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Home My WebLink About258 FLOWER ST - Building Permits(714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address?35B-FLOWER ST � � Suite No Vicinity: Parcel Nunmber: 17729402 , _ - , - _ --__ _. _,i�i-`.- _ _ _._ � , Status: ISSUED Applied: 08/25/2003 Issued: OB/25/2003 ISSUEDBY: ��6- ;>'�_ _-�. '__, . Applicant: JOHNBENNETTj."'�--` � `�, /, - . Address �`, u. -, � - , . _ . � �. �� • :��;, .�� . i ,- � _ � Phone�. 714-963 6975� �� . � c- `.� �� _ Zip ; _ ! `- 1 ; ,�V A �, � ' `� i i/ � __; �, � '.� _ � ,; � , _ , , � �� i �� f - " " � ` . ` i �`��.\ Ow�er.�%"TEMPLETON SCOTT�� /� �� . � � ' � / j�� Address `358 FLOWER�ST�#B '��' �cA� �j � �.��i �.�`'� � . � . • :/ �� Phone: �� . � ,, , � � 7 i %=' ` �.. , % , � (i� . , � COSTA MESA. CA Zip:. 92627 ��:i� . . � �� `'. � V � � „V � �'ii�. 1 . . . _- _ ••��' 1:�� , " - _ . ' .. . .�� , � ' 1 , ��,Contractor: � BENNETTS PLUMBING , ; _� � _, - - � � ��, , , _ - � �� i � ! Atldress: � . �20382 GRAYSTONE LN � � - - � ' � � ` v� _ . ,r� . , � . '- -.. - , � . _ ��. . .i. , � . - - .. _ - � � Phone: 7149636630 - . � � ' , � � . , � ' ` 1 . ', �' °:.. � � � ..-�„�,� \. ,t- i '-` � � ., � �, - � HUNTINGTON�BEACH, CA Zip: 9266 , ? \ � �1 �� ' � �� . ` � . , � � . � � • ' , % License: 406317 _ ` ' � i. . � I � �Arch /�Eng,� �� ". �i;-,: �� T -- ,- , - �' ,. - �� ' �` �� i� .,�._. __ : , _....__...'-_"'., . •• � , ' Address: �' - � � - - � � � ' �1 ,� , � �`�� , � l ` 1 i, 1 \\t`, - , �.�, Phone: _l`�i_ =��Zip:;- , 4 r . ... _ - License' , _, � /�� - -' � �. V'=•�� ' _ A�',"�, ' SCOPE OF PERMIT= L - \,\ ,� S, `�� REP,LACE EXISTING GASLINE 8 GAS SERVICE, UNIT'REPIPE: =- \ �� , -\t�,_ . _ � , �.. �I.i i � ��I - i , � � � �`-.,- � f � /, , �, � � . f� _ �/w J /' // ��\`/�i� / � i , rr �� , `'� _ � � �`� � � =6EE-SUMMARY,_, : ,, . ` �, , ,; � � " , r.. . i �r � ,f it t ' � Ati� '._, AMT�A. QTY . „ , _: AMT �'��QTY - j j� r.'I / 7AMT QTY ISSUE FEE V�,,�,, ` ��:. $23 50� ; � . � r:- .,Laundry Tub / Washer. $0.00 -; '-0 .' , �'�'Surtip�Pump ,!�t$0.00 0 Backflow irngation., $0.00 �, �0 �, '� �Landscape-Irrigation ,, $0.00 0 �� , Swirriming Pool � � /y; $0.00 0 Backflow Preventer�, �$0.00 0"' � P-Trap `� , -' %s $0.00 0 , � �Trap Primer �„ � $0.00 0 Bathtub ��.��, �-�$0.00- 0��'�� •-,PressureRegulator'� $OAO 0 - " �Unnal��.' �",� $0.00 0 Clarifier System �\ � $0.00, . �. �0 � � � � Process �Piping (per 10 ft) - $0.00 _0 = . � Vacuum Brkr BkBow(1-4) $0.00 0 Connect Qce,Soda,etc)�-�� $0.00 - � 0 ' � Receptors, _-- __ $0.00 _ 0 -�' .- �Vacuum Brkr Bkflovd(5+) $0.00 0 Dental Units � � �$0.00 �� 0�=� �� '� Septic Tank - - � $0.00-- 0 � �.`Wash Basin:. % .� $0.00 0 Dishwasher \'�$O.OP.� 0-.,-• %i �-�SewerCapforDemo $0,00 �0,-� �\ .�WashBasin�Set $0.00 0 Drain, Floor $0.00 �� 0 Sewer Connect �� '$0.00 ^ 0 Waste;2nd�Vent System $0.00 0 Drain, Rainwater $0.00��.� 0 ��_ �. �� Sewer P�ivate Line ' � � $0.00 '- 0 � Water Closet (ToileQ $0.00 0 Drain,Roof $0.00 �0�'-" _Shower` `J�. ,\„ ^�..$0.00" 0 -Wa[erHeater/vent $0.00 0 Dnnking Fountain $0.00 0 '� � � -Sink, bar , $0.00 j ;0 � � %,_�'� Water Piping (Inst or Rep.) , $0.00 0 ExpansionTank $0.00 0 -"Sink,commercial�__ _,30.00�-�0 �� WaterRe-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor ---- -- -- $0:00 � 0 Water Service $0.00 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statules and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This pertnit shall automatirally expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a pedod of 180 days. . INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inapeetions end flnel epproval must be obtained. Failure to obtain inspections and (inal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 ' 2aaaee �aroo� WORKERS'CtlMPENSAnON DECLARAnON: � �� I hereby eHirtn untler penelry ot per�ury one of Ihe following declaretions: � _ ❑ I have end will maintain e ceniticete of consent to seli-Insure tor workers' compensetlon, es pravitletl for by sectlon 3�00 of the Lebor Code, for the peAormence oi Ihe work tor whlch this pertnit is Issued. ❑ 1 heve en0 M�I meintein workers' compensation insurance, es required by section 3700 af Ne Lebor Catle, for Ne pertortnar�ce of the work for which this pertnit is Issued. My workefs' wmpensaUon Insurartce car{ler antl poUcy numher are: � cema�: ,4d,Dn.�-�.�.�, f (—O -- � PolicyNumhec _3%O Lti/ (Ihls sectlon need not bs complete07! the pertnlf is va/uetl et one hundred dollars ($100) or less.) ❑ I certify ihdt In Ihe pertortnance of the work for which Ihis pertnit is issued, I shall not employ any persan In eny manner so es to become subjeCt to ihe workers' compensalion laws of Califomla, end agree that if I should Decome subject to ihe workere' compensation proNslons of Section 3700 of t�e Lebor Cotla, I shell forihwlih comDly wilh these pro%v e'ons. Applicent Slgneture: / � � Date: _ �/� S�/� � _ / WARNINO: FAILURE TO SE WORKERS' ODMPENSATIqJ NVERAOE IS UMAWFUL PND SWUL SUBJECT AN EMPLOVER TO CRIMINAL P TIES MID GNL FlNES UP TO ONE HUNDRED TFIOUSAND OOLlA�7E (51 , 0), IN ADDfT10N TOTHE ODST OF COMPENSAiIIXJ, DAMAGES AS PROVIDED FIXi IN SECTON 3108 OF TME LABOR CODE, INfEqEST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirtn tnet I em Ilcensed under provi ic force end etlect. �c. N_-?� � � Contrectors slgneture: te Chapter 8(commencing with Seccion 7000) of Division 3 oi Ihe B ; / 7 .z� Class p +s--- % Dete: Professlons Cotle, and my Iicense Is In full CONSTAUCTION LENDING AGENCY: ❑ I hereby at�� Nat Nere is a conslructbn IefWing age�y fa the peRama�e oi ihe wo`fc for whidi tfiis pemrii Is issued. (Sec. 3097, Civif Code). Lentlers Name: Signeture: _ Lenders Atldress: Date: OWNER•BUILDER DECLARATONS: I hereby eHirtn tt+at unOer penelry of per�ury that I am EXEMPT FROM THE COMRAC70RS LICENSE LAW tor the following reason (Sec. 7031.5, Business entl Professions Code: My Gry o� �unry which requires a pertnit to conswd, alter, improva, tlemolish, or repflir eny structure, pdor to its luuance, elso requires the applicant for such pertni� to flle a slgneO s�element thet he or she Is Ilcensed pursuent to Ihe provisions of ihe Cantreqors LJcense Lew (C�flpter 9(commendng with Section 7000) of DlNsion 3 of the Business entl Professions Code) or ihet he or she is eaempt therefrom end the besis br the allegetl eaemptian. Any violation oi Section 7037.5 by any epplicant for e pertnit subjects the eppl��ent to a cMl penalry of not more than fve hundred dollers ($500).): ❑ I, es ownel oi ihe properry, or my employees with wages es Iheir sole compensatlon, WILL DO 7HE WORK, antl the struaure is not intentled or offered tor sele (Sec. 7044, Business end Professions Code: The Contrectors License Lew tloes nat apply to en owner of properry who builds or improves thereon, end who does such work himseli or nerself or through his or her own employees, providetl Ihet such improvemenis ere not intended or otteretl tor sele. If, however, ihe building or Improvemen� Is sold within one year of comDletion, the ownar-builtler will heve the burden of proving Ihat he or she tlid not build or improve for purpose oi sale.). ' ❑ I, es ownef oi the proDerry, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTAACTORS to construct the project (SecJ044, Business and Pmtessions Code: The �mrectore llcense Lew does not apply ro en owner o1 properry who builtls or improves thereon, and who wnirects tor such proJact with e contractoqs) license pursuent to ihe Contredoro License LawsJ. . ❑ I em exemp� under sec. Business antl Professions Catle for Uis reason: Signelure: Date: Owner ID veritie0 Dy Arivers licensa. ❑ Yes ❑ No Drivefs License No. VeriNcetlon of Ownership by (rype of tlocument, i.e. - properry tex blll or deed): DIVISION OF INDUSTRIAL SAFETV PERMR CER7IFICATON: Ezpires: ❑ 1 hereby certify that no ezcave�ion five (5) or more feet in depth into which a person Is required to tlescend, will be made in connection wlih worlc authorized by Ihis partnit, and �hat no builtling atruclure, scaftolding, falsework, or demolition or dismaniling Nereof, will be more Ihan ihlrty-six (36) feet high. (Chep. 3.2. Grp 2, Ah 2, Sec. 341, Title 8, CelHomia AtlminiSirelNe Code). ❑ As owner-builder, I will not employ anyane to do work whic� would require e pertnit from the Division ai Industrial Sefery, as noted ebove, unless such person has e pertnit to tla such work irom Ihe division. Signature: Date: Division of Induslnal Safery Permi� NumDer. CERTIFlCATE OF COMPLIANCE AND AUTHOROATON OF ENTRY: I certify under penelry of perjury that I have read this application end state that the Infartnatlon given is coned. I epree to wmply with ell stete laws en0 ciry ortlinences releting to building construction, end authorize representatives of t�e Ciry ot Casta Mesa to enter upon the above-described property for inspeclion purposes. 1 agree not to occupy or ellow occupancy of any building authorized by [his partnit unUl flnel inspeclion. COOE �. �y$Q�QN.DPE -... . . PAg u��LS 1616 � Flxetl Syslem Final Fire Preventlon 1266 Pool Spa Finaf � 200 Final Re-Roaf 201 Flnai Blo�k/Reteining Well 202 Final FeMory Fire Place 203 Finel Sipn 204 Finel Demolition �/� � %`B3 —� oa�e � CO�Et INSPECTIONTYPE 206 Finel Mechanical 208 Final PlumMng 210 Finel Elecincal 212 Final Fire Preventlon 220 Final Planning Appro�al 222 FInalSite 250 Final BuilCingiOccupancy ueie � �, � t CITY OF COSTA MESA ,•'` � ; ° BUILDIN6 DIVISION � -- � DEVELOPMENT SERVICES DEPARTMENT 898-01263 � � - PERMIT PERMIT NUMBER ''w dp 'E�aeiN (714) 754-5273 • Fax (714) 754-4856 gUILDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 258 FLOWERST Suite: � Vicinity: . . . ,. Parcel Nunmber: 11721402 Applicant: BURR, STEVE Address: SETBACKS� MAIN STRUCTUI ACCESSORY PARKING NOTES: Zoning: Phone: 714-548-2965 V C�7Ji`� '��i \ Requi ed:�0 t� �! I�1 rPropo`sed � 0``-`� :% '� � �=', '\�' l � ; 'J '� �'' � , ;%� : � v: ��`, ` . � } ec�.� 0 __ ,i..'Y =A ', c. �-/= „',�^' �,.�. '__ T_+-,v_�i_��'� _- Status: ISSUED Applied: W/15/1998 � Issued: 07/15/1998 I 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 pedod of 180 days. � ' INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all �equired inspeettons end flnel epproval must be obtained. Failure to obtain Inspections and final approval will rasutt in the expiration of this permit. FOR INSPECTIONS CALL: (774) 7545828 WORKERS' GJMPENSATION DECLARATION: ,. , . , � � � I �ereby affirtn under penelry ot perjury one of ihe following tleclaretibris: �, . , .. . ❑ I heve antl wlll meintain e certlficate ot consent to setl-Insure for workers' compensatlon, es prwided for by sectlon 3700 of the Lebar Code, for ihe peAortnence of the rk iw which this pertnit Is IssueC. ' I have en0 will maintein workers' compenselion insurence, es required by sectbn 3700 of Ma Labor Code, for Ihe perfom�ence of Me work for which Mis pertnk is issuetl. My workere' satlo Insuran rtler end Ilry number are: � �i ��%,�--�—�f� Certfer. �� POIiqNumber. 1/ T(�s> >_ry (Ihls secUon need not be complered i! fhe permlt Is velued et one hundred dollars ($ f 00) or Iess.J � � ❑ I certify Na� in fha pertormence of the work for which this pertnit is issued, I shell not employ eny person in any manner so es to become suD�ect to ihe workers' wmpensatlon lews ot Celito ia, end e that if I should become subject to Ne workers' compensation provisions of Section 3700 oi ihe Lebor Cotle, I shell forthwith /' comply wiM t�ese io (/ Applicent Slgneture: ( Dete: �'- � � —�O WqfiNINO: FAILURE TO SECURE WORKERS' COMPENSATIIXJ WVERAGE IS UNLAW FUL AND SMALL SUBJEGT AN EMPLOYER TO CRIMIW�L PENALTIES AND GVIL FlNES UP TO ONE HUNDRED T/10USAND OOLLARE (5100,000), IN ADDRION TO THE CQST OF COMPENS/TION, DAM4GES AS PROVIDED FOfl IN SECiION 31O60F TNE LABOR CODE, INiEREST, AND ATTORNEV'S FEES. LICENSED COMRACTORS DECLARATION: I hereby eHirtn thet I em licensetl untl r provisions oi C a$ter 9(commencing with Sectlon 7000) of D'Msian 3 of the 8usiness entl Py� i�ssi Cada, enC my license is in full force antl ettect. Lic. # _ w��a �i ^ L� Class M C_ J� ContrectofsSigneture: �,r-. _� _ Date: %—/� CONSTRUCTION LENDING AGENCY: ❑ I hereby aifirtn that Ihere Is a construcGon lending egancy for ihe pertortnence of the wark for which this permit is issuetl. (Sec. 3097, Civil Code). Lentlefs Neme: Lentlets ACdress: Signeture: Dafe: OWNER•BUILDER DECLARA710N5: I hereby ettirtn thet untler penelry of perjury ihet 1 em EICEMPT FROM TF1E CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business end Proiessions CoOe: My dry or wunry which requlres e Dertnit lo consWM, alter, Impmve, Aemolish, or repair eny strudure, ptlor to its Issuance, also requires Ihe epplicant tor such pertnit to flle e signetl atatement that he or she is licensed pursuent to the provisions of t�e Contrectors License Lew (Chapter 9(commencing with Section 7000) of Division 3 of t�e Business and Professions Code) or that he or she is exempt Iherefrom antl ihe besis for ihe fllleged exemption. My violallon of Section 7037.5 by any applicent for a pertnit sublects Me epplicent to e civll penalry of not more than five �unAretl dollars ($500).): ❑ I, as owner of t�e property, or my employees with weges as their sole compensatlon, WILL DO THE WORK, antl ihe struc[ure Is not Intended or oHeretl for sale (Sec. 7044, Business and Pratessions Cotle: The Coniractors License Lew does not apply ta an owner oi property who builds ar improves thereon, end who does such work himselt or herself or Ihrough his ar her own employees, D�aWOetl t�e� such Improvements ere not Intended or otteretl for sele. If, however, the Duilding or Improvement is soltl within one year o1 completlon, ihe owner-builtler will heve the burden ai praving that he or s�e tlitl no� Duild or improve for purpose ot sale.). ❑ I, es owner of Ne properry, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the pmject (Sec. 7044, Business enO Professions Code: The contractors License Law does not apply to en owner oi pmperry who builds or Imprwes Ihereon, end who wn�reds for such proJect with e contrector(s) license pursuent to Ihe Contractars License LewsJ. p.1 am exempt under sec. Business antl Profeuions Code for this reason: Signeture: Date: Oaner ID verified by Crivefs licensa. ❑ Yes ❑ No Dnvers License No. Expires: VeAtication of Ownership by (rype of tlowment, I.e. - property lerz bill or Oeed): DIVISION OF INOUSTHIAL SAFETY VERMR CERTIFlCATION: ❑ I hereDy certlly ihet no excevetion Me (5) or more feet in tlepth Into w�lch a peraon is required to descend, will be metle in connectlon with work authorizatl by this pertnit, and that no Duilding structure, scaRWding, falsework, or tlemolition or tlismantling t�ereof, wiil be more than thirty-slx (38) feet high. (Chep. 32, Grp 2, An 2, Sec. 341, 71t1e B, Calitomla AtlminisiraNve Coda). ❑ As owner-builder, I wlll not employ enyone to tlo work which woultl require e permit irom Ne Divislon of Indusinel Sefery, es notetl above, unless suc� person hes e pertnit to tlo such work from the division. Signature: ' Dete: DlNsion of Industrial Safery Pertnit Number: CERTiFlCATE OF COMPLIIWCE AND AUfHOflVJ1TON OF ENfRY: I certify under penalry ot perjury that I have read ihis epplication and stete ihet ihe information given is cortecl. 1 egree to compty vriN all state laws anE ciry ordinances relating to building construction, end euthorize representelives of Ihe Ciry ot Coste Mesa to enter upon lhe above-tlescnbed properry tor inspectlon purposes. I agree nol to occupy or allow occupanq of any building aufhorized by Uis pertnit until fnal inspection. �Signeture Of Legal Owner(s) Da .�=.� �- /S=�Ss AnNOr Authonzed Applicant Date COOE �. IMSPELTIONTYPE 1818 Flxed System Finel Fire Preventlon 1268 Pool Spa Finel � � "- 200 Flnal Re�Roof ' 201 FIneI B1acMRetalning Wall 202 Finel Fedary Fire Place ' 203 Final Slgn � 204 Final Demolition ^ 24t8d8 ` GAg U17IDlL5 . ,7 �-9� "_-_� GOOE• INSPEC110NTYPE 206 Final Mechanicel ` 208 Final�Plumbing� � � 210 Fnal Electrical � 212 Final Fire Prevention 220 Final Planning Approval 222 FInaI511e 250 Final Bulli \ � . �' `'F:. � 1768' �- COSTA MESA BUILDING-SAFETY DEPARTMENT. P. O. BOX 917 COffiA MEBA. CALIFORNIA For Applieanf to Fill In Complefely TYpE OR PRINT � BUILDING 7 ('' / ADDRESS /. S3 �` OLU N.N .- COSTA MESA. CALIFORNIA i--� r'7 r i / �"' TEL. CITV �S NO. ARCHITECT TEL. OR ENGINEER '�'��IQC ADDRES6 - _ 11 ■ 81ZE L NO. OF BLDGB NOW ON LOT B6TBACK LINE RROM � CeNTER OF 6TREET REAR YARI 81�E YARD I LEFT � I RIGHT DESCRIPTION OF WORK / /�, / �1 WALL �� BE 9 �� •. .AUG 2 2 1962 � �� : APPLICATIO�F�� ERMIT�� BUILDING For Office Use Only NECEIPT NO. I �PENMIT NO. r�/ !� /1Oe77 RECEIVED qY I Df�TE NECEIVEp _I ATE �84 /D CiV /l Z c+I � oZ�`(O BUILDING ' ADDRE55 COSTA MESA, CALIFORNIA FIRE � ZOtdING ZONE NO.OF 6E OF % �� PLAN9 � UILDI� "'� LEGAL I. I _ � - DESCRIPTION rO A. P. NO. � ( � YAR�S EVES APPROVE� ALLOWI 7 ICENT6R LINE 9T.\ p / 4 � FRONT �/ FT. f— APPROVED U 'r��71 I HEREBY ACKNOWLEDO6 TNAT I HAV6 qHAD iH18 APPLIWTION }HE AMOUNT BHOWN UN�ER VALIIATION IB POR THE AND 9TATE THAT THE ABOVQ 18 CORRHCT ANO AGRE¢ TO COM- pUIiPOBE OP E8TABLIBHING F aERMIT FHE ONLY. PLY WITX ALL ORDINMNCEB AND BTAT¢ W8 REpULATINO BUILDINO C BTit � , ' VALUATION 3 SIGNATUR OF I PERMIT FEE $ b' � PERMI � n O $ /UI � PLAN CHECK $ ' /"Si "' __ � � . , � "`�, '7'7� - �COSTA MESA BUILDING DEPARTMENT � P.O.�BOX 31] • COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN BUILDING � �LO�i✓`� �� A�DRE55 COSTA MESA, CALIFORNIA OWNER LLEN ' oNNoY� � MAIL 7 6 g FLA W E/�. �]T. ADORE55 O� ARCHITEGT LIC. OR ENGINEER NO. AODRE55 ' � CITY LIC. NO. � TEL �ESCAiPnoH INOTp� � � IBLOGK /7 ITRAC A.P. NO. / / / _. � I �_ � � / T � snF �I1 . . . � _ _ . Irvo. oc' e�ocs. USE OF • EXISTING BLDG. � SETBACK LINE FROM CENTER O`' STPEET hI��i SIDE YARD RIGHT ��V LEFT DESCRIPTION OF WORK- NEW ALTERATION ADDITION REPAIR MOVING DEMOLiSH BUILDING NO.OF SIZE Q r ROOMS STORIES E%TERIOR WA�I ROOF COVERING COVERING lISE OF NEW f i __ / ��E (��.�EIVED � (o -i�(--58 fINANCE DE�PyT. APP�A�"IrONAFO'R� PERMIT BUILDING FOR OFFICE USE ONLY AECEIGT NO. PERMIT NC 7�' �ECEIVE� BY DATE RECEIVED pA ISSUj �✓!i�-TJ I /n .l�� L /� ADORESS � �' a / � �/D COSTA MESA. CALIFORNIA BY SUBJECT TO �{t� DATE ��/(i�i RECTIONS Utl'T. HEG. /O-/tL J d'�S O F' — �% I MEREBY M1CKNOWLEOGE THPT I HRVE REAO TMIS TPPLICATION FNO STATE THAT TME /�BOVE I$ CORPECT PND AGREE TO COMP�Y WITH FLl CITY OROINANCES f�NO STFTE La�NS FEGULATIN BUILUING CONSTRUC� noN. Q � VALUATION SIGNATURE F PERMIT FEE S PERMITTEE ] I/,y�/l .Z,� PLAN CHECK $ $ �� Cl � J AUTHORIZED AGENT � TOTAL FEE $ � / / �srr 33— ; , ':� ��o - : COSTA MESA BUILDING DEPARTMENT P.O. BOX 31� � COSTA MESA. GALIFORNIA � FOR ,4�Rr..ICANT TO FILL IN BUILDING n r r� , i r_,,. ..�. OWNER MAIL ADORE55 ARCHIAECT OR ENGWEER ADDRE55 LEGnL LOT OESCRIPTION NQ, A.P. NO. /, ` SIZE OF LOT S USE OF 'EXISTWG BLDG. SET9PCH LINE FROM CENTER OG STREET /' CALIFORNIA � � . TEL NO. LIC. NO. CITY LIC. NO. TEL. j �] �BLOCK d �TRAC - / - b o't X I ��i. /� NOwOON LOTS �• DESCRIPTION OF WORI(� NEW �/ ALTERATION ADOITION REPAIR MOVING DEMOLISH BUILDING NO.OF SIZE Q ROOMS STORIES EXTERIOR WAL ROOF /Y +1 COVERING (�Gr COV INGIQ ' S/7 iicr ne nir..i . . . . �1 � . % � ��E REC�tVEp ��-S� ASP�L� �A��OR PERMIT BUIL ING FOR OFFICE USE ONLY RECEIPT NO. pf}j�11.ZjJ(. RECEIVED BY OATE PECEIVED OATE I Uf �7w�o� /'l{�/0 - � S�- / l O�G ADD EI55 . Z' V � �/ Ow��`_. COSTA MESA. CALIFORNIA FIRE ZONE � ( 0 r�%R� DATE CORRECTIONS CLTY O� ��' ., SUBJECT TO By ;� n. n•;es� J�i��. UEf'T. REG. /O-i� � ' .. _ " " ' r . �SO S _� I HEREBY ACKNOWLEDGE THAT I HAVE flEA� THIS FPPLIC�ITION 4NO // Q STnTE THAT THE R90VE IS CORNECT nND /�GREE TO COMpLY WITH PLL /�_ �� C/[ OROINPNCES ANp STATE LFW$ REGULATING BUILOING <ONSTFUC� �� T�ON. ' VALUATION Q'� PERMIT FEE S SIGNATURE OF � PERMITTEE $ �O I— PLAN CHECK S �a/ .J / AUTHORIZED AGENT . � TOTAL FEE $ 3!t' ��M�