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PLANNING
APPROVAL
City at Costa Mesa Planning Div.
Subject to Building Division Rags.
Sri Revision must be approved.
Required Prior to Building Final:
CIYES NNO Zoning inspection
DYES .J O Traffic'Park Fees
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#111 . CITY OF COSTA MESA , r
4,4011,1* 1 ' DIIILDING DIVISION V
4-Siiint,Ai DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER
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er : PERMIT
1 B05-01459.
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1546 CORIANDER DR Status: ISSUED
Suite: Applied: 09/01/2005
Vicinity: Issued: 09/01/2005
Primary Occ: R1 Type of Construction: V-N
Parcel Number 13949121 Zoning: R3
Applicant: PANARISI, JOSEPH M
Address: 2850 CHIOS RD
Phone: 714-557-7733
Zip: 92626 ISSUED BY: (49k.....—
COSTA MESA,CA
Owner PANARISI, JOSEPH M '''''''. .`:14':';':-....,..;'' : ''',."ts*'-'.- :• „ez, ,
Address 2850 CHIOS RD... ... ,
--""er-' ,?_±-• !Phone: 714-557-7733
COSTA MESA,CA- -', ,4.:- 4.f.i ;:0 Zip 9.2,:.
Contractor: OWNER-BUILDER, .,... . ,,,,,,e.: ../ • , ....A.—
Address:
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Zip:" License: 000000
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Arch . , • . „a., Eng:
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Address:
Phone:
Phone:
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SCOPE OF PERMIT
TEAR OFF EXISTING Woop• HAKiANI:3:1NSTALL 1-30LB FELT AND 40 YEAR COMP.SHINGLES'.AN APARTMENT BUILDING
. -M4,7.''••\ - IV; "4'1'("; a -;'''-i.,,- '4,
FEE SUMMARY -t
Plan.- Check
: $9.00
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.1,.i: Ca1F_. .Valuation:2 ,,
V. .„.:.$
14,00 0:0
0
Permit: $237:25Claim Valuation:
: $ 4.000.00
SMIP Res-' -1 $0.00:A:'
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SMIR Corn: '.- $0,00-
other: : $9 . .. ',.., „‘...i-,' -,-.' ,Aa•-cy -- -:,,,i-,; -;:'f,f' .;-: ,s,..t.z,.;.-. :.. : : :-..',.:0--' ":_cr-, -w
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". 0 00 . ":x'k '''''-'1 1 .
Inspection: - '.r: : . ,
.;STotal: .. $237.2.,51
, . . PLANNING &ZONING „ ..„.. . „, , • ,
SETBACKS
MAIN STRUCTURE. ' ;6,,);',?•-?....-
' 0-0 - - Right .•,,,,0-9.
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ear
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.Front ,
•'-'' Hi> - ,-..... .,,,, " ,',",- ',?t: f .' ,,tte ,-.
ACCESSORY' 'r- Front-„,..„."!,9-0 ....,,. j, 0..... „.. Left:; ,...,v-n Ridht.—A,§•0_0
....:47; we
' • VV ' '-C PARKING Existing:00Req.uir-ed-1e 0 Proposed:
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. RRIP
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 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
fora period of 180 days.
required inspections
In order for the work authorized under this permit to be considered legal, such work must
comply with all applicable codes, and all
Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-48(6600)
DECLARATIONS l.�
WORKERS°COMPENSATION DECLARATION: + x
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit Is valued at one hundred dollars($100)or less.)
•
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Processions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). '
(KI,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ m e pt under sec.IV a Business and Professions Code for this reason:
Affrified by driver's tic:le. /jos 0 No Drit No. ._ xpires: — i
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feel of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aPPermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 311 Yes LJ No
(Section 65850.2 of the Califomia Govemment Code requires that the requested information be fumished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑Yes 0 No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date: -.--1' Ise .>+.<+r -
t. 1
lati
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury 'l lve reads applice T•ij g state thh 4•rmation given is
correct. I agree to comply with all state laws : d city ordinances relating to building construction,and auth a repro atives 9fl of Co.* ?;o enter upon the
above-descriproperty for inspection puyfes.I agree not to occupy or allow occupancy of any building authorized by his rmlt until final inspection.
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/ Signal el.%reg- Ow.:r(s) c6ate
And/Or Authorized Applicant Date
CODE t INSPECTION TYPg DAIS INTITIAL5 CODE I INSPECTION TYPE DATE ECM&
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final � 208 Final Plumbing
200 Final Re-Roof q-7"C7/ 444-x- 210 Final Electrical
201 Final Block/Retaining Well _ 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition ., 250 Final Building/Occupancy
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PLANNING DEPT.
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SUBJECT TpX.DG. DEPT. REG.
BY1thetit. .-CrATE./1-01:,2---2 7
DIRECTOR OF PLANNING
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• STRUCTURA_ APPROVAL
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ALL INS;PTION REQUESTS
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City of Coy9 Building Dept.
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. • , THESE PLANS MUST 3 Cit4 JOB AT ALL TIMtS .
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MAKE NO_CHANGFSAM- T 1IDLIT---PRIOR APPROVA
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OF PLANS AND SPECIFICAllOr S ALL NOT BE CONSTRUE)
Ccc) TO BE A PERMIT FOR, OR AN d Pn OVAL OF, ANY VIOLATIO 4
poar,.. sE 7-20 :
OF_ANY_OF-THE-PROVISIONS-0 H S-..,ULlt. NU PLRMIT PRE
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SUMING TO GIVE AUTHORITY II /IDEATE OR CANCEL TH
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PROVISIONS OF THIS CODE S I I L BE VALID. EXCEPT IN SL
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FAKAS-THE-WORK-OR-USE-Wifiii I ALTTHORIZES IS LAWFUL
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. THE ISSUANCE OF A PE iM T BASED UPON PLANS ANC •
*Ttaint< . _SPECIFICATIONS-SHAtt-NOT-PRI I E 41 TICBU I LDING OFFICIAL
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FROM THEREAFTER REQUIRING IT tORRECTION OF ERRORS
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M reAlAT 1 NS AND SPECIFICA"0 it OR FfilllyL_PEEVENTING
ii/A1C Xis iL% 1(17‘1".OPERA!! -13111,-4-0411 EL. 0-N-THEREUNDER WHEN -
IN VIOLATION OF THIS Olit 0: ANY OTHER ORDINANCE t
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City of Costa Mesa
Building Safety Department CERTIFICATE OF OCCUPANCY N° 2210 C
P. 0. Box 317
Costa Mesa, California
The Building located at 1566' $este, tlbj4et &L_So D
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group 11 & 3 Occupancy.
Use of Building ' f A ess✓tizm_,ac :'f .ori e� 1.-16. 'ior um t, ar7: : a4..,.I
Legal Description Treat 547 • tat
(See reverse side for Metes and Bounds)
Building Permit No. 632583 Electrical Permit No. 23762 ��p�Plumbing Permit No. 5
Floor Load Signs have been installed as Room Capacity Signs have been instaled as
required under Sec. 2308 U. B. C. required under Sec. 3301 (1) U. B. C.
17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied
until the owner or operator has been issued a valid certificate of occupancy by the enforcement agency.
(b) A new certificate of occupancy shall be obtained whenever there is a change in:
1) Occupancy classification of a building or portion thereof
2) The number of apartments or guest rooms
3) Ownership
If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California
Administrative Code, Title 8, Chapter 9, Article 8.
Number of apartments— 11 and/or guest rooms_
ISSUED TO: Building Official
by a , tar -----
Date 11. 1$65
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed
011 except by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Form Bun4-1M-11-63--S-B P
OWNtR SIMICH. Robert DATE 11-17-75
JOB ADDRESS 1946 Coriander Apt. B BUILDING PERMIT NO. 40862
GENERAL CONTRACTOR (Sears) Air Flo Co. DESCRIPTION of WORK Patio Cover -
AP No.139-491-21 LOT 39 TRACT 5475 FIRE ZONE VALUE $ 200.00
INSPECTIONS Signature Dote TYPE V GROUP •1 ZONE R3
SOIL SUBCONTRACTOR PERMITS ISSUED
GAS Dote Number I Signature
WATER Plumbing
J\ROUGH PLUMBING
JPROP. SWR. LINE LJ HOUSE CON. ❑
]SPRINKLING SYSTEM
MISCELLANEOUS
,$
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER ❑
ROUGH WIRING Heating and Vent.
TRENCHES ❑ FORMS H STEEL REINF. fl
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUT n
PLASTER. BROWN COAT
STRUCTURAL, FINAL Electric
HEATING, VENT., REFRIG. AND A,C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL
BUILDING. FINAL •mC S- 44 . 76
FAlb
"Iov 17-75c„5.00
40862659* Is:**s5.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
. AP I:I TION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
✓� �q �j/''
,REIV D DATE RECEIVED /DA ISSUED
/$�SJU E/DBUILDING J et
ADDRESS � �0 fC /It/tAti��-Ir�- 012 (i / Q + / -/ 7-7ft
. lll//o S i roi fG, A.P.NO. /C / I -7 l ERMIT NO.
OWNER Berri-
MAIL ^�,�J /� a �jJ BUILDING / /�
MAIL ES/S` ( Ci'c' �' ^U I”(//� //,�" T N ADDRESS ��IF L,���j Io
CITY CQ �- 04 cr4- NOLS 5:6?0 TRACT GJ'' 5I LOT'3 / BLOCK
CONSTRUCTIONNDERp ON - NEW ADD ALTER(REPAIR IMOVVINfp DFMOI ISH
BRANCH OWN ER\/x/` �JA I'lrFI •
ADDRESS _ VALUE j/�(1l��/�J
ARCHITECT {, , OM 6- TEL. USE Z7 L-(J�r1=-rl- $ ✓r/ "
OR ENGINEER M1/
FIRE //�//
ADDRESS ZONE -NPE' t( GROUP
• �/- .I cr
CONTRACTOF( r�y}�L..I )p (t]/-r� �j APPROVED
DATE —' 7-7...)
ADDRESS 3 b( L `l/J'e/u'�(w/Ft.J VLvJ ZONE NO.OF USE OF NEW - '
TEL. �� f
PLANS BUILDING �no C_�
CITY GY R C7 e/✓/t NO. 1` uG-P
# STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC.NO. ' MAIN BUILDING _ ACCESSORY BUILDING
W SIZE ' I NO.OF BLDGS. (FROM C7..21-1—FT.
//LSTREET)
C. OF LOT NOW ON LOT FRONT Z / l FT. FT.
• a USE OF
O EXISTING BLDG. R:SIDE'V t7 FT.
S Separate permits are required for L.SIDE 'C) FT. - FT.
#l•
electric,plumbing and heating work.
W - REAR 721 tFT. FT.
[.y USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
QX MAIN BLDGS. ACCESS. SLOGS.
.-1 7 • VAR.# DATE
a �/� ( U tv1 /t� � J CU % Car. C.U.P.#' APPROVED 7
.7' `lb r r // DROVED/-,.��/�{.y/ DATE //._/• .-7c
W gig r
W I hereby acknowledge that I have read this application and state
n.
pG that the above information is correct and agree to comply with
m
all laws regulating building construction, and I shall not employ
i
Z any person in violation of the workman's compensation laws of E
Sthe State of California. 63- m
I hereby certify that I am properly licensed as a contractor under SO. FT. N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I .• THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: b
\(1' am exempt from the provisions of the State of California Business ` '
.-(%1'
and Professions Code,
--Division
%Chaaanntt r9s...�f � VA/LUA�TION PERMIT FEE $ Gs �
Signature f � It � , �-y'/•
PLAN CHECK $ ✓ 'n
QQQQQ ���� (/ o
Permittee �/ $ D TAX $ 50
LL
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Authorized Agent TOTAL PAID $ L5 6
,
��UIIPICK - USIC '- « . •
JOB ADDRESS 1546 Coriander BUILDING PERMIT NO. 43548
GENERAL CONTRACTOR er Builder DESCRIPTION of WORK Add external door to •are
AP No. 115-491-21 LOT 39 TRACT 5475 FIRE ZONE VALUES 100.00
. V _
1' INSPECTIONS Signature Date ,TYPE V - GROUP T ZONE P-3
• SOIL - • PERMITS ISSUED
1 GAS SUBCONTRACTOR
Dote Number Signature
AWATER Plumbing
�al ROUGH PLUMBING
X. PROP. SWR. LINE Q HOUSE CON.
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND 0 POWER 0
ROUGH WIRING Heating and Vent. . •
TRENCHES FORMS STEEL REINF, -seg fl
FLOOR SYSTEM C rk •- 3 A R
BOND BEAM n STEEL REINFORCE in SUS i. f Po
g - W y
SHEATHING ''{ (� \4 r,4. I y .,,.r ..,a I
FRAME AND FLASHING - O N Ii ...a
LATHING — IN OUT n 4-114d.4,0072 .._
PLASTER, BROWNN COAT
STRUCTURAL. FINAL .-..
HEATING, VENT., REFRIG. AND A.C., FINAL U~ 1 aC1rLG�� a
I
PLUMBING. FINAL AND GAS TEST n - -
ELECTRIC, FINAL
BUILDING, FINAL
/ • 43548PElu .� + r /
'E�i 2-7777;00 i 11 s'=- x.501
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
• For Applicant to Fill in Completely — Use Ink Only APPLICATION FOR STRUCTURAL PERMIT
RECEIIN DATE RECEIVED DATE It U FFFE�_Li
)(BUILDING LL,,/ ��// 2-`21:247
+\ADDRESS IAr3ep C�L)FI�,,,,4„I�/).E,P 3DK 9
SOWNER 'V igHt0A , e jibe X.CL-S A.P. NO//��I /�/
MAIL BUILDING l /// , !!!
ADDRESS
Ass--Y -A r'072/An�AE� .)/e.
ADDRESS .5 /O/1�(n Pr Pr
TEL. TflACT. ( LOT�f BLOCK
CITY ( o JTA '/tlrlJO NO.3fr//o-3/4 ! 7 " / -
CONSTRUCTION �s� NEW ADD ALTER REPAIR (MOVING DEMOI ISH
/yONE - IR C
BRANCH
ADDRESS OWNER�e nod ^ , 41'jj ,J
/(�,(f / s O C.-T., / ` VALUE /06e W
ARCHITECT TEL. �9'E / i • arc if Ai Of I $ `
OR ENGINEER • / / Ne.S - -..!' - . "'
FIRE
ADDRESS ZONE ' E '/l GROUPOr
_ / t APPROVED Z2r-
ONTRACT OR ' / n�ay �p_e BY r DATE G /
ADDRESS """ GGGUSE �J'/'j'/jI /J/ 'C/
CITY NOL ZO Fj /� IPLANS� BU G , ' "IQ/
.F. STATE CITY U/Y[A`RD`SS APPROVED ARDS APPROVEDPP`' ,
gLIC.NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
k7 SIZE NO.OF BLDGS. (FROM C/L STREET)
0. OF LOT NOW ON LOT FRONT F , F_C.
Q USE OF Jr) (VT /J
.�., EXISTING BLDG. R.SIDE `. FT .. 5�-
m r�tl UVY-'
Separate permits are required for L.SIDE / F /. FT.
G electric,plumbing and heating work.
REAR
fV'
E.-. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN
Q< s /J MAIN BLDGS. ACCESS. B .
DATE
C U.p# .,,.)/ APPROVEEDQ
ROVY d 7
>. AN) £Y/ _'tA// �L� /N nDATE,-.4C . /V..O f= G .fiA/..F
La
Q I hereby acknowledge that I have read this application and state o
N
14 that the above information is correct and agree to comply with m
0-1 all laws regulating building construction, and I shall not employ
Z any person in violation of the workmen's compensation laws of
14the State of California. ro
I hereby certify that I am properly licensed as a contractor under 5G. FT. tv
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR o
Chapter 9, end that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; e
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ d
and Professions Code,Division 3,Chapter 9, n
Signature� /// _ — / ~ PLAN CHECK $� c
Permittee/V �< f/ L6N/Lv .�.�.C $/�'71 TAX $
,/ (�. (� 5. .qo U �
Authorized Agent TOTAL PAID $
n
•
.7 , 23258 FEE RECEIVED
••
DEC 1 1964
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P.O.BOX 817 COSTA MESA,CALIFORNIA
CITY OF COSTA'MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
,'Cc4 TYPE OR PRINT BUILDING ,
BUILDING //� �� _ For Office Use Only
ADDRESS /s'r(tel.Cl i�(/9 At.6 Z.`l�
RECEIPT NO. P
COSTA MESA, CALIFORNIA 258
J ` ♦ RECEIVED BY DATE ECEIVED DATE ISSUED
OWNER,/IA� '�"�CL'7/� OL`cECL er
/'3"-�7 DEC' 11964
BUILDING
MAIL / ADDRESS
ADDRESS /��f Z �' &('c/ JFIRE
��
• TEL. ZONE TYPE / GROUP /`-' /
CITY rU LLt fL it:41 No. it 7f•6[3� ,
APPROVED
ARCHITECT TEL. BY DATE
OR ENGINEER NO.
- ZONING n�
ADDRESS Llr- jet(
_ ONE I NO.OF I I USE OF NEW
`' ` L ( PLANS 0( BUILDING f
CONTRACTOR /J L'L'( L^u 4"�/it(' L /'v!Z.S f7 � _ L�7 1:'
LEGAL
DESCRIPTION z-1-0 TI Y d S /
ADDRESS
(w V 2- ' . t+ cc._S / z)
VV l
CITY
/C-4/ I IL`/Z/7././ J
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE TEL. 30"TO SIDE @ REAR P.L.
LIC.NO.�/B LG �( NO. �7/ 'dZJ_}
q EAVES •
OF LOT /'r.31 X / / / NO.OF ELDOS.�' ALLOWED (U.B.C.REQUIREMENT)
G [: 'U NOW ON LOT
YARDS APPROVED YARDS APPROVED
USE OF _ MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/LSTREET)(
SETBACK LINE FROM / CLI._
5/ FRONT ^_�//FT.
CENTER OF STREET J ' REAR YARD /
- c' FTP FT.
SIDE YARD LEFT // I RIGHT' //%/ R.SIDE )0_
DES SIDE/8 OF WORK L.SIDE� FT Fr.
NEW ALTERATION _ ADDITION REAR /0 FT, FT.
DISTANCE BET. BET.MAIN&
REPAIR MOVING DEMOLISH MAIN BLOCS. ACCESS.BLOCS.
" G VAR.* • DATE
BUSIZE DING�/ �/T- / ROOMS a5 STao RIES C.Up.P. APPROVED
EXTERIOR WALL / ROOF V O A AP1 RE�4 l � ^^ 0—6 I
COVERING � D COVERING BY 1.A/1M. GATE // _�
USE OF BUILDING AND WORK TO BE PERFORMED _. ll// /
C/- /.)/, X - Gl//9— 4/Y G---`4,— �j //n /y/
/e// /(�/a80.FT. G r S./ 96
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION 18 FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY BIIILDIITH ALL CITY NG CONSTRURIO INN CA AND STATE LAWS OULATINO VALUATION `7 a 8 •
/ PERMIT FEE $ /o�Q c,
SIGNATURE PERMITTEE OF` � rG"Yr(// /,�//y/ `,�/ Fa
S / / /5-/ '` C EC • - X
AUTHORIZED AGENT /9:2L
TOTAL FEE $
an
•
��, ?3?A3 QTY Or �s• ;STA 6 SA
COSTA •MESA BUILDING-SAFETY DEPARTMENT MAR 21 1965
P.O.BOX 917 'COSTA MESA.CALIFORNIA .
r
For Applicant to Fill In Completely PPLIC
TYPE OR PRINT
1 ` 9 gi For Office Use Only
f BUILDING 1- / C .� 2
ADDRESS 1, R.'11.
/ /6`J"/, 7/...' !'� l�-� RECEIPT NO. PR M 0•
.^
COSTA MESA. CALIFORNIA "Mit.
� Y OA BREC:.VEO -�O EISS 1O
- OWNER c'�`/ ea/
6j .�T /�//� 10
_ ADDRE33 i �G (� Go e ciAtSp FL:� Il
FOREE TYPE GROUP rJJJ
: ARCHITECT TEL, - :;PROVED DATE 3/U
-,
ZONING .
PLANS "v- I. ADDRESS
B DING NEWIEIE OF ��/'e1 I-
' A-
'
DESCRIPTION
Lot_ } ye.i_iJSyT.1
CITY im (
(� r NOTE: NOEAVE OVERHANG SHALL BE LESS THAN • .
- STATE TEL.LIG.NO. �Z,40 y Z NO. JSSi'SiZ 90"TO SIDE 0 REAR P.L.
SIZE ' ' I NO.Or'meas. - ALLOWED (U.B.C.REQUIREMENT)
'' OF LOT NOW ON LOT I
YARDS APPROVED YARDS APPROVED
USE OF ' MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. M •
ii (FROM C/L STREET)
.SETBACK LINE FROM �I .. FRONT FT. FT.
CENTER OF STREET - .q$ REAR YARD / U ,
SIDE YARD I LEFT- '---------- I RIGHT -!� R.SIDE
DESCRIPTION�/ OF WORK L.SIDE Fr.
•
NEW JV ALTERATION ADDITION REAR FT. FT.
DISTANCE BET. BET.MAIN Q
REPAIR MOVING DEMOLISH ' MAIN BLDGS. ACCESS.SLOGS.
•BUILDING - NO.OF' VAR:$C . DATE •
' SIZE ROOMS . STORIES C.U.P. APPROVED
EXTERIOR WALL'-- COVERING BYPROVED (� O /.O �T�, I / r/
' COVERING it tel,/ “l! )
USE OF BUILDING AND WORK TO BE PERFORMED t
a ". N
J .' SQ.FT. . . c
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE 7
AND STATE.THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION Io
• BUILDING CONSTRUCTION -
.
SIGNATURE OF QA - m
PERMITTEE �-0,14-14"±^�'!
s2a I' Q
t AUTHORIZED AGENT Lj °'
,. . TOTAL FEE _ J