HomeMy WebLinkAbout3205 MINNESOTA AVE - Building Permits(714) 754-52�3 • Fa�c (714) 754-4g56 • www.ci.costa-mesa.ca.us 77 FAtR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Viciniry:
Parcel Nunmber:
3205 MINNESOTA AV
13908110
ELECTRICAL PERMIT
Applicant: JOEL WRITH
Address: 180 NEWPORT CENTER DR #180
NEWPORTBEACH,CA
Owner: GNIFFKE, CHAD & JENNIFER
Address 3205 MINNESOTA AV
COSTA MESA, CA
Contracror: ACME �LECTRIC
Address: 180 NEWpORT CENTER DR #180
NEWPORTBEACH,CA
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Molors to 1hp
Motors to 10hp
Motors to SOhp
Motors lo t00hp
Mo[ors over 700hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
ISSUED BY:
Phone: (949)644-8801
Zip: 92660
Phone:
Zip: 92626
Phone: (949)644-8801
Zip: 92660
License: 527459
Status: ISSUED
Applied: O6/10/2004
Issued: 06I10/2004
SCOPE OF PERMIT
ELECTRICAL TO INCLUDE: 1 SERVICE TO 200 AMPS, 3 MISC. CONDUIT AND 1 MISC. CONDUCTOR.
323.50
$0.00
$0.00
$0.00
so.00
$0.00
$0.00
$0.00
$0.00
$0.00
ao.00
530.50
$0.00
50.00
50.00
$0.00
$0.00
50.00
50.00
50.00
$0.00
so.00
30.00
Quantity
FEE SUMMARY
Temp Dist System / Lighting
Busway /100 ft
Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up l0 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System ! Ckt
Misa Conduit
Misa Conductar
Circus ( gen or ride)
Cirws (mech ritle or lights)
ChrisGnas Tree Stand
Fireworks Stand
ONer Electriral Fee
investiga6on Fee
Plan Check Fee
Reinspection Fee
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$54.60 3
$18.20 1
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
50.00
50.00
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 9248, § 1, 12-21•92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned
tor a period of 1 BO days.
INSPECTIONS: In order tor Ihe Work euthorized under ihis permit to be considered legal, such work must comply with all applicable codes, and ell
requiretl inspectlona and finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2d46-06 (6I00)
WORKERS'COMPENSATON DECLARAnON:
I hereby aHirtn under penalry of peQury ona ot Ihe tWlowing tledarations:
❑ I heve entl wlll mair��ain a certificeta of consent to self-Insure lor workere' compensetion, as providetl for by saction 3700 af the Lebor Cotle, for the peAormance ot the
��work for which this pertnit is IuueA.
i� 1 have antl will main�ain workers' compensation insu2nce, as required by section 3700 of the Lebor Cotle, tor the pertortnance of Ihe work for which ihis pertnit is issued
a carder and policy number ere: �
�;� �/ �S ��3
Policy;Number. ki
permlNs valued af one �untlre0 dWlars (5/00) or /ess.)
❑ I certity thet in lhe pedormence oi Ihe work tor w�ich Ni5 Dertnil is issuetl, I shall not employ any person in eny manner so B9 to become 5ubject to lhe worker5'
compansation laws a� Califomie, ena egree chel il I should become suD�ect to Ihe workeB' compensetion provislons ol Sectlon 3700 of the Lebor Cotle, I shall tort�with
wmpry vrith ihese O�a���^s. / c�
AP �wnt ignaturei�� — �-�� � � tB>�f.. —14— ZUU7
�WARN F.AY1WEaTObEC�1RE ORKEiiS'COMPENSATI� COVEMGEISUMAWFULMIDSMALISUBJECTANEM,OYEfiTOCRIMINALPENALTIESANOCNILFlNE$UPTOONEHUNDRED
�•. ..:
T�USAND DOLURE (5100. , IN ADDfi1dJ TO THE COSi OF COMVENSATION, DAMAGES AS PROVIDED FOR IN SECTIIXJ 31O80F THE UBOR CODE, IMEHE5T, AND ATfORNE1^S FEES.
LICENSED CONTRACTORS DECLARATION:
untler proWsions of Chapter 8(commencing with Section 7000) ol Divislon tpe.8usiness end Professions Code, enA my license Is in full
Lit. M
CONSTRUCTION LEN6ING AGENCV:
❑ I hereby aHirtn that there Is a construction lentling agency for the peAortnance of t�e work lor which this permli Is issued. (Sec. 3097, Civil Goda).
Lontler's Neme: Londets Address:
Signeture:
OWNER-BUILDER DEC4�ATIONS:
Oete:
I hereby atfirtn thai under penalry of per�ury t�ai I flm EXEMPT FROM THE CONTRACTORS LICENSE LAW for t�e following reeson (Sec. 7031.5, Business end Professions
Code: Any ciry or counry which requires a permit to conswct. atler, imprwe, demWis�, or repeir eny structure, prior to its issuance, elw requires t�e applicant for such permit
to lile e signed statement thet he or sha is licensed pursuent to the pmNsions of Ihe Cantrectors Ucense Law (Chapter 9(cammencing vrith Sectlon 7000) ot DlWsion 3 of Ihe
Business end Prafessian5 Catle) or t�at �o or she is 8zempl Iherefrom entl the basi9 for Iha ellegetl eremption. Any violetion af Section 7031.5 Dy eny epplicent for a pertnil
suhjocts the epplicant to 9 ���I penalry of not mora than tive huntlretl dollers (5500).):
❑ I, as owner ot Ihe propeny, or my employees with wages es Iheir sole compensation, WILL DO TME WORK, end the sWcture is not intentletl or atteretl tor sele (Sec.
70a4, Business and Pmfessions Code: The Contractors License Law does not apply to en owner of property who builtls or impmves thereon, and who tloes such work
himself or �erself or through his or her own employees, proviAed ihe� such improvements ere not imendetl or ottered lor sale. If, however, Ue building or Improvement is
saltl within one yeal of completion, the ownervbuilder will have t�e burtlen of proving ihat he or she did not builtl or improve for purpose of sale.).
❑ I, as owner of the pfoperty, am EXCLUSIVELY CONTRAC77NG WITH LICENSED CONTRACTORS to construct the project (Sec. 704d, Business antl Professions
Code: The contract0�s LlcenSe Law tloes not appty ro an rnvner ol property who bullOs or Improves thereon, and who contratis for 5uch praect with a contrector(s)
license pursuant to Ihe Contrectors License Laws.).
❑ I em exempt untler bec. Business antl Professions Catle for �his reason:
Slgnelure: �ate:
Owner ID vedtied by tlriv6ts license. ❑ Yes ❑ No DmefS License No.
Veritication ol Ownere�ip Dy (type ot Aaument, i.e. - Droperty tax blll ar tlaetl):
Expires:
DIVISION OF INDUSTRIA� SAFETV PERMIT CERTIFICATION:
❑ I �ereby certify that no ezcavatian five (5) or more feet in tlepth Into which e person is requlred to descend, wlll be matle In connection with work euthorized by this
permit, and tha� no Dulltling siructure, scattWding, falsewo�k, or demolition or dismantling thereol, will be more ihen thlrty-sl: (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title B. Calitom�a Atlminlslrative Code).
❑ As owner-6uilder, I wlll not employ enyona ta do work which wwld require e pertnit Irom the DMslon of Industrial Salery, es notetl above, unless 6uch person has e
pertnit to do suU work Irom ihe division.
Signature: Dale:
Dlvision of Industnal Safery Pertnil Number:
CERi1FlCATE OF COMPUANCE ANO AUTHORIZA710N OF EHTAY: I certity under penalry ot perjury that I have reatl t�is application and state that t�e intormation given is
correct. I egree to wmply wil� ell state laws end ciry ordinances relating to building conswction, end au�hodze representetives ot t�e Clry of Costa Mesa to enter upon t�e
ebovo�tlescribed property lor inspection purposes. I egree not to occuDY or allow occupency ol eny huilding authorized by this permit until finel inspection.
COOE 1. IN57ECTONTYVE PdIE lii�fi
1618 Fizetl System Final Flre Prevention
1268
200
201
202
203
204
Pool Spa Finel
Finel Re-Roof
Flnel BIxWRetalNng Well
Final Factory FIrO Place
Final Sign
Finel Demolition
FOOE� INSiECTIONTYPE
206 Finel Mechanicel
208 Final Plumbing
210 Finel Elec�ricel
212 Finel Fire Preventlon
220 Finel Planning Approval
222 FInelSite
250 FinalBuilding/Occupenry
Date
PAIE
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cmtrecb 1or wd� propqs vmh e mmrada�q fsensod pvauem m ihe Gaqrecan liw�vs Lew�.
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wweiam.
Dero: ApplceN:
WOPNEF'S COMGEH4ITION DECL�P�TON: I MroEy eKum uMer prosy d pujury ons d Ns IaOorrinp Eerluetum:
❑ IM1e�avdxYmeinlanecenEiu�aWmnsenitoeeXtiwnMxakerimnpaivalun.myovdedfaby5aclianJ"lOOdlMlebn
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c�«:
Pdiry Number: — � 1� � � � 9�
�ia extim need nw be completed,I the permR ia M om huMied dall /SI su )
J I centy thm in tha pMormme d iM xrork Iw whch thie pe�mn ie ehdl m� empby eiry {wem in ury mennar w u to
become wEjeq io ihe wwkan' canpeneetbn lev.a d Celibmu. uM o� ihal X I ehouk Wrnne wb�ee to iM Mwken'
cnmOenaalion Dm ' iom GeCL'� �)00 d �M lebor COEe. I aMll Mh �� comW wiN IMee Mw+�.
DNe: ApdkenL
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pallormenp d the vmk br whicM1 Ihe paiml ie osued (Seaion �09J, C'v. C�.
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CITY OF COSTA MESA - BUILDING PERMIT
/'1SERM NO: B 080371
FERMIT NO: B 080371 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V-N FERMIT TYPE: STR PURPOSE: OTH
SOH DESCRIPTION ; T/OFF & REROOF W/FIBERGLASS SHINGLES SQ FT: 3,Q90
CLAIM VALUE: 3,090.00 CALC-VALUE: 3,090.00 GROUP OCC: R-3 /
COMMENTS: RESIDENTIAL REROOF
3F if if iE 1E f(-�IE K- %%3E %%iE % IE %!E iE IE �f �IElF iElF ftlklf iE if iF if iF iE iF ff iE if iE iE k iE iE if fE !b 1E fE k �F �FlF k!E 3f iE iE �E �E iE-7E iE ih iE iF 7E fE iF K fF IE IF If K- IF 3E If iF �K-
Z 0 N I N G� ERTEBQAUCIKRSE M E N T S
------- - — MAIN BUILDING ---------- --------- ACCESSORY HUILDING ----- ---
FRNT: FT 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: 13908110 ZNE: REF NO:
PLANNING NOTES>
�E if 1E 3E iE iE fE IE IE If iF IElElE ik �f iE jE iE IE if ik 1E iF �f 1E 1F iE if !E 1E 1ElE iE if iE 1E IE if ff i! Ik 1E iE 1E �E IE 3E iE �E iE 1ElE 1E 1E 1E �E iE 1E 1f 1F IF if df iE 3f iE iE 1E 3E fE iE
D E V 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= Z' S
ZONING APPROVED•BY .
DATE:
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY: DATE: �" `%�
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LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 87.25 Y. 50
SMIP/NON-RES
PLAN � , � ,.�
ISSUE FEE
HUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 87.75 0.00 � 0.00 87,75 87.75 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 87.75 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHAN2C FIRE SMIP/TOT GRADING PLAN-CHECK
8�,25 � .5�
iE ik 1E 1E iE iE iE iE 1E iE iE iF iElf 3E'lE iE iE IE iE'lE �(-iE'.E �E iE fE iE ik fE 1! 1l'!E ik iElF 1E iE 1E.'1F fE ik iE 1E i! 1f iF iE 1E 1E !E ik �7E iE iE 1E iE 1f iE iE 1E 1E 1E 1E 1E'lE �1E 1f if iElE 1E'1E iElE iE iE fE #
I N D I V I D 0 A L �F,'E E B R E A K D 0 W N
TYPE QTY D E S C R I P T I�O N� UNIT COST TOTAL COST
�Y
SFR 3090 ALTER BY VALUE RESIDENTIAI� NOZONE ].,00 3,090,00
�END OF FEES
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DkTc: 11/07/95 TIttE: 15:05
CJNSTRUCTION AND PLANNING POOL F � 4
_r APVROVALS Permit �h Oate �Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soi1 Pipe-Undrgrnd. , 53. Steel Reinforcement
3. Eleclricel Conduit Utility-Undrgrntl. 54. Forms �
4. Electric2l Conduit-Undrgrnd. - 55. Electrical Bonding . .
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVALTO COVEA�GUiViTE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test �
9. Water Pipe•Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
70. Struttural Floor Syscem � 61. APPROVAL TO D'ECK .
t t. Property Sewer Line & House Connection 62. Backwash & Receptor�Final
�z• SQ`ve� CaP - 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System • Final
14. Rough Glumbing - � 65. ElectricabFina�
75. Rough Electrical-Conduit 66. Solar System�Final �
16. Rough Electric Wiring 67. Fencing & Access ApP�oval
17. Rough Wiring Sign 68. APPROVED FOR P�ASTERING
18. Rough Electrical-T Bar Ceiiing 69. POOUSPA SYSTEMS FINAL
18. Rou9h Heacing & Air Condicioning . FIFE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70, Underground Hydro
22. Duas, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pip¢-Rough & Test 72. U�derground Flush
24. Roof Framing 73. Undergr�d. Storage Tank O Gas ❑ Oil
25. Roof Sheathing �i �3.g� G� 74. Overhead HYdro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Fla:hing 76. Ory Standpipe
28. Lathin9 & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PflEV. FINAL
30. Drywall Nailing HEALTH OEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Fina� Electric Notes: /i_/g_S�L p f� �f}��Q p�.
34. Final H¢ating & Air Conditioning �-� �� �j�y/'Q` sy'� ✓
�/ /
35. Finai Gas Pipe-Test (��.E.� /)J,�d,) m^J -
(i .�_,�
36. Hood or Canopy ���(a �� ��
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Finai
40. Gas Service-Fina1
41. So�ar DOmestic-Finai
42. Backflow Preventer
43. Backf�ow irrigation
44. �andscaPe Irripation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING '�'y �6
48. FINALPLANNING
49. Eleciric Release to Ed+so� .
50. Gas Release to Southern Califor�ia Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
"' RV VH11LiR� VGIVG
�JOB ADDRESS
dGENERAL CONT ACTOR Costa Mesa
`�i1P No. l�q_p81-10 LOT 2 T
�I' ECTIONS
GAS
W ATER
ftOUGH PLUMBING
P I 5
SPRINKLING SVSTEM
MISCELLANEOUS
ROUGH NEATING AND AIR CONDITIONING
UNOERGR011ND � POWER
ROUGH WIRING
TRENCHES Q' FORMS �
FLOOR SVSTEM
BONO BEAM � STEEL RE
SHEATHING
FRAME ANO FLASHIN
LATNING — IN OUT t
PLASTER.BROWN COAT
M NG, VENT..
P. dING, FINA
ELECTRIC, FINAI
BUILDING. FINAL
IEFRIG. ANO A.C., FINAL
AN� GAS TEST I—I
7UP I TYPE
SUBCONTRACTOR
11 y� Vv
� PERMIT N0.
�y�/
r �,�:--- .� 29356
COSTA MESA BUILDINCrSAFETY DEPARTMEM
P.O. BOX iZ110 - COSTA MESA, CALIFORNU Y262E
For Appficont ro Fill In Completaly
TYPE OR PRINT
COSTA MESA, CALIFORNIA
� MAIL
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NOV 12-bSPAI��O 403� ****7_7.OG
CXSA
APPLICATION POR PERMR
BUILDIN(i
for Offlce Use Only
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.. No.oI�LDos. ; ALLOWiD (U..B.G.REGUIRHMENT:
��w � YAROBMPROVHD YAROSMPROVEO
T7i_.�.i•L'-w� � MAIN BUILDINO ACCES80RY BUILDINO
toY (J-/ I
R � R�ARYARD G�
�f / /
�.r S R�oHr S
DESCRIPTION OR WORK
4No.o�
�R�OOMH �y
RI OOr I
gq uae
� vut. # J�— S�—[n ti I owre
i�u � ■ C.U.P.� APPROVHD I/
.�i0� �"A9YQDf iQ , ...__ /� r -
1 HHPGBY ACRHOY/�6006 THAT 1 XA1R R6AD TXIO APVLICATON
AND 9TI�T8 TNAT TX6 ADOV6 I� CORq6CT ANO /�Ope[ TO COY•
PLY WITX �LL CITY ORDIIUNCU AND �TAT[ {,AWO R[OYLATIHO
UUILOINO CONBTRII4TION.
61ONATURE OP
PERMITTHa
AUTNORIZQD AG[ � �
rrii a
07
�
3 � �. �. �
0
n�e wrounr exowN uHoea vewenon �e �on THs j
IUFP09H OP [BTA0�18M�N0 A PBPMIT R88 ONLY. q�
VALUATION /�— �
// p�Q PERMITFE6 S �
s�/Ss� 9� w
TOTAL FEE � / �
OWNER HOVATTER, Mr.
JOB ADDRESS 3205 Minne
litNt
`�l'y.
� SOIL'
v
��:\1 GAS
\ WATEF
ROUGM
PFOP.
LRNEOUS
CON.
ROUGH XEATING r1N0 AIR CONOITIONING
TEMPORARY SERVICE OR GOLE
FRAME AND FLASHI
LATHING - IN �
PLASTER,BROWN C
�.TUFAL, FINAI
�h �NG, VENT., R
PLUMBING, FINAL I
EIECTRIC. FINAL
7ZN11
DATE 6-2-75
BUILDING PERMIT N0.
L
SUBCONTRACTOR
. .�� � 40068
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fi/l in Comp/etely
BUILDING �"� n —
ADDRESS eL ( � Y
OWNER �L /' �
MAIL
Z ADDPESS
a U CITV �. /'/ NOL.S Y.) `/i
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BRANCH
ADDFESS
ADDRESS
CONTRACTOR pa�/�
ADDFESS �3� � L/ �
qTY
STATE
�ic. No. ,�L� � �
SI2E
OF LOT
USE OF
EXI5TING BIDG.
SIZE OF
NEW OLDG.
EXTEflIOR WAL�
COVEFING
USE OF BUILOING AND
TEL.
TEL.
No..sys3�i
CITV /
L10. NO. Q _�
INO.OF BLDGS.
NOW ON LOT
NO. OF
ROOMS STOfl
ROOF
COVEPING
K TO BE PERPORME�
//� �!/ 0.��.
BUILDING
ADDRESS L
TRACT
OWNER
E
IIf}I —?"�]SPAlOOO (�0�'''S *��.:��5.50
r.:t��
TION FOR BUILDING PERMIT
�ATE RECEIVED DATE I�
L.. ri_�
j LOT ..(� -BIOCK
(! L� � � �/
� IL/A' � � VALV$ //U A
� XVPE / 11 GROUP �.T
///L ❑pTE I — !_ � �
ZONE � NOAF USEOF NEW �/aG�
PLAP6 Z. BUILDING � L
VApDSAPPROVED VApOSAPPqOVED
MAIN BUILDING ACCESSORY BU�LDII
(FROMC/LSTREET) „
DISiANCE BET.
MAIN BLDGS.
VAR. aW
C.U.P.�
APPROVED /.,
I hareby acknowledve that I have reatl this application antl state
that tha above intormallon is correct antl a8ree to comply with
all laws regulating builtlinB canstruction, end 1 shall not employ
any person in violation ot the workman's compansation laws of
the State'ot Californie. yn�`
I hereby certify that 1 am proDerly licensed es a contractor untler �--'��"+�' FT.
the Staxe of Californie Business antl Professions Cotle, Divisicn 3, THE AMOUNT SH
C�epter 9, antl that such licanses are In full torce and effeei, or I TNE PURGO6E OF F
am ezempi from the provisions ot the State ot Catifornla Business VA�UATI ON
antl Profassions e, Divislon ; Cha ter 9. �,J✓�,
Slgnafure of /�. /� ✓
Peimlttee � � . $ L/
i �Authoiizetl AgenY
DATE
��C
STATE
T� O
VAWATION IS FOR �
A PERMIT FEE ONLV: ¢
E $ t �=_ N
�
f' m
K S E
� � LL
I $ �
', .�- � 1���'7
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 9f7 C08TA ME8A. CALIFORNIA
For Applican+ fo Fill In Complefely
LOT Z-TR 62 PE OR PRINT
BUILDiNG 3205 MINNESOTA AVENUE
ADDRE66
C05TA MESA CALIFORNIA
oWNER KCNKO� CONSTRUCT�ON C0.
MAIL �555 j�LACENTIA AVENUE Pe�
nooaess
_ NEWPORT BEACH TEL.MI -32 BUILOI
FIRE
F�.� ��G�c���
..L,-� 5-�3-Eo
;iiVAf�CE pEP�.
C1TY 0� �,�iT}1 �^'if.$�1
APPLICATION'FOR PERMIT
BUILDING
For Office Use Only
PECEIPT NO. PCRMIT NO.
oeTe IB8uc0
'� Y�
GOSTA MESA. CALIFORNIA
TYPE GROUP�
ADDRESS �555 PLACENTIA AVENUE ZONING
CITY NEWPORT BEACH ZONH I NO.OP I UBE OP NEW
PLANB BUILDINC
6TATH 6t t95 No: MI 6-3zz7 �o,,,.
LtG. No. oeecn�PiioN
81ZE /O X l oo I NO. OP BLD68. o
OF LOT O � NOW ON LOT .�..�
3 BLD NONE YARDS
APPROVED
llNB FROM SO � �� � (CBNTHR LINC BTJ
ip srnegi REAR YARD FRONT
RD I LEFY 5' I RIGHT �' R. SIDE
DESCRIPTION OF WORK
BUILDING / NO. OF / �
81ZE �O� �• ROOMS � STORIE6
EXTERIOR WALIS.�UCCO ROOP ROCK
COVERIN� COVERING
USE OF BUILOIN6 AND WORK TO BE PERPORMED
SIN(;LF-FAMILY RESIOENCE AND ATTACHED
GARAGE
PLAN No. 1-H
I HCHHBY ACKNOWL81
ANO BTAT6 THAT 8
PLY WIiM ALL
BUILDINO GON V
� AUTHORIZED
iH THAT 1 XAVB PGD TH19 APPLIGTION
I1BOV8 IB�GORACGT AND AOliHB TO COM•
APPROVED
-L6
n1e AMOUM BHOWN UNOEH VALUATION IB POP THH
PUPPOBE OP EBTABLIBHING A PERMIT F66 ONLY.
VALUATION
///�/ ��� pp PERMI7 FEE $ � N
S " " � PLAN CHECK $ /�+ � n
i
i /,�„� a
TOTAL FEE Y d