresh Compactor Rainspection Fee $15 luue Fee DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By 8uilding APProved By Appliwtion Issuad By FEES $ 3 '� SUMMARV OF FEES - BUILDING PERMIT $ SMIP $ � ` `PLAN CHECK $ PERMIT ' �PLUMBING $ rl,� �SSUANCE ; $ ., PLAN CHECK 25% $ ENERGY P.C. $ ��,ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ i MECHANICAL $ TOTAL FEE $ :SOD `�PLAN CHECK 25% $ Q� oao4a�ss-uao,a�s9 ��-,-�- - ;;. 4�TE: 0➢I=9Iu�i tSfi'cc f,�,:;� � �.;� - �, . .. . . CONS7RUCTION AND PLANNING . POl SPA Date Inspecto. � Date Inspector APPROVALS Permit # APPROVALS Permit # '1. Temporary Electrical Service or Pole . � 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. • 53. S[eel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms ' 4.•Electrical Conduit-Undrgrnd. . 55. Electrical Bonding 5.`Steel Reinforcement . 56. Rough Plumbing & Pressure Test . 6. Electrical UFER.Grnd. 57. APPROVALTO COVER�GUNITE 7..Footing5 , . . 58. Electrical Conduit-Undrgrnd. S: Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, O Undrgrnd. 10. St�uctural 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 Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final ��.6. Rough Electric Wiring 67. Fencing & Access Approval 17,. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18� Rough Electrical-T Bar Ceiling � 69. POOUSPA SYSTEMS FINAL � �i 1�. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 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.StorageTank OGas ❑Oil 25. Roof Sheathing ' 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & 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: �O'j�i�T �'►Y�' Dp�a6 r(.OT 1M01 34. Final Heating & Air Conditioning w� �, ��,��._ L, �p 35. Final Gas Pipe-Test ,3�!-`t0 ��Qyr�.T EwPtr� �p PifL_ ZO.$ 36. Hood or Canopy V�G -(...E.li 37. Final Factory Fireplace 38. Final Plumbing �� f. � 39. Water Service-Final t % �t. 40. Gas Service-Final ' r.. 41. Solar pomestic-Final � • 42. Backflow Preventer r-� 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation ''- 46. Handicap Regulations �� . 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Felease to Edison � , , � 50. Gas Release to Southern California Gas Co `' !� ' 51. CERTIFICATE OF OCCUPANCY �� i No. Date �� o �%- LoT 1 rRnc �287 :� . . �s�� COSTA MESA BUILDING-SAFETY DEPARTMENT � P. O. BOX 977 COBTA MBBA. CALIFORNIA For Applfeanf fo Fill In Complefiely TYPE OR PRINT � BUIIDING CdSTA MESA. CALIFORNIA ENNETH W. KOLL ADDRE65 � PLACENITA AVENUE rt� c�T. NEWPORT BEACH N�'I� 6 Zz BUIL ADDF ARCHITECT TEL. OR ENGINEER ' NONE NO.------ nnnwcee ___"'_______" '_'______ FIRE NEWPORT ABEACH . TEL. �� X �2�� NO. OP BLD6B. 9HTBACK LIN¢ FROM ceetiea on ern¢ai r � REAR YARD � SIDE YARD I LEFT � o� I RIGHT � O� DESCRIPTION OF WORK NGW I X II ALTERATI�N I II A�DITION I R: FE JA��,G��VED �INANCE �EP�. C1i`t OF COStA MESA APPLICATION FOR PERMIT. BUILDING For Offiee Use Only RECEIPT NO. PEPMIT NO. BY COSTA MESA. CALIFORNIA ZONING ZONE NO. OF UBE OP NEW T. �—� PI.ANB Z I BUILD�N6 W/q �aa�o,e.,,,u Lo f / 9 Tif 11 tcarrtert urva er.� FRONT TS R. SIDE �� L SIDE 30 � REAR �'S � APPROVED . /�� BY "W3 �I IN. __ . IN. IN. A/�� iN. narc �� 9 �G 2. U6E OF 9UILDING AND WORK TO BE PERFORMED j' , TRIPL� FAMILY DWELLLING WITH � ATTACHED GARAGE . PLAN � 1 H6REBY ACKNOWL¢UG¢ THAT 1 XAVC HEAD THi9 MPLIGTION THE AMOUNT BNOWN UNOER VALUAiION �B POR THE AND 6TATE THAT TH8 A90VE IB WRRlGT AND AGqEE TO CON- PUPPOBE OP E6TqBLI8HIN6 A PERMIT FEE ONLY. PLY WITM ALL CITY OPOINANCEB AND 9TATH LAWB FEDULATINO BUILDINO CONBTiUR10N. VALUATION / SIGNATURE OF �/�� PERMIT FEE $ SF'�� PERMITfE � 3 ��i ��''�3 pLAN CHECK $ � �' AUTHORIZED A6�NT � � _—