HomeMy WebLinkAbout3072 COUNTRY CLUB DR - Building Permits,� .� `,.
PflOJECTAOUHESS: 3O%Z COUNTRY CLUH DR
OWNEfl'SNAME: MC KEE, DOROTHY E TR
aooeess: 3072 COUNTRY CLUB DR
C�3STA MESA,Cr1 926"l6
714) 546-9151
FflCHIENGINEEB: BEG.NO.:
aonaess:
UNIT:
uxit:
PEFMITTEE GRAHAPA PROS INC. (719)596-1653
nooRess: 2952 CENTURY PL
COSTA P1ESA CA 92626
IICENSE� CONTBACTOP OECLAHATION: I �ere�y a��irm �hat I am licensetl untler pmvisions of Chapter 9(cammencing with Sec�ian
70001 a� Division 3 of ihe Business antl Pm�essions Code, antl my license is in lull lorce an0 eifecl.
ciTruc.: 005963 STATELIC.:29HE}( 'V�-�� cuss: C�—�20
�Daie' _��Z/ 19y SignalurM'� ��� �'LI�Y
RENS' COMPENSATIOpNr oECIAflRTION: I hereby allirm that I have a cenilicate of consent to sel6insure ar a ceNficate ol Workers'
CompensaGon �ns�cl D 1 U��eU GPL �be�oi�s�mion 3800. Lao. JS / O 1/ 9 9
voucrno.: LIBERTY MUTUAL EXP.ORTE:
COMPANY:
, CeN1ie0 copY is here�y Iumishe0. � Cenifie0 o y is Iiied wilh ihe ci�y Building Oivision.
ApplicanC� � �'��� �
%E ION FBOM W flNEflS'COMPENSATION OECLABATIDN: (Thisseclion neetl nolGecomple�ttlif��e permi�isiorone hunOre0�511p)orless�.
tlily t�at in Ihe pedormance ol l�e work br which Ihis permi� is issuetl. 1 shall noi employ any person in any manner so as to �ecome
5u�leci to Ihe Workers' Compensation Laws ol Califomia.
� �ale: SignaWre:
, NOTICE: I�. af�er making �his tleclaraiion, yau s�oultl become sublect lo Ihe WOBers' Compensa�ion pmvisions of t�e Labor
bt Catle. you musi foMwith comply wilh such pmvisions ar this permit shall be tleeme0 revoke0.
� CONSiflUCTION LENOING AGENCV: I hereby a�hrm ihat Ihere is a tons�mc�ian lending agency �or �he pertormance of the work br
whlth IhlS permil is issued (Setiion 3097, Crv. C).
LENOEP:
� FDOflESS: -
OWNEB BWLDEP OECLAFATION: I hereby atlirm that I am exempl Imm Ihe Contraclors' State License Law br the lollowing reason
(Sec�ion 7�3L5 6usiness antl Professional Code'. Any city of counly whic� requires a permil to cons�mct, alter, impmve, tlemolis�, or
repair any s�mc�ure. Orior Io i�s issuance. also reQuires Ihe applicanl lor such permit �o �ile a 5igne0 5�aiemen� ��ai helshe is licensetl
pursuani la Ihe pmvisions oi the ConVactors' Slale License Law (ChaD�er 9(commencing with Section 7000) o� Oivision 3 0� Ihe Business
ane Prolessions Cotle) or Iha� he/she is e�empt there�mm antl Ihe basis �or Ihe allegea exemption. Any viola�ion of Section 7031.5 by
any applicanl �or a permit subjec�s �he applicant �o a civil penalty oi noi more Ihan �ive hunOrea Oollars (5500).
I, as owner of Ihe pmperty ar my employees wilh waAes as iheir sole compensation, will tlo the work, antl ine
❑ Slmc�ureis noiin�endetl oroftere0forsale�5ection 7044, Business anU Pmie55ionalCoOe: The Contractors' S�a�e License Law
Eoes not apply lo an owner o� a pmperty who builds or impmves I�ereon. and who tloes such work �imSelL�erselt or I�mug�
his Or �er own employees, pmvitletl t�al suCh impmvemenl5 are n0i intend¢4 ar oflere0 for Sale. If, how¢v¢r the builEing Or
impmvement is soltl vnt�in one year ol complelion. Ihe owner will have Ihe burAen oi pmving he/she ditl not builtl or imOwve
for Ine pWoose of sale).
I, as owner of the pmDeny, am exclusively coniracting wit� Iicense0 coniractors to constNct ihe pmlect (Section 70d4, Business
❑ antl Pm�essions Code: The Con�raC�Ors' S�ale LiCenSe Law tl0e5 no� apDty �o an owner Of property who budas Or impmves lhere0n
antl who contracts �or such pmlects wi�h a conlractoqs�license pursuanilo �he Contracbrs' State License Law). I am aware
Ihat pwo� o� Iheir WOBer's Compensa�ion insurance shoultl �e pmvitled �o me.
Q I am exempl untler Sec�ian: B. 8 P. C. .
lor Ihis reasan:
Oale'. Owner.
I ao hereby ceriity �ha� I am aware of antl un0ers�ana �he requiremenis oi Califomia Heal�h antl Satery Code Sec�ions 25505. 25533, antl
25534 and Ihal I or any IUWre butlemg occupan� willlwill not (circle one) need ro camply with sai0 atate catles and �he requiremenis lor a
permA lor constmclion or motli�ica�ion �mm �he Nu Ouahty Management �isirici. ResiOen�ial conSVuction applica�ians are exempt �mm
ih¢5¢ p�0V1510�5
Dale: Ap01¢ant:
I �ereby cenilythai I have read �his applica�ion antl slale �hai Ihe above iniarmatmn is correcl. I agree�o comply wi�h all ciry and county
ordinances ana slatelawsrelatinq�o builemg cons�mctio hereby aulhorizerepresenta�ives af�his cityio enter upon�he above-mentioneU
pmperly lo� inspecuon purpases. .
� �/�__ \ ,`m'
. Uaie. «-1 SignaWre: T ` � ""^�
� i's �icense or Sociai Securi�y p: �]
�64La6 Wl�ne—Builtling: Green—Code Enlorcement: Canary—Applicanl: Pink—Revenue; Goldenrotl—Assessor
CITY OF COSTA MESA — HUILDING PERMIT
PERMIT NO: M Oo6489 PLAN CHECK NO: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: MEC
PEP.M NO: M 066489
GC�VT: N SUPP: N
PURPOSE: ALT
JOB DESCRIPTION : REPLACE W/NEW FAU SQ FT:
CLAIM VALUE: CALC—iTALUE: GROUP OCC: H-2 /
Ct�MMENTS: C�NLY MECHANICAL WORK AS L�ESCRIBED AHOVE
*���c****���***ac*r�x�jt-�c****�**�*****�x�**�*ac-**��±�*�t-�**�i�**+�*�**��**�c��+c-*��*��-***�***+�
Z O N I N G R E Q U 2 R E P4 E N T S
S E T H A C K S
----------- MAIN BUILDING ---------- ----- -- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN AEAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT I1J
PARKING REQ: PROV: PARCEL: 91817401 ZNE: REF NO:
PLANNING NOTES>
>
i[� iF iE iE jE iF ic iF iF iE iF iE iE ik iE?E iF iFlf iE 7E iE �)c 9F �lf it �N- tE iE iE 9E �IE jF iE iE 1E it�)f 3E?f iE iF iE �f il� iE if� M ih if 1E iF if �IF �Y+E # iF iE iF iF iE iE if if iE �E iE if iE"iE iE iF iE iF iE iE �)F if
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 T S
ZONING APPROVED BY .
BUILDING APPP.00'ED HY :
APPLICATIGN ISSUEP BY:
if if iE �Y?E 3R #!E 1F jE � iE aE aF jF K?F iE �4 7F j4 if�Fi�Y
9E if dF jE iE �E jF 1F �k-# �IK iF �1( iE aF iE iF 3E 1E ff ?E!E if iFlf if �Y�lF iP iF 1E N- �E -lE'
e
LEGALIZATIOU;N F E E S U M M A R Y
BLUG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 9,OU
UATE:
DATE:
DATE• � �-I��
F��'r iE �Ic-iE jE+E i(- # iE iE-lE�'� 3F7FiEi i'f'iFi4 �IE
iE 3E if fF 9F i61F iF if 3F �? jf 9E 1E #�E i(� jE it dE #-)f if if iE 1f iF
STRUCTURAL SEGMENT;N
FIRE SMIP/RES GRAL�ING
�., 25� SMIP/NON—RES
PLAN
ISSUE FEE �/ ,—� 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 9.00 15.00 0.00 24.00 2�.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 24,00 OVER/SHORT: ,00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRAPING PLAN—CHECY.
-� 2'4 . ��
iF i' i(-iFlE 1E if j(- jE �E k� iE if iE iE-N- iE } if if �1E ib ff #' �14 �c iF iE iE iF iE �lf �IE i: if�iE #E iE 3F iE �lE if iE iR iE iE j( jf �)F 1f ik *�IE if *�lE iE !F �E # iE-k iF 1E �f if * ih �1E fE �7E?F if M iE iF 1E iE iE
I N D I V I D U A L" /`F E E B R E A K D C� W N
TYPE QTY D E S C R I P T I O N-i UNIT COST TOTAL COST
ij
MEC 1 INST FORC—AIR/GRAV''FURN �= 100 K BTU 9.00 9,00
END OF FEES
ai 00157487—�0157487 T O T 24.Q0
OATE: 03/2i194 TINE: 11:1E
CONSTRUCTION AND PLANNING POOt 'PA -,
APPROVALS Permit # � Date inspector APPROVALS Permit # Date inspector
t. Temporary Eleccrical Service or Pole " 52. Pool & Equipment Location ,
2. Soil Pipe-Undrgrnd. • - 53. �Steel Reinforcement .
3. Etectrical Conduit Utility-Undr9md. 54. Forms .
4. Electrical Gonduit�Undrgrnd. 55. Electrical Bonding
5. Steei Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFEfl Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit�Undrgrnd.
8. Foundation � 59. Gas Pipe, � Undrgmd., Test '
9. Water Pipe�Und�grnd. ' ' 60. Backwash �ines, P-Trap. � Undrgrnd.
10. Structural Floor System ' 67. APPROVAL TO DECK _'
11. Property Sewer Line & House Connection ` 62. Backwash & Receptor-Final ��.
12. Sewer Cap ' 63. Heater & Vent-Final �
13. Roof �rains 64.� Plumbing System � Final
14. Rough Plumbing 65. Electrical-Final �
75. Rough Electrical-Condu;t 66. Solar SYstem-Pinal
16. Rough Electric W�ring 67. Fe�cing & Access Approval
17. Rough Wiring 5ign 68. RPPRQVEp FOR PLASTERING
18, Rough Electrical-T Bar Ceiling 69. POdUSPA SYSTEMS FINAL
79. Rou9h Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPRDVALS Permit #
27. Dutts, in Structure . 70. Underground Hydro
22. Ducts, Ventilating 71. Product Pipin9 �Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof framing 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing 74. O�erhead Hydro
26. T�Bar Ceiling (5tructuraq & 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 pEPT. REQUIREMENT s
37. Plaster Brown C'oat 79. FINAL INSPECTION
32. Electrical Power Meter�Finai 80. FOOD CERTIFICATE ISSUED
33. Finai Electric Notes: -Z G`� �,� -C �^ f
34. Final Heating & Air Conditioning I 3 �'-�G-`�'-"�"�_ '- _�.L-
.� �l ' _ "� _ � �7�' �G!LcE-� _:�l � ��.
35. Final Gas Pipe-Test -,
36. Hood or CanopY .
37. Final Factory �irepiace
38. Finai Plumbi�g
39. Water Service-�inal
40. Gas Service-finai �
41. Solar pomestic-Finai
42. Backflow Preventer '
� �.i
43. Backflow irrigation
44. Landscape irripacion Sys[em � �
45. Sound Attenuation
46. Handicap Regulations ��:.-
47. FINAL STRUCTURE & BUILDING r -•
48. FINAL PLANNING ""'�
49. Electric Release to Edison � �' ,
50. Gas Release to Southern California Gas Co �--�
51. CERTIFICATE OF OCCUPANCY ` `
No. Date
. . . . _ ,
' -A -.CITY OF COSTA MESA; �ALIFORNIA ; i� " r , . '
, Co�c � Corsr � . . . � 'Corsc; ''..� , �� _ _. .
.. . , .. .;..,:.; .
; " - � :; . : a��r, ?3, 1962 y . .
'�. .
� , .. : . . } . . A. .
, _ „ . _ .
. -
' N�. Walter Gaynor .. � " . . • . - ' •
. � Jema3ca Construction Cc�y.. ' _ . . . . .
. 3]20 Eermuaa nrive , � -
Costa Mesa, ;CsLiYornia , . - ., �- " � ,
- SUBJE�: : Fo�uidai;ion wa11s eupporting wood" - Sectiqn 2805 (e,). ik�i.farm Building .
" 'Code. - : . .; .
. ,�� . , ,
Dear Mr. Gayisor: � � ` . ".
. . . �' � � . .� .. ..
Tfd.s letter is an instruinent oYirecord to confirm aur telephone conver- '
sation bP Jani�ary 18� .7.9&2 on �tke abave sub,ject. Nh�._ C�c�ynor, sa y�oi► will ±�emember,
aur teleplicne c�versation xev�lved q.ronnd thc'minittnun_sequ3rements of the�height� ;
f stYUCtural`��tood meml�rs a'bove'�PinisJx��ade, that is, Section 2805 (a) of the "
form Bui]�liag Cade states; .3n pert tbtak�-fovmdation �aa11s sugport4ug "Wood sha11 - w
, end at"least eix,;inches sbove the finish,g're.de.adjacent.to the vrall at all "_ �
: ints.. , t . ' � _ .- . � � • .
.. . •- This .oYYice.is Frell ii�mre tl�it; ^in, most. caaes, the new harae cremer, in . -
].andscaping� his yard;' :bringe; the earth np _to the i;bp 'oP �he soleplate Yor his . ';�I
Ylu�rer beda , Ia" doing thie act'.of mwing the ,earth to thYs elevation; he ��
'' D s not reRllze tha�t- his Ploarer beds are appraxim�ately two inches higher than . 1
. s i�inisri Yloor,'particulexly-,for'homes=conatructed on concrete slsb Yle�s: . a •
� The end.result oPten times i:s.that�moisture eutera the wa]1 awd onto floors
- causing demage to .furniehings, ' iret ira118,. Beeli.x� Paiat? and moZd, � all fram �
• re,ins or iiateria� 'oP�tYte plaixL•e-and.la4rnsi :etc.' All above mentioned d�mage' � '
could be :eliTaiaated'if the pz�oper �radisi� oY Ehe eartii to ite, finf.sh level �
. Urid flll OtYt81d2 WR1S:�.YOUridA'CiOriS h&d.b2P.ri pG'Ii0YE12B. either, by �the contractor � ��
_ .f or the armer. . ¢. � - .. . .. .-
. . ; _ ' . ' �. ,
� :.Since our'teleph�ie camrersation as me.ationed,preyious� this ofPice has_ ,
received a letter Yram a Mr:`, Roy A. ; Steclanesser c�hoso hcmie is lxated at 3080.:
Covatiy Club' Drive. . Ii►'hi."s.lebter°to thts.oYficQ, he' states.tlnt his floor :
level an.d the.graund level is in,v3o]st.ion.oY the ffinimum six inch.�adi.ng ..
clsuce as'set Yorth in the Uniform�Bnilding Code.` � •
. , : . . - „ • .
• • ' . ' � Mr. ` Gqynor�,. ae a. busiues�an in'the conatruction field, I- ]mar. that ", ' • ., .
. you�have ivaqy.problems to solve.�'tCnowiag this; S am conPldeat that you will '.
. solve thi.a knotty.problem of.gradin� to the sstiefaction of al7:.concerned.._.
- , ' . ' ' � .. . : EiespECtftilly y0Ur6�
. , . . , . � ` " MICSAEL .HIIVGHAM � :
' ` - ' °Building'OP�iCial � .
" - ,.`. , , ;�
. MB;dh `Y , ". - ' ( . -,
, NUPE:. copies oY this�.letter.�rere.seat to H�. 8o Mre. Willi�ns and�.Ptr. 8Ceci�sser� �
. .., ,- , ��' ... • . � • - ,
% � : : - � ..
� �. CITY �:OF COSTA MESA, ALIFORNIA � ,,�� ' , - ' � . . . .
-. : , : � , _ ' ., , , , . .-. -
, . '� --�-, � ...� . -. ,'., . .
° - • r 'e, ,� P9arch 23, .196?_ ' ' . ` . . ,. '
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:. . - . ` , ; ' � . , .
. .. .Y, � . . . - s �l � . . _ . " •
• � '• • • • . . - • . '. � . � .
.'.: . " y � . ' -' : . -r . . � . - .
- MT. Wi713smD � _ , . • � . � .
306o co,mtry C1ub . nrive_ `:, .i � '
' � OutB.P�sa;''Ct�.7.iPorniB , ' . , `
.� .�4� � I ' . .
. . � � . . . _ . . ` I ' . Y a • .
- SUST�.�' CT: t�rch 23, �_'19� =_ 10.15. At�9 to l0:45 �AM -= re-issepection 'oP. propertY ia ..
Tract 3363, � u9, locAted_at'3060 Country'Club Drive iri'tho City oY -" ,_
. ' ' Coats N�sa� CounLY.uY O;an�ei. 3tste of Catifornia . . ".
Dear Nh'. Wi7.7.iem8: J , . � . ' ' . ,
During our telePhane cottversatioxi yesterdaY aPternoon, March 22, 19�,' ,'..
z+equested a re-inspection of y�our ha�e and a letter to you oY �qy�fiadings.,
' ' . . �, I .h , - . � h' " '
��Y� �Y,m.member�. I made �`my�;Yirst inspection of y�our� ha�e aPter yrou .
,� 'a,dded two caa►crete. slab pours to your home, and it ha8 rsi�d pr3:or to my }
'�'inspection: ThSa inapectiam wa�t �ede i.n_tho,]fitte'r parL of Janvary, prior to
_.. . rece4ving a copy of o letter sent:to Ne3lter 6aynor, d�ted Januaxy.23, 1g62. ``. _;
� t tha�time of udi firat.:inepeotion, I Yourid�water backed up to,the,west.w311
oundstiam. .Thie occurred iri the floster ead shrub beds nesr'your Pront eatry. ;. -
. . . . .:. 4'... .. ' . . . - ' , . ' , � . ' . .
� . ; . �� �..�aiuiams Bn�erea �y=�q;�st:tnat° i:be aiio�rea. to �sse�t tr,�
. �. lx+operty by skaving me tho .interior':oY' the ho�e.. ".�I fotmd"no trace at this ti.me
. oP where:water. hud eutered the ticm�e,, Irfound nothin� ia.tk�e vay oP 8am�ed Pur-
• shings caused�b3*�+ater or moisture enterin� the hamie. '.Nor did.I find struc- :
ural demage to the luterior:" , . .- ..
� Ydrs. • t,lilliaws ehaaed me to; the. outel8e �ere I' foimd water backed t� .
. to t,hcc� eicterior watl Poundstione at �'these`, loeattons: `.. �
. , , �. , .
` � ,1. Along�the soutki.iaall at the corner where.a nex conerete- ...
, •� � slnb had'heen.poured uader' a slider window off of the 'be8room. �� -
- �� 2: • Along the south i�]�.,'beginaia8 at a poirtL raheie tlie uetr� �. � . .
concrete slab.encied� aad.extending alon8 the south ea11 goiag _ . ..
• ' east.to the.coxner; and:�extending eround tIle east xall for.ap- ..
1 . • , gsroaimately three �3) Peet. � . _ , ' . �
� 3. .. A�praximnte];y � ss'x (6 )�. Feet; of , the e�st • w�,l]. ,tv�x�l thQ `♦ . r :
� north corner of the . east t�aL].; watei Fr�sa �backed �p to the �
, .. .. ` wal.l'in sort �of. a pool, agpToximeteljr five (5) feet out, �.,
�. : Y1'at► the eaet. wall.` . . � . . • '
- :. . , • ' ,. .. _. _ ;...
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. - : -' .
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' ' ... . � _ a , ' * 4: . . ' . ' ' .,
' . '�� � ' . 5.�. : -'�. ' . �. , '. ' .. ' . . , +.,
���CITY OF COSTA MESA, .,ALIFORNIA :-,¢ � • • . -. , . :. . .
Mr. .F71l1ians, � . . ., . .
. t�rirch' 23, . l� . . , . . . . ,
• � ,. .. '' • ' ,
-. � 4. Weet alamg the north �a).1 fi�acn the eact corner'.to s
<. ,�point eac3ing et the= concrete s]ab. . �� ' , � . . . - .
- - . � �
M�'�h �3� .19� . ^ ., : . , � � - ,
'' Nh�. `Williems, _ toc'l�y, se requested, Z vreat to y�our h�" to re-in§pect . .
the exterior finieYied earth grade in relation-toyouur Plnish Ploor elevation. �. ;•
. _ Yiudixlge todey.weTe the seme`ae,on:my.first"inspection except•for�one Ytem� ' ;'
no.woter. standing: :Finieh� Yl.�r elevation the sa�� aiot eix (6) 'inchea above �
finiehed earEh•�ade. No ialter9.or dait�ge to fluaishings aad no 1irteMor"daw�e ._ ' -
to structure: - - " ' � : ` ;
� •! Section 2805 (a) oP the ,1955 Eclit9.on of tho t1n9.Yorm Bui�a� Code, states ` ,
1n P�s beginning�-with the second seatence of the sec�d pez`agta,B�a `�Fbundation '
erallo s,�{pportsus•c�rooa shau�eictena at lesst ssx.:(6) iacbee.abo�re the s'�.nsehed� . ,_
�acle ed,jBCent to the �•t811 at' sl). "poiuts": ' . . � : '
� If thie oPPice cAa be oP,any mseietance, glease adyise: :. ,. .
+.D. ; , : . . _ . Very trt�y.youre, � - -
� '' - . -. .
_ ,, : � . .. .
� ' •` . .. ' .
, � . . • IDffCHAEL=BIIJGHAM - _ .
. . ':. Building OPPiciel _
, . . . , . . . ". • . . . .Y . ' .
' �J`�`�. . . . . ' .. � � . \i , ' ' ' ' + .
, ' . . _ " . . _ . . . , r.. � h'. � . � .. .
' • "cc: Donald D�a�gan, �City Attox�ey ' • . . . .
,
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'COST/( MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C08'�A MEBA. CALIFORNIA
For Applieanf fo Fill In Complefely
- TYPE OR PRINT �
ADDRHSS 3072 Couritry Club Drive
COSTA MESA. CALIFORNIA
OWNER Jamaica Cpnstruction�Co.
'""" 3120 Bermuda Drive
ADDRE85 7
CITY COSYiF� IVTBSa. N0�7/O/
Corona Del
CONTRACTO� � '� � � � ,
ADDRESS 3120 Bermuda Drive
�,T., Costa b4esa
�ic No.180186 �/No: KI 5-9767
81ZE � hf _ (i_ I NO. OR BLDG0.T
OeE �F None
EXISTING BLDG
� 86'fBACI( LINe FROM �n �
■ BUILDING
� I LEFT Z( t I RIGHT �'
DESCRIPTION OF WORK
BE
0
� J ��
W
1 HEREBY ACNNOWLEDOC THAT 1 XAVE READ THIB APPLIGTION
AND BTATE THAT TH6 ABOV¢ I6 CORRECT AND AaPEe TO COM-
PLV WITX ALL CITY OPOINANCEB AND BTAT¢ L�We R¢GULATING
BUILDING TPUCTION. •
�� ` /
SIGNATURE OF�fAw. � il //� �_ �w w
■ AUTHORIZED AGENT
��E ���;���E�
-`�--� 4-�n_���
�IIV�Ne� Q�P�.
CITY Q� RAST� M�SA
APPLICATION FOR PERMIT
BUILDIPIG
For Office Use Only
FECEIPT NO. I /[{iMlj NO./
� b�VS��
RECEIV6� BV OATE REC6IVED DATE 196UE�
�2�--�1 �i�— i� 6� I APR 2 4 sacn
BUILDING
COSTA MESA, GALIFORNIA
FIRE
ZONING
NO.OF {� IISE OF NEW i
PLr�NS J— BO�LDWG / , l` _.
L¢GAL
YARDS
APPROVED
(CHNTEN LINE 6TJ
APPROVED
EVES
THE AMOUNT 6HOWN IINOER VALf1ATION 18 FON THE
PUIiP08E OF EBTqBLIBXING N PERMIT FEE ONLY.
VALUATION //.� �p
� ' PERMIT FEE $ yb(�
$ �p( �O� PLAN CHECK S ��• �O
/
TOTAL FEE $ G 3. �