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Home My WebLink About319 FLOWER ST - Building PermitsQ Q Applicant to fi11 in all spaces except those within heavy CorCer lines anG si9n all appropriate Eeclarations. ,¢�� ME(S�A CO^N1S"TRUCTION PERMIT rojer.•�Address `21-I ��111```� �v.X�r' C�. ,ApplicanCs Mailing Address ��"'�,-�' ✓�'�� • /' Owner's Name � � E-1�-�I�� Ph��as� Address' �� '-�9 �ST.� , Arch/En9."- - License No. — Address - ' � Contractor's a hone5�� = Address,lmailing) �� 7��n �' � �� ' C' IM • City'License.No. �? �h � LICENSED CONTRACTOF DECLARATION Chereby afflrm lhal I am licensetl untle� provisions of Cha�te� 9(commencing with section 7000) otbivision 3 ot the Busine55 antl Protesslons Cotle,�antl my license is in i II fo ce a tl eftect. Licenie Clazs - iCen e No: Date � � Siqnature: WORKERS' COMPENSATION DECIARATION. � hereby atfirm that 1 n5ve a certificate oi conseM to sel/-insure or a cerliticate ' Workers' Compenzation Insurance, or a certifietl copy thereof (Sectlon ;00. Csb. .�n��;�� ' ',�� (� � Nolicy No. ompany��j� �)� �Certifietl copy is hereby furnishetl. � Cer ieU-�Q is e ith the cit �y� Itlin OiviYq n^ Date �(�� ApplicantY �S . A f/ , p� l! EXEMPTION FROM WORKERS' COMPENSATION DECLARATION � -(Thissection neetl nofbe completed it Ihe�permit is tor one huntlretl ($300) or less). I c¢rtify [hat in Ihe performance'of the work /or which this pe�m�t i5 i55u¢tl, I shall not employ any person in any manner so as to become,subject to the Wotkets' Compensation Laws of CalitOrnia. Oate Si9nature NOTICE: If, after makin9 this tlaclaration, you shoultl become subject to the Workers' Compensation provisions ot Ihe Labor Cotle, you must forthwith comply with such-provisions or-ttiis permiE shall be tleemetl revoketl.' CONSTRUCTION LENDING'AGENCV I nereby affirm that there is a construction lentling agency for the performance of the' work for which IhiS permit is i55uetl (Section 3097 Civ. CJ Lentler's Name Lentler's AtlOress � OWNER BUILDER.DECLARATION I hereby affirm that I am exempt from the Contractor's License Law tor the tollowing reason (Section-]031.5 Business and Profe55ional Cotle: Any city or wunty whicn requires d pe�mil to Const�uct, alfer, iTO�ove, tlemolish o� repai� .any SVucture, prlor to its issuance, also.�equires tM1e applicant f0� such permit �to file a signea statement that he/she is licensea vursuant to the provisions ot the Contractor4 License Law'(Ghapter 9'(commencinq with Section 7000) of � 'Division 3 of the Busine55 antl Profe5von5 Cotle) or that he/she iz exempt -herefrom an0_tne basis for the alle9etl.exemption. Any violation of Section 031.5 by any applicant tor a permit subjects the.ap0licant to a civil t-e�nalty of not more Ihan five huntlretl tlollars ($500). ' . LJ I, az owner of the property or my employees with wa9es as their sole '�compensalion, will tlo the work, antl the Structu�e is nof in[entletl or4ffe�etl for sale (Section 7044, Business antl Grotessional Cotle: The Contractor'S License Law tloes no[ applY to�an owner of a property who builtls or improves thereOn, antl who tloes such work him5elf/herselt or thrOu9h his o� h¢r own employees, provitletl that suGh Improv¢ments are not intentletl or offeretl tor sale. If, however,.tM1e builtling or improvement is soltl within one year of com- pletion, the owner will have tne burtlen oi proving he/she tlitl not builtl or im- prove for the pu�po5e of sale). � ❑ I, as owner of the property, am exUusively mntractin9 with licensetl con- tractorsto construct the Oroject (Section 7044, Business antl Professions Cotle: The ConVactor's License law tloes not apply to an owner of property who builtls or imOroves Ihereon. antl'who contracts fo� such oroiects�with a r.on- � tractor(s� Lcense pursuant ro me ConVactorY License Law). I am aware tha[ proof ot their WorkeYs Compensation in5urance shoultl be provitletl to me. ❑.1 am ¢xempt untle� Section B. &�P. C. tor this rea5on. Date Owner � 1 hereby cercify that'I�have reatl this application antl state tnat the above information is correct. I agree to comply,with all city antl county ortlinanGes antl state laws relating to builtling construction, and hereby authorize repre- sentatives of this cit entp� r upon the above-mentionetl property tor inspection qrypos / � ,�. '�� Signature �< S! Dat � ;brivers' License or 55 � � `�-�-� - �' _..� � 7� S� � _. � --_ -_ � ....,, ,.�. TYPEOFCONSTRUCTION . NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OT ER � � DESCRIPTIONOF,WORKNSFOF.,BLDG��.SI " 7� aA \ ICEIVI TVPE OF PHiM1T LJ GRADING -� TENANT ❑ ELECTRICAL� ❑ OTHER PROJECT DESCRIPTION Sq.FT._ 1FOUNDATION LJSTRUCTVRAL Pt.UM81NG ❑ MECHANICAL CONSTRUCTIONTVPE - VALUATION$� ZONE GRACIINGCU.VOS. ACR Remarks: � Sink Preventer_ ; Irrigation Clarifiers Dishwasher' Drinking Fountains Floor Drains Floor Sinks Gas Service� � Outlets Kitchen Sink - Lavatories . P-Trap Roof Drains . Reinspection Fae $15 Boiler Duct - Under Ground, Duct - Strucmral Duct- Ventilating Exhaust SYstem ❑ Multiple FirepUFact. BIL iC80 # Heating System & Ducting �0.100,000 BTU 0100,000 Reinspection fee � � $15 0865-46, rev. 5/98 White - Builtling: Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collecmrs � Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet - � Water Heater . . Water Service Auto-Wash � . Isue Fee Hood or Type I ❑ Canopy Typell ❑ Refrigeretlon System ❑0.100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee A.P. #'` � 2ona S Main Building: �� Accessory Building: E Z T Front - O A Rear N C Aight ' � . N g. Left � " - � R Ping: Ref. # �- Parking Req./Provided � .' E "Planning Notes: - ' ryQj T $. Automatic Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Eleci Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator �0-5 KW C ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW , 5�15 KW Meter LJup to 100 amps , Meter ❑over100amps ' Sub Panel , � ' Morors OO-1 HP O1 %�- B InaSolar �9-15 HP �16-15+ Microwave ' Pole Light . •�r. Range I',,�,� Sign . Standing Sections Trash Compactor Reinspection Fee $15 15sue Fee DEVELOPMENT SERVICES REQUIREMENTS: $.3 Zoning APProved By FEES Building Approved By � $ 3 FEES $'3 SUMMA V OTF FEES , � BUILDING PERMIT $ ��.LJ SMIP $ PLAN CHECK $ PERMIT � PLUMBING $ �SSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ E�ECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ � MECHANICAL $ TOTALFEE $ PLAN CHECK 25% $ _ , \ '�'a t�4ff2b�32—G4Ct2d833 TfJ e °�4,5�7 �\"`�'� DA7E. D2/?iiv9 TIPIE: :f:?9- - CnNSTRUCTION AND PLANNING APPROVALS Permit # 1,'Temporary Electrical Service or PoIE i� 2. Soil Pipe-Undrgrnd. i�� 3.� Electrical Conduit Utility-Undrgrnd: 4.-Electiical Conduit-Undrgrnd. .�- 5. Steel Reinforcerrient ; y 6.; Electrical UFER'Grrid�- -, , • '1:� Footings � ' - 8 Foundation - � 9,�Water Pipe-Undrgrnd. � 10., Scructural Flobr System .-� 11.. Property Sewer Line & House Conn2ction 12. Sewer Cap �• • �} \ � 1 13. RooffDrains � �-� �.^ �.; - 14. Rpu�h Plumbing�, .� - 15. Rough Electriral-Conduit 16. Raugh Electric Wiring .�17-. Rough Wiring Sign . ' �18. Rough Electrical-T Bar Ceiling ' 1.9. Rough Heating & Air Conditioning %20. Rough Factory Fireplace ;v -21. Ducts, in Structure 22. Ducts, Ventilating 23. Gas Pipe-Rough & Test 24. Roof Framing ^1 25. Roof Sheathing � � 26. T-Bar Ceiling (Structural) & Monocoat 27. �Frame and Flashing 28. Lathing & Siding 29. Insulation -.�� 30. Drywall Nailing �. 31 . Plaster Brown Coat � � 32. Electrical Power Meter-Final 33. Final Electric 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 � 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation � 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Soer.ial Reauirements Completed 49. Electric Release to Edison 50�. Gas Release to Southern California Gas Cc 51. CERTIFICATE OF OCCUPANCY No. Date ' � _� Date Inspector , ti � � � POO� ;PA APPROVALS Permit # 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. �APPROVAL TO COVER-GUNITE 58.� Electrical Conduit:Undrgrnd. 59. Gas Pipe, � Undrgrnd., Test . 60. Backwash Lines, P-Trap, O Undrgrnd. 61. APPROVAL TO DECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System - Final 65. Electrical-Final ' 66. Solar System�Final - 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. �POOL/SPA SYSTEMS FINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hydro 71. Product Piping � Gas ❑ Oil 72. Underground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL • HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: "�! Date � Inspector � AOV�icant to fill in all soaces except tnose within neavY �ortler lines and sign all aoo�opriate tleclarations. . :ITY OF COSTA MESA CONSTRUCTION PERMIT _ PERMIT2NO. � TRACT NO. LOT NO. UNIT NO.� - Project Address �I� �� P= . 1 ' J v � . .- ' � Applicant'S Mail' ddress �' i.+J�-� C-� l. TYPE OF CONSTRUCTION NEW ADD ALTERATION '' REPAI R ' ♦ ��,��.�� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER" Ap #, Owner's Name C' � hone3@��3 DESCRIPTION'OF WORK/USE OF.BLDG. �aa.r . A P.mv�-�� To Address � ��-�-�-�r''�2 ST• Q'y-y!�P"(P'-"�4 � '7 µct^J .�.0-S� V ' S Main Building: ' E _ Arch/Eng. - License No. TVPE OF PERMIT' GRADING ❑ FOUNDATION STRUCTURAL T Front - � Add�C55 � � � � ❑ TENANT ❑ ELECTRIGAL ❑ PLUMBING �MECHANICAL . B Rear C��L�E�� ' Phone ❑ �OTHER • . _ . � . - � . ' . A Controctor's Nam , C Right ' . . ' - PROJECT DESCRIPTION 5c1: FT. ! Zbb - oCCUaANCV �"�� K. Addre55�mailing) . . CONSTRUCTIONTYPE `��L�'=� VAWATION$.�� g Left City LiCenSe No. ' ZONE GRADING GU. VDS. ACRES P�ng. Ref. #' � LICENSEO CONTRACTOR DECLARATION � I � ' � � ' � � ' i I'herebyptfirm that I am licensetl�untler provisions of Cnarte� 9(commencing Remarks: � , � _ Planning'Notes: with.5ection ]000) of DiviSion 3 of [he Business-antl Professions Cotle, antl my.license�is in fulliforce antl etfect. , ' , ' ' j _ ' . License Class License No. - � oate . Si9nature �- . " . PLUMBING ' FEES ' WORKERS' COMPENSATION DECLARATION ' � � . -- 0328 5/�4/84 - -y,pp TL Zone - - � Accessory Building:- � . Z - " _ • "O . . . � v. ' . • N � - ' N 1 � R • Parking Req./Provided E . 1 - , - r . " M , , . T . . ' $. ' h¢�¢by �dtflfrtl Ihdl 1 hdV¢ a C2�fitiCat¢ Of cOnSZnt fo SEIf-inSU�C O� 3 CCrtifiCdiC Bar Sink � � Showers . i Workers' Compensation Insurance, or a certifietl�copy thereot (Section gackflow.Preventer ' ServiceSink� 1800, Lab.- C.) - , ' '' � , - � ' — - - -- P.utomatiC WaSher _ Policy No. � Company � � gackflow Irrigation' . � Sewer Cap ' � Construction Pole Sub. eCertifietl copY is hereby furnistietl. ' , , � ' Certifietl copy is tiletl witn the city Builtling Division. , Bathtubs Sewer Connection Cooking Unit � Date Applicant , � EXEMPTION FROM WORKERS' COMPENSATION DECLARATION CldrifierS ' •v SOIar C011ectOfS Di5hwa5h¢r � (This section neetl not be mmpletetl if the pe�mit is to� one huntlretl ($100) o� � iess): : ' �- � Dishwasher Solar Pipin9' � Dryers ❑Gas: DEI I certify that in [he performanCe of the work for which this perm�t is issuetl, I . , shall not employ any person in any er so eco e subject to ihe Drinking Fountaini � Solar Tank Fan � Worke�s'�.�q�npeygb(ion•Laws of Gal o nia. ' � ' ' , Date `f�lY [[CSr � Si9nature ' Floor Drains �� Swimming Pool w/Spa F.A.U. NOTICE: If, alter makirig this tleclaration, ou sFoultl becom subject to tne Workers' Compensation provisions of ih Labor Cotle, you must forthwith FIoo�Sinks . ' Urinal � � Fixtures compry with such provisions or thi5 ermit 'Shall be emetl revoketl. --- CONSTRUCTION CENDING•'AGENCV ' � ' ' ' " Gas$¢NiC2 , �Utl2t5 Wdt¢�CI052t ' ' D¢vic¢BOx25' I he�eby af(i�m that there iz a�construction'lentlin9 a9enty fo� the pertormanc¢ � of IM1e work for which this permit is issuetl (Sec[ion 309'] Civ. C.) Interceptors Watef Heatef . � Outlets Lentler'S Name.� � ELECTRICAI � � Transformer ❑ 15-50.KW. O 50,+ KW Meter ❑up to 100 amps Meter ❑over100amps �en0er's'Atltlress. - � - Krtchen Smk . Water Service . � OWNER BUILDER DECLARATION�� - ` ' � Swi[che5 I hereby affl�m that I am exempt (�om the Contracto�'S License Law for the . LavatO�i25 ' � Gd�bdg2 DiSposal , following reason (Section 7031.5 Business antl Professional Cotle: Any city or county whith requi�es a pe�mit to Construct, al[er, improve, tlemolish o� �epair P=T/dp • any structure, prior to its issuance, also requires tne applicant tor such permit Generator �0-5 KW 05-15 KW to file a.siqnetl 5[atement thatihe/she is licensetl pursuant to th¢ provisions oi R f D � 5� ' � ' - ISIOfI 3 Of Lh2 6U51(1255 dlltl YI012551005 CW2)'OI [! refrom antl the basis for�the allegetl exemption. Any ILS by_ any applicant tor a petmit subject5 the:, alty of not more than five huntlretl tlollars ($500). ' I^as owner of [he.property�or my.employees witt i nnzatinn_ will tln tM1e work. antl the sGucture is no' 7000) oi oo rain is exempt , _ . � of Section , to a civil ' ' their sole ' ReinspeMion Fea - � $15 Lirense I�w tloes not apply to an owner of a property who builtls or improves thereon; antl;who tloes such work himselt/h¢rself or through his or her own , emD�oyees, proviCetl that SucM1 improvemants are not intentletl o� ofleretl for sale. It, however, the builtling cr imOrovement is soltl within one year of com- pletion, the owner will have tFie burtlen of proving he/she tlitl n0t builtl o� im- �ove�for the purpose of sale). ' i LI I, as owner of the oroperty, am exclusively contracting witn licensetl con- Itactors to const�uct the project ($¢C210l1 %OQ4. BU510¢55 dllG PIOf25510lIS CO�O: . The ConVactor's License Law does not aPpIY to an owner ot Oroperty wh0 builtls or-improves Mereon; antl�who mntracts for such projects with a con- tractor(s) license pursuant �to the Contractor's License Law). 1 am aware that proot ot their WorkeYS Compensation insu�ance Shoultl be provitletl to me. ❑ 1 am �exempt untler Section�B. f P. C. Por this reason / Date � I ff)f7! Owner p— e�,l% aouer - . Duct - Under Ground ' Duct � Structural � Duci - Ventilating Exhaust System ❑ Mul[iple ❑ FirepVFact..Blt. ICBO # �5£jl Heating System & Ducting ❑ 0.100,000 BTU � 100,000 BT mspecLon pur s / �q..� � n`, Signatur . � � _ Oate %7/bv!`�' Drivers' Licerise 55 � Heinspec[ion Fee CMF 0865-46, re .4/84 - yyhite - uiltling; Canary -Applicanh Pink -Accounting; Goltlenrotl -Assessor $15 � Issue Fee iANICAL ' Hoodor Typel ❑ J Canopy Type I I ❑ � Refrigeration System ' ❑aioo,000eru ��oo,000e System Repair/Alteretion � � $'3 t Issue Fee . $ 3 Su6 Panel � � � � Momrs DO-1 HP �1'/z - 8 Inc.Solar �9-15 HP 016-15+ Microwave Pole Light Range Sign ' Standing Sections � Trash Compactor ' � Reinspection Fee I$15 ' I Issue Fee .;DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By : - Building Approved By � � � FE �� u $ 3 � . SUMMARV OF FEES ' ' BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMI7 PLUMBING � , $ ' ISSUANCE $ , PLAN CHECK 25% $ ENERGV P.C. �$ ELECTRICAL $ GRADING $ PLANCHECK ,50% $ � MICROFILM $ MECHANICAL � $ ,� L� `� TOTAL FEE $ �_ % �� PLAN CHECK .25% $ � . � � F�� CONSTRUCTION AND PLANNING � � • PO� _,,� SPA- - APPROVALS Permit# � Date Inspector � qppROVALS Permit# Date.' Inspector 1. Temporary Electrical Service or Pole �� .. 52. Pool & Equipment�Location � .-'� � 2. Soil Pipe-Undrgrnd. ' 53. Sfeel Reinforcement � � , 3. Electrical Conduit Utility-Undrgrnd. = � 54. Forms- � _ ' � ' � - 4. ElectricaPConduit-Undrgrnd. • , � � - 55. Electrical Bonding . • ' � � �.5. Steel Reinforcement . � 56. Rough Plumbing & Pressure Test, � `,1 � 6. Electrical UFER Grnd. - ' - 57. �APPROVAL�TO COVER-GUNITE -' � �� 7. Footings . . � . 58; Electrical ConduibUndrgrnd.� � 8. Foundation, � �- 59. Gas Pipe, O Undrgrnd., Test _• � ' , .,., � .. ' i ,9. Water Pipe-Undrgrnd. ' � ' � 60. Backwash Lines, P-Trap, O Undrgrnd. �,+ 10. Structural Floor System � • ' 61. APPROVAL T,0 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 - � 16. Rough Eleciric Wiring . ' - � .� 67. Fencing & Access Approval 77. 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 � � rf � ,� APPROVALS Permit # 21. Ducts, in'Structure . ' 70. Underground Hydro _ �'22. Ducts,:Ventilating � ,71. Product�PipingOGas ❑Oil ' 23. Gas Pipe-Rough & Test - � ' 72. Underground Flush � � � 24. Roof Framing ' . - , 73. Undergrnd. Storage Tank%0 Gas ❑ Oif 25: Roof Sheathing - , - 74. Overhead Hydro � 26. T-Bar Ceiling (Structural) & Monocoat � _ 75. �Dry Chemical � . � 27. Frameand Flashing ' � � 76. Dry Standpipe .� 28' Lathing & Siding r ' , ' 77. FIXED SYSTEM FINAL � ' 29. Insulation ' 78. FIRE PREV. FINAL � ' � 30. Drywall Nailing �f. - , HEALTH DEPT. REQUIREMENT � 31. Plaster Brown Coat�� , � 79. FINAL INSPECTION . � '32. Electrical Power Meter-Final � . � ' 80. FOOD CERTIFICATE ISSUED . 33. Final Electric � � � Notes: �� /�� 34. Final Heating & Air Conditioning � � � 35. Final�GasPipe-Test ' - � � � . . 36. Hood or,Canopy � � � . ., , 37. Final Factory Fireplace � � Z �� • . . 38. Final Plumbing � ' �- - ' 39. Water Service-Final , � 40. Gas Service-Finil '' � � � . , 41. Solar pomesticFinal � _ , . ' ' � � 42. Backflow Preventer ' ' � � � � , 43. Backflow Irrigation . �, . � . ' . � � 44. ,Landscape Irrigation System � - � ' - • 45. Sound Attenuation ' ' � � . . �� , . 46. Handicap Regulations ' , � � , , ' ' 47. FINALSTRUCTURE & BUI�DING ' . � � 4S. Special Requirements Completed . 49. Electric�ReleasetoEdison . , �� ' � 50. Gas Release�to Southern California Gas Co � • ' . ,, ,� 51. CERTIFICATE OF.00CUPANCY � . , _ _ .. � . ' ' No. ' - Date . � � OWNER �A, JOB ADDRESS GENERAL CON ; o. 117-2 Ih�r'ECTIONS SOIL GAS WATER ROUGH PLUMBING PROP. SWR. LINE SPRINKLING SVST MISCELLFNEOUS UNOERGROUND ROUGH WIRING TftENCHES � FLOOR SYSTEM BONO BEAM � SHEATHING ANO AIR CONDITIONING VICE OR POLE ] POWER � FORMS n STEEL REINF. REI FRAME ANO FLASHING ' LATHING - IN n OUT n PI �ER, BROWN COAT 5 IURAL, FINAL HEATING, VENT., REFRIG. PND A.C., FINAL PLUMBING, FINAL FN� GAS TEST n ELECTRIC, FINAL BUILOING. FINAL DATE (-1'%-7� BUILDING PERMIT N0. RIPTION of WORK In er.�� ZONE VALUE$ 1,000.00 PE V GROUP I 2 SUBCONTRACTOR PER Z . w w aU Z ZQ ON a m J � J N Q W 21 J • tt] J Q U N Za W � aw W Z J Q m Z J � W w O= Z � O W 70 F z Q U J a a Q � �"' N z � � U � � f" y Z r•. COSTA�MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applican[ to Fill in Completely _ OWNER MAIL CITV BRANCH ADDRESS ARCHITECT ADORE55 CONTRACTOR� ADDRESS L CITV STATE LIC. NOa � SI2E OF LOT USE OF EXISTING BLDG. 512E OF NEW BLOG. EXTERIOF WALL TEL. CITV �,"/ LIC. NQ`J/i NO. O� I NOW ON LOT NO. OF ROOMS STOi ftOOF COVERING G AND WOFK TO BE PERFORMED I hereby acknowletlge that I have reatl this applicaiion and state ffiat [he above intormation is mrrect and agree to comply wiffi all laws regula[ing building consvuction, and 1 shall not employ any person in violation of the workman's compensation laws of the Stare ot Calitornia. I hereby certify that I am properly licensetl as a cOntractor untler tha State ot California Business and Professions Code, Divisicn 3, Chapter 9, antl that such licenses are in tull force antl eftect, or I am ezempt trom the provisions ot the State of California Business and Professions Cotle, Division 3 hapte� 9. Signature of Permlttee Authorized ABent i � saniu t a�t��- ub, t�-7.cr�sr�0i79i� -10.50 APPLICATION FOR BUILDING PERMIT A.P. NO./ I I�`i J� BUILOING � j � ; ADDRESS FIRE 20NE T APPFOVED BV Z E NO.OF PLANS VARDS APPROVED MAIN BUILDING (FROM GL STREET) VALUE USE OF NEW � E BUILDING ` /� L��/_� ! VARDS APPqOVED ACCESSORV BUILDING DI5TANCE BET. BEf. I MAIN BLDGS. ACCE VAR.� DATE C.U.P. # _ qPPR( TqX m SQ. FT, o THE AMOUNTSHOWN UNDER VALUATION IS FOR THE PURPpSE OF ESTABLISHING A PERMIT FEE ON�V: m ¢ VALUATION p� Ay) � PERMIT FEE $ /fJ �yaL N � m $ / bOQ, gU PLAN CHECK $ � E � /� � `o TOTAL FEE $ (,� LL I�' �-�� 'j:. 4 17437 COSTA MESA BUILCIING•SAFETY DEPARTMENT P. O. BOX S77 COBTA MEBA. CALIFORNIA For Applicant fo Fill In Complefely TYp6 OR PRINT A�DRESS �I / � / /0 W { ~ � � COSTA MESA. CALIFORNIA nwt.�ce 1�l0// V'A I /(/. �/i�J 0 ADDRESS � ' /G W ��"' S � r TEL. c�n v / -�'' No. L/ ARCHITECT TEL. NO. OF BLD�9. USE OF EXI87'ING BLDG. eera�cK une vxorn DESCRIPTION OF WORK BUILDING . NO. OF SIZE ROOMS EXTERIOR WALL ROOF COVERING S�tJ 0 COVEF U$�, OF BUILDING ANO WORI( TO E _. D� 1,. h..l.. Y'r.�d 1/w:_ FEE RECEIVED Jl7L 2 1`d6Q FINANCE DEPT. APPLICATI��F �� MESA BUILDING For Office Use Only RECEIPT NO. I PEpy{Lj [i0. VG � ��i BUILDING ,�y�i �� ADORESS I / � COSTA MESA, FIRE . . QC• ZONING � NO. OF USE OF NEW� PLANB � I fiUILDING t� 1 07' ,� °� fi /� � / � r � ��.s 3 --ao EVES (cenrew urve er.� �q�I �. . � OUI-S�/ � HEREBV ACKNOWLEDO TH�1T I HAVE RHAD TH19 APPLI TION THg qMOUNT 6HOWN UNDER VALUAT�ON IB FOR THE AND 9TATE THAT THe ABOVE I8 CORHECT RN� AGqE6 TO LOM- pUftPO6E OP ¢BTABLIBHING A PEpMIT FEE ONLY. PLY WITH ALL CITY ORDINANGE9 ANO 9TATE LAW6 REDUL�TINO euu.olNo coNBieUttloN. VALUATION <j _ SIGNATUFE OF � PERMIT FEE $ c7 PERMI7TE $ � � � PLAN CHECK $ �- AUTHORIZED AGENT_ ^ ^ � � /�