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Home My WebLink About2928 ANDROS ST - Building Permits(714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa. BUILDING PERMIT » FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2928 ANDROS ST Suite: Vicinity: Primary Occ: Parcel Number: Applicant: Address: ;.� Fian ROOF R3 Dwellingsi Cong Res <70 13928402 STEVEN SCHNIERER 229 E COMMONWEALTH AV FULLERTON,CA Owner: RENKA, Address 2928 ANp OFF Type of Constructian: V-N �Zoning: R1 �. r R "� . `� 4* � h � , � Ph ,,� � � .. ;"._,,.x�... ,,,. INC M Phone ��'�..�. . «-, . � . Phone: Status: ISSUED Applied: 07/25/2005 Issued: 07/25/2005 ISSUED BY: � �, � �-• x��`• >��a. � � } � �xz � s � ;, x A" r�. �,., 92626�' �� . ;.� ' �;" � x, � �4" , ..w� � �g,:. �a aa, , ,� � `> ��;� (714)7313425 ,t� ' nse: 729560 ' Eng: � �Address: �, ;.� �...avvrcv�,-r�ninr.r, .. I LAYER OF 30# FELT; A�NpD 30 YE F� N ; w v (' FEE SUMMARY .=,` � ��' 1z�.. � .��F �� "'^K' yn .��,.. q. .::.,y 9 _ ,. � � � � PLANNING & ZONING � - .�"� = �� SETBACKS �.a"' � . �;>z�_ � ,k�� »�+��"� q "`'�� MAIN STRUCTURE Front �• 0-D:; ,� ,�Rear 0-0'�.. ,,� Left'� � d�0 "'� �. a;Y � ;<.. x::�;��:. ACCESSORY Front 0-Oc:i,� s Rear ;0�0 '�� z;:� Lefl `� 0=0� -- ��' c:, a;: ; , . c ire ; �� .,w � �y,, .., '' PARKING Ewstin : 0�� <Re wred. 0� -" -- Proposed�� 0 ...xr«�' ,�.<... � .c� ,� ..5„s��,; ,r� ��x ' .. Right � 0 ; ..... ��;:. � � `u a'' �: `� „�- � s €$- � �y , �y5: �.,� .,�� ' NOTICE: The work authorizetl by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire a�d become void if work is not commenced within 180 days, or N work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspectlons and flnel epproval musl be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (77A) 754-5826 zaansa �e�w7 WORKERS'COMPENSAnON DECLARAnON: I hereby attirtn under penalty of perjury one of the following tlecleretions: . � � ❑ I have antl will maintein e certificate of consent to self-Insure for workers' compensation, es provitled for by sedion 3700 of ihe Lebor Code, for the pertortnence of the �,-woAc for WhiCh Ihis pertnit is issuetl. .. '��:+4he� antl will maintain workers' compensation insurance, es reqWred by section 3700 of Me Lebor Code„for the pedormance of the work for which thls pertnit Is Issued. _My,workers' compensallon Insurence carrie� end policy numbar are: � �arne�•.��sC�,t� �nd — �;�,� �:=��b359fo1- zooS �(ih s section need not 6e completed il Me permit Is velued at one hundred dallers ($f00) or Iess.J ❑ I cerlity ihet in the performance of ihe work for which ihls pertnit is issueQ I shall not employ eny person in any mennar so as to become subject to ihe workers' compensation laws of Celifomie, and agree �hat if I should become subject to the workers' compensation provislons of Sectlon 3700 of the Labor Code, I shall forthWith comply with these py sio I Applicerrt'SI§natuie� �� ::+Daie:,; - 3 7jZSf O_�'i' WARN ' tlRB'TfiSECURE WO ERS' COMPEN�TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMP�D ER TO CRIMI�NALrPENALTIES AN� CIVI� FlNES UP TOIXJE HUNDRED USAND OOLLARE ($100,000). IN ADDITIIXJ TO THE C0.9T OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIpry 37pg OF THE LABOR CADE, INfEREST, AN� ATTOFNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm,that,l em.licensed,under provisions ot Chepter 9(commencing with Section 7000} of Oivision 3 Cotle, and my license Is in full CONSTRUCTION LENDING AGENCY: - ❑ I hereby aHirm that tliere is a consiruction I�ndfng agency for the peKormance of the work lor which Mis permit is issued. (Sec. 3097, Civil Code). Lendefs Name: I Lentler's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penelry of perjury thet I em EXEMPT FHOM THE CONiRAC70R5 LfCENSE LAW lor Me follawing reason (Sec. 7037.5, Business and Professions Code: Any ciry or counry which requires a permit to construct, elter, improve, demolish, or repair any strudure, pnor to its issuance, also requires Ihe epplicant for such permit to file a signed stetement that he or she is licensad pursuant to ihe provislons of the Contractors License Lew (Chapter 9(commencing with Secllon 7000) of Dlvlsion 3 of the Businass and Professions'Code) or thet he or she is ezempt therefrom end the basis for the ellegetl ezemption. Any violatlon of Sealon 7031.5 by any epplicent for e permit subjecis ihe eppllcent to a civil penelty of not more than five hundred dollers ($500).): i ❑ I, as owner of the property, or my employees wlth weges es iheir sole compensatlon, WILL DO TFiE WORK, and ihe siructura Is not intended or oHered tor sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not epply to an owner of property who builds or improves thereon, and who does such work himself or herself or through hfs or her own emptoyees, provided that such improvements are not intentled or offered for sele. If, howevar, the buildirig or improvemettt is sold within one year of completion, the owner-builder will heve the burden of proving that he or she did not builtl or improve for purpose ot sale.). � i ❑ I, as owner of the property, am E%CLUSIVff�Y CONTRACTING WITH LICENSED CONTRACTOBS to construct ihe project (Sec. 7044, Business and Professions Code: The conirectors License Lew does nd� apply to an ownar of property who bullds or Improves thereon, end who coniracis tor such projact with a contractor(s) license pursuant to ihe Contradors License Laws.). i ❑ I am exempt under sec. Business and Professions Code tor this reason: Signature: � ' Date: Owner ID verlfled by drivers license. ❑ Yes ❑ No Drivers Licanse No. Expires: Vedfication of Ownership by (rype of tlocument, i e. - property tax bill or deed): ' DIVISION OF INDUSTRIAL SAFETY PERMIT CEATIFICATION: ❑ I hereby ceMty that no ezcavetron tive (5) or more fest in deptb into whkh a person is required to descend, will be made In connection with work authodzed by this permit, and ihat no tiuilding stmcture, scallolding, falsework, or demolition or dismantling ihereof, will 6e more than thirry-six (36) feet high. (Chap. 32, Gry 2; Art 2, Sec. 341, Titla B, Celifomia AdmfNstrative Code)� ❑ As owner-builder, 1 will not employ anyone to do work which would require a permit trom the Division of Industrial Safery, es noted ebove, unless such person has a permit to tlo such work irom Ihe division. SignaWre: Division ot Industrial Satery Permit Number. Dare: 1 Will the epplicant or present or future bulltlin9 occupant neeC to file end certity e Business Plen for emergency response to releese or ihreatenetl release of e hazerdous meterial? ❑ Yes ❑ No (Section 25505 ot the California Heallh antl Sa(ety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mese Fire Department by every business which has at any one time during a reported year a quantity of hezerdous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed ges at standard temperature and pressure). .....�buildin....occu...ant.^...........o tile e re istr ...... .......r...... ... ........................................, ............... .......... . .. PP I . ...p . .. . ... . .............. ................................................................... ........... ......... .......... 2 Dces or will the a licant or resent or future g p Bed t g ation form to ecutely hezardous materiels7 ❑ Yes ❑ No (Sectlon 25533 of Ihe Californle Health end 5efery Cotle, with some exceptlons, requires registration with ihe Costa Mese Flre Department by each buslness which et eny one time has on hand e quantiry of acutely hezerdous metenals equel to or greater than e weight ot 500 pountls, or e volume of 55 gellons, or 200 cubic feet of comDressed aas at stenderd tamDerature and pressure). 4 of WIII Ihe appllCeni of V ,es u rvo i (Section 25534 of the Califomia�Healih and Depertment of an RMPP by businesses whk uoes or win me epplicant or present or rumr� omiair from the South Coest Air Oualiry Manegeme�t 0isiri� (Section 658502 of ihe Califomla Govemmen� Code ................................................................................................. . ............... . W ill any part of tha facility to be constructed Under th occupant neetl to prepare an RMPP (Rlsk Manegement and Pravention Progrem for eCutely hazardous meteriels)7 �de provides that the Caste Masa Fire Department may requlre the preparetion', certification end filing with the Fire uired to reglster eately hazerdous matetlels with �he Fire Department. int requlra For ihe work which is the suh�ect of eny other eir pollution control dlslHCM or egenq thet the iepuested intortnation be furnished on e �a plication a pBrtfili 10! SUCh COnSINCtIOn Of Yes u No �or non-residentiel building permits). (tl "yes', the facility must meet the requireme�t of Sections 25534 antl 423W of [he California Health entl Safety Code). ........................................................:.............................................................................................................................................................................................................................................................................................................................. 7 If e parmit from the South Coest Air �uelity Manegemant District or other elr pollutian control disinct or egency is required for Ihe work which is the sub�ect of thls application, have all of ihe tlisclosures prescnbetl by Cal'rfornia Health and Sefery Code Sectlon 42303 6een made? ❑ Ves ❑ No ....................................................._�.._......................._..................,..........................,......................................................................................................................................................................................................................:........................., 8 (If'yes", etlach certificata of compliance from ihe appropr�ate air pollution control ofticer). CERTIFICATE OF COMPLIANCE: I cerlify tdat under penelry W perjury the iniormalion given above�is corred. I agree to comply wi[h all state laws end ciry ortlinances regarding Hazartlous Materials and Emissions. i SignaWre: I Date: CEH71FtCATE OF COMPLIANCE AND AUTHORIXATION OF EMRY: I cedity urtder penalry o� perjury that I heve read this epplication a�d state that the infortnation given is correct. I egree [o comply, with ell s[ate laws end ciry ortlinances ralating to building cnnstruction, entl euthorize representatives of tha Ciry of Coste Mese to enter upon the ebove-described property ior inspection puryoses. I agree not to occupy or allow acupancy of eny building euthorized by ihis permit umil finel inspection. COpE t• INSPECTIONTVPE � 1676 Fixetl Syslem Final Fire Pravention 1266 Pool Spa Final I 200 Finel Re-Foof ' I 201 Final BIocWRetaining Wall i 202 Final Fadory Fire Place 203 Final Sign i 204 Finel.Demalition'� . . IZ5i3 M�il�t�� *�' � � , Date COOEt INSPECTIONTYPE 206 Finel Mec�anical � 208 Final Plumbing 210 FinelElectncal 212 Finel Fire Prevention 220 Final Plenning Approval . 222 Final Site 250 Final Building/OccupenCy QdjE INTRIpL3 Applicant to fill in all spaees exeept those wit�in heavy bortlerlines•anO�ign all appropriate tleelaraiions. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address .� 9.� g /�nc�,Qa4 Applicant's Mailing Address ; c+e/� �Qpc Owner's Name —�'e� • � • Phone7 �v+=-,•_�� Addreu Arch/Eng. License No. Address Contracmr'sNam�Q � '� � Phone�9�90ti5 Address�mailing) G mC�nK.¢N �/� fi .rWin� in S�.Pi/�/ Ciry License No. 'i 0�f 3 5 LICENSED CONTRACTOR DECLARATION I hereby atfirm that I am Ilcensetl untler provisions of Charter 9(commencing with section �000) of Division 3 of the Busineu anA Professions Cotle, antl my Iicense is in tull force antl e�tect. License Class — e se N Date �—" � 5 9 t � 'vORKEftS' COMPENSATION DECLARATION i¢reby affi�m t�at I have a certificdte of consent to self-insu/e or.a ce�tificate i Workers' Compensation Insurance, or a certifietl wpy thereof (Sectlon 3800, Lab. CJ . . Policy No. ' Company BCertifietl copy is hereby turnishetl. Certifietl copy is filetl with the city Builtling Division. , Oate Applicant EXEMPTION F0.0M WORKERS' COMPENSATION DECLARATION (This section neetl not be completetl if the permit is for one huntlretl ($300) or � less)- I certlfy'that in the performance of the work for which this perm�t is is shall not employ any person in any manner so as to b me subje e� Worker C- ens Laws of Califo � �/ � Date ��Signature kL NOTICE: If,�a ter mdking thi5 tle[la�ation, you shoultl become Subject to the- Workers' Compensation provisions Of.the Labor Cotle, you musf forthwith comply with snch provisions or this permlt shall be tleemed revokeA. CONSTRUCTION LENDING AGENCV ' I hereby afffrm tha[ ih¢re is a tonstruction lentling agency for the p¢rformdnc¢ ' of the 'wark for which� this permit is issuetl (Section 3097 Civ. C.) �entler's Name txntler's Atltlress � OWNER BUILDEH DECLARATION • I hereby affirm that I am exempt from the Coniractor'S Llcense L.aw for the foilowing reason (Section� 7031.5 Business antl Professional Cotle: Any city or county which requires a permit to construct, alter, improve; tlemollsn.or repair any structure, prior to its• issuance„also requlres the applicant for such permit to file a signetl statement that he/she is licensetl pursuant to the provisions of 'he Contractor's License Law (Cbapter 9(commencing'with Section 7000) of ivision 3 of the Business antl Professions Cotle) or that he/she is exempt arefrom antl the basis for the allegetl exemption.�Any violation of Section ,031.5 by any applicant for a permit subjects the applicant to a civil � �enalty of not more than five huntlretl tlollars ($500). ' �, . LJ I, as owner of the property or my employees with wages as their sole compensation, will tlo the work, antl the structure is not intentletl or offeretl ucense �aw aoes no2 appiy [o�an owner or a property wno owias or improves ihereon,' antl who tloes such work himself/herseli or through his or ner own employees, provitleC that such improvements are.not intentletl or offeretl tor sale. If, however, the builtling dr improvement is soltl within one year of com- pletion, the owner will have the burtlen of proving he/she tlitl not builtl or im- �rove for the purpose of sale). . � . , LJ I, as owner of the property, am exclusively contratting with IicenseC con- traciorstd construct the project (Section 7044, Business antl Professions Cotle: The Contractor•s-License Caw"does not apply t0 an owner ot property who builas or improves thereon, antl who contracts tor such piojects with a con- tractor(5) IicenSe�Dursuant to the Contractor•s License Lawl. ❑ I.am exempt untler Section B. & P. C. for [his reason � TYPE OF CONSTRUCTION LJ NEW LI ADD LJ ALTERATION I—I REPAIR _ ❑ CONVERSION ❑ OEMOLISH ❑ OTHER .DESCRIPTION OF WORK � TYPEOFPERMIT LIGRADING�FOUNDATION LISTRVCTURAL ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL ❑ OTHER � PROJECT DESCRIPTION Sci. FT, oCCUaANCY— CONSTRUCTION TYPE VALUATION $ ZONE GRADING CV. VDS. ACRES— Remark5: Showers Preventer • Service Sink :e: .- Irrigation Sewer Cap Sewer Connection Drinking Fountains Floor Drains Floor Sinks Gas Service � Outlets Interceptors' Kitchen Sink Cavatories P—Trap Roof Drains, � , Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Wate� Heater �,�, A.P. # S Main Bi E T Front B Rear A C Right K g Left Ping. Ref. # FEES Planning Notes: - Reinspection F.ee , $25 � � � Isue Fee � $ 3 �- Boiler i Duct - Under Graund � Duct-Structurel � Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Date � Owner � � Heatin9.System & Ducting I hereby certity tha4 I have reatl thls applicatlon.antl state that �tFie above ❑4100,OOO�BTU �100,000 informatlon is correct. I agree to comply wit I city antl county ortlinances antl'state laws relating to builAin9 cons[ru o, antl hereby authorize repre- . sentatives ot this cify fo enter up n e ove-mentlonetl property for ' Inspection pur �e es Signature . _ Date l -R�✓ Drivers' Lfcense or 55 � � Reinspection Fae CMFO865-46 rev.12/83 �White-Builtltng;Cznary-Applicant;Pink-Accounting;Goltlenrotl-Assessor Hood or Typel ❑ CanOpy Typell ❑ � Refrigeration System ❑4100,OOOBTU ❑100, ❑ System Repair/Alteration $25 I I Issue Fee $ 3 Automatic Washe Construction PoL Cooking Unit Dishwasher Dryers ❑Gas C Fan ' F.A.U. Fixtures Device Boxes OUtlets Switches ' , Garbage Disposal Generator �0.5 Sub. � IZone Accessory Building: Park.Fees $ ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW ❑5-15 KW , 'Reinspection Fee � $ � PUBLIC SERVICES RE�UIREMEN7S: I Zoning Approved By Building Approved By � Aoolimtion Issued Bv Meter LJup to t00amps Meter ❑over 100 amps Sub Panel Motors � 0-7 HP � 1%- 8 Inc. Solar 09-15 HP 016� Microwave Pole Light Range Sign Standing Sections Trash Compactor , laue Fee 0 $ 3! SUMMARV OF FEES � ! BUILDING PERMIT $ . SMIP � , $ ' PLAN CHECK $ PERMIT � PLUMBING �$ ��— ��UANCE '$ PLAN CHECK 25% $ ENERGV P.C. �$ � ELECTRICAL $ � GRADING $ PLAN CHECK 50% $ � MICROFILM �$ MECHANICAL - $ TOTAL FEE $ �', 00 PLAN CHECK 25% $ . � � _ , _ Z O N 1 N G R E U U � R E E i f TL �CONSTRUCTION AND PLANNING , . � � POO, ;PA _. - _ ,, . , � : � � Date I nspector - "�� ° ' �Date ' � Inspectoi ' -APPROVALS Permit# � APPROVALS� � Permit#� - , � v � 1. Temporary ElectriC81 Service or Pole � � - 52: Pool & Equipment Location � _ - � , - . � ;t : , .� 2. Soil Pipe-Undrgmtl. �- � - : ��53:.' Steel Reinforcement' - . .- _ �: ` . - ' �: 3. Electrical Conduit Utility-Undrgrnd. ` . � . 54. Forms � � , , ��' - ' • r+ �� ' 4. Electrical Conduit�Undrgrnd. . � - ' S` `55:� Elecirical Bonding; ' � ' , - _ � � � . , c 5. Steel Reinforcement , - - 56. Rough Plumbing'& Pressure Test � � ' , : � � .� �' , 6: Electrical UFER Gmd. ;, 57: APPROVALTO COVER-GUNITE. .' ; i 7. Footings . � �' 58. ElectricafConduit-Undrgrnd. �� ` ,:�'" 8. Foundation ' � � 59. Gas Pipe,.O,Undrgrnd., Test '� � 9. Water Pipe-Undrgrnd. - . 60. Backwash Lines, P-Trap, 0�Undrgrnd.:� ` � '•"" ' 10. Structural Floor System �' ' 61. APRROVAL T0. 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 � � � � • � - ' � ' . i 15. Rough Electrical-Conduit � � - - ' � ' i66.� Solar Sysfem-Final� � � ; - � - � ` - ; - � 16. Rough Electric Wiring .. ' 67. � Fencing & Access Approval � � . - `- � - " '""- _ � 17. Rough Wiring Sign 65., APPROVED F.OR PLASTERING `�- � 18. Rough Electrical-T,Bar Ceil.ing 69. POOL/SPA SYSTEMS FINAL � i 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT,- � 20. Rough Factory Fireplace , � � ApPROVALS , Permit #� � � 21. Ducts, in Structure � � 70. Underground Hydro � � � : _ � ` � � � 22. Oucts, Ventilating � �7L� Product Piping QGas'�`.00�iI � � j. � � , 23. Gas Pipe-Rough & Test � . � � i 72.' Undeiground Flush. : � � 24. Roof Framing , •� 73.� Undergrnd. Storage Tank �.� Gas � � Oil -; ' � 25. Roof Sheathing • � " . _ 74.' Overhead�HVdro . ' � ' � � Q6. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � � � ,' ' I' t . �5 _27. Frame and Flashing , �, ' 76.� Dry Standpipe ' � '- � � ' ' � . i � � r 28. Lathing & Siding �77.; F�IXED SYSTEM FINAL �' � � � ' � i , . 29. Insulation - �78. FIRE PREV. FINAL ' � � ! � � 30. Drywall Nailing i HEALTH DEPT. REQUIREMENT , � 31. Plaster Brown Coat 79., FINAL INSPECTION . I � I 32. Electrical Power Meter-Final � 80.' FOOD CERTIFICATE ISSUED . j �' � - -- 33. Final Electric . � Notes:��r��.!�� - 34. Final Heating & Air Conditioning ' ' � � � , ` , , - - . . , . _ .. .. 35. Final Gas Pipe-Test . �_ � � . ' . - ., . . , 36. Hood or Canopy - ' ' -� • - - - ' - �' - ' � , 37. Final Factory Fireplace . _ . ' . � , - ' ., 38. Final Plumbing . . � ' �5' L�I7 , � � � � � � ' �, - . � _ � 39. Water Service-Final � ' . � � � �� .. � • 40. Gas Service-Final . - � � ' r , � � -` ` " � ' 41 . Solar pomestio-Final - - - - � - ' � � � d � � ' � , � , , 42. Backflow Preventer . ' � ' _ _ _ . i . � � . -� , , t 43. Backflow Irrigation � - - , - � - , ' • ' � , i . 44. Landscape Irrigation System ' , 45. Sound Attenuatiqn � � ' - ' � ��.� ' � , � . � � 46. Handicap Regulations : � . � . . ' ' . - ' . . � �� 47. FINALSTRUCTURE&BUIL'DING . - � � . � � ., . �� - 48. Special Requirements Completed' ' ; � � � ' � ' � � ' � � ' ' �" 49. Electric Rele9se tq Edison , - . � � , t� , � � � 50. Gas Release to So�thern California Gas Co � ' i � � • �` � , �� , � � lo � ' ` i 51. CERTIFICATE OF OCCUPANCY , - � , --- - - � ?--' ' I � . � • . � , , No. - - Date ' . . . : . . � _ . _ �__ � . � . . ._ . .-, ... . . - .. .. . ��, �=�E �� ay �� COSTA MESA BUILDINGSAFETY DEPARTMENT ��i J/ � 7� �/ P.O. BOX 317 COSTA ME5A• CALIFORNIA FIfVA�CE DEPT, crrv or cosro-� r�Esra fOR APPC/CANT TO F/[[ /N COMPCETE[Y APPLICATION FOR PERMIT TYPE OR PRINT BUILDING 3UILDING �p8 Andros St• 4DDRE55 COSTA MESA, CALIFORNIA fOR OFFICf f/SE ONIY flECEIPT NO. I ITj /i� �WNER r:�,Qmj H -i- MAIL B�X 6J NECEIVE� I OAT PEC IVED I�O,P('E�51959 ADDRE55 V G �ITY��'b08 Island,Calii'. TNoor3-4220 BUILDING AODRESS 4RCHiieci ' ��c. COSTA MESA, CALIFORNIA JR ENGINEER NO. FIRE . � •T'_, T IEGAL i3dCC0 ( OX C7 1 .OT 1'], !O. � 7aoo STATE IC. NO. ZONING NO. OF/� I U6E OF NEW PLANSf /U 9UILDING NO.OF BLOGS. 0 ' yARDS NOW ON LOT REqUIRED (CENTER LINE 8T.) SETBwCK LINE FfVOM �ENTER OF 6TREEf REAR YARD SI�E VARD ILEFT � RIGHT � DESCRIPTION OF WORK I II MC i64i/W�6 9 STOR i� shing] ;PERFORMED 1 ��yp d 1 HEREBT FCKNOWLE�GE THAT I HAVE READ TH19 FPPLICATION /�NO 6TATE THAT THE ABOVE I6 CORPEGT PNO AGNEE TO COM- PLY WITH ALL CITY ORDINhNCE6 AND 91ATE LAW9 REGULATING Bl11LUING CONSTftUCTION. SIGNATU °Piv�I�E HOMES, INC. PERMI' � � � THE AMOUNT SHOWN IINOER VALUATION IS FOR THE Pl1APO8E OF E9TABL15H1NG A PERMIT FEE ONLY. VALUATION � PERMIT FEE $� $/I �/Q � PLAN CHECK $ �� 'L � TOTAL FEE $ �'/