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COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 3f7 C09'�A MEBA. CALIFORNIA
For Applicant to Fill In Complefely
� TYPE OR PRINT
BUILDING 7OD S
ADDRESS \J
COSTA MESA. CALIFORNIA
■ STATE
�555 PLACENTIA �1VENUE
�555 PLACENTIA ,QVENUE
TEL.
No. Mi 6-_�2z�
INO. OP BLDGB.
OF LOi V 1 � X 1 OO. �� � NOW ON LO'
U8E OF NONE
EXISTING BLDG.
aere�cec ur�e raom 1
CENTER OP STReET � REAR YARD I
61OE YARD I LEFT p� p�� I RIGHT O��
DESCRIPTION OF WORK
OF
EXTERIOR w/LL.TUCCO
GOVERING J
USE OF BUILDING AND
GARAGE.
SHINGLE
BUILDING
ft Kt(;EIVEU
SEP 27 t.,61
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
RECe1Pi NO. PERMIT NO.
BY
COSTA MESA, CALIFORNIA
ZONING
ZON6 NO.OF U9H OF N6W
R-�I PLAN9 Z BUILDIN� y,
LEOAL � 0 � � 'J-�!J
DEBCRIPTION � ��
2 �� fCCNT6R LINE 8TJ
FRONT �
r�
6
Z
9/2�
I HEREBV ACNNOWL8D0B THAT 1 HAVE RlAD TH18 APPLICATION 7HE AMOUNT 6HOWN UNDEP VALUATION 16 FOR TH!
AND BTATE THAT THE ABOVE IH COPRECT ANO ApREH TO COM- pUftPOBE OF EBTABLIBXING A PERMIT FEE ONLY.
PLY WITX ALL CITY OHOINANCEB AND eTATE {.AW9 RBGUTATING
amtolr+c coHernurnox. VAWATION r
SIGNATURE OF PERMI7 FEE $ �✓�
PERMITTE �/�� 7A, /'%
��v PLAN CHECK $ /� �O
� AUTNOR�ZED AGENT _ ��7 ,� �
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
ForApplicant to Fillin Completely APPLICATION FOR BUILDING PERMIT
RE IV BV ATER CEIV D DATEISSUED
BUILDING � _ ��- � �'� � � /' �Ji/��
AODRE55 �Y ���7
I PERMj�
OWNER I/L ✓� � i, A.P. NO. -� ` �
MAIL r BUILDING �O � ^, � �
ADDRESS �� ADDRESS u
Z ya a z LOT BLOCK
W W TEL. � TRACT
4 U CITV s NO. S y/V^
Z Q CONSfRUCiION W AD
O N LENDER
am
J � BRANCH
J � OWNEfl � � �.
m J ADDRESS VALUE
m ARCHITECT TEL. S ' S
'� N OR ENGINEER N .
V Q FIRE •
w� ADDRESS ZONE TVPE GROUPJ
d w APPROVED
w Z CONTRACTOF � BV DATE � �
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m Z
J � ADDRESS
w w TEL. ZaNE / NO.OF USE OF NEW
�= CITV NO. I P�� � BUILOING
ZH
W O STA7E CITY VARDS APPROVED VARDS APPROVED
y� LI0.NO. LIC.NO, MAINBUILDING ACCESSOpVBUILDING
�� SIZE NO.OG BLDGS. (FFOM C/L STREET)
OF l0T NOW ON LOT FRONT FT.
USE OF
EXISTING BLDG. FT
F SIZE OF NO. OF
Z NEWBLDG. ROOMS STORIES L.SIDE FT.
Q EME:�IOR WALL ROOF
V COVERING COVEftING REAR T. FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISfANCE BET. BET. MAIN &
a MAIN BLDf'�S. ACCESS. BLOGS.
a
Q % � VAR..$ �ATE
O � / C.U.P.�I`- AGPROVED
r ' APPROVED
y �� «. -n� -7
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UI hereby acknowledge ihat I have raatl this application antl stare STA7E
� that ihe above information is correct and ag�ae to comply wlih /�
� all lews reguletinB Ouilding consttuction, antl I shell not employ � y
r any person in violatton ot the workman's compansatlon laws ot
the State of Calitornia. �
zI hereby certity that I am proparly Iicensetl es a contrector untler SQ. FT. T� O
the State ot Celifornia Business and Professions Code, Di�isicn 3, THE AMOUNT SHOWN UNDER VALVATION IS FOiI �
Chapter 9, and that such licenses ere in full f rce antl efiect, or I THE PURPOSE OF ESTABLISNING A PEFMIT FEE ONLV: ¢
am exempt t�om the provisions of the S te t Callfornia Busin¢ss VALUATION
entl Professio de, Divis aP r- . 0 G'" �/� W
r B PERMIT FEE $ ��Z/ j
Signatur of ' I / -_ m
Permi a � $ / DD P�.4N CHECK $ E
/ r LL
Authorized/ gent TOTAL FEE $ iL���
UWNtK HA1VK15UN� J � U'
JOB ADDRESS 3005 Babb St.
GENERAL CONTRACTOR O`mer-Bldr. DE:
P i i-133- 7 LOT, TRACT FIR
❑ .:TIONS Si nature Dme 1
SOIL
GAS
WATER
ROUGH PLUMB�NG
PROP. $WR. LINE r] HOUSE CON. �
SPRINKLING $YSTEM
MISCELLANEOUS
ROUGH HEATING ANO AIR CONDITIONING
UNDERGROUND
FOUGH WIRING
TRENCHES �
FLOOR SYSTEM
BOND BEAM �
SHEATHING
POWER
FORMS U STEEL REINF.
STEEL REINFORCE I-I
FRAME ANO FLASMING I�
LATHIN6 - IN n OUT ` �
PL<`TER,BROWN COAT
5 1RAL, FINAL
Ht .G, VENT., REFRIG. ANO A.
PLUMBING, FINAL AN� GAS TEST
ELECTRIC, FINAL
BIIIL�ING, FINAL
FINAL
BUI
SUBCONTRACTOR
IT
N„_ ,� Sr.
7 ,��� _�-,���.;. oo ,o� > ,:� � .. . �
�- ". 38
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
A L ATION FOR BUILDING PERMIT
Fo� Applicant [o Fill in Completely
� R BV DATE RECEIVED DATE IS��
BUILDING
ADDRE55 �
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OWNER '�„°' L L� .J • A.P. NO. � •�
` !�/ AD�DR�E S 3vOS �/A �
Z , /
ADDFESS t%D=l .'S .�T'
aU CITV lj NOL'�jZ .y/Q� TRACT%' LOT BLOCK
Z
Z Q CONSTRUCTION W AD A R P
ON LENDEfi
am
J � BRANCH
J N OWNER
m J ADDFESS VALUE �Jy �U
m AqCHITECT � TEL S � CE S ��1��
J N OR ENGINEER N.
Q F I R E '�i�
w� ADORESS ZONE 7YPE � GROUP `J
a w � APPROVED
W Z CONTRACTOR / - BV DATE '
J Q
m Z
J � ADDRESS
w W TEL. Z� NO.OF USE OF NEW �
�= CITV NO. 1 P�`� BUILDING
zr
wO STATE CITV VARDSAPPROVED VAFOSAPPROVED
y Q LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
� O � (FROM GLSTREET)
S I Z E NO. OF BLD('aS.
OF LOT NOW ON LOT FROM FT. � FT'
USE OF
EXI5TING BLDG.
F— SIZE OF NO. OF
Z NEW BLDG. ROOMS STORIES L. SIDE FT.
a EXTERIOR WALL ROOf
L% COVERING COVERING REAP FT.
J USE OF BUILDING AND WORK TO BE PERFORMED OISTANCE BEf. BET. MAIN &
a MAIN BLDf'�S. ACCESS. BLDGS.
a ,
Q ^ VAR.#E DATE
O //((. � � - �G ' , � '/11 C.U.P.# p MPROVED
� � ' qPPROVED/, // � �
(q J ii rts� /�+^ I/v �
z
� .a�t
U1 hereby acknowlatlge that 1 have reatl this application antl state D•P
� thet the above info�mation is correct antl a8ree to comply with
� all laws reguleting builtling conshuction, and 1 shall not employ ,
F any pe�so� in violatian Of ihe wO�kman's compensation laws of
y the State of California. j`.� �
�r.
z I hereby certify that I am properly Iicenutl as a contractor under SQ. FT. O'
the State of Calitornia Business and Protessions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, antl that such licanses are in tull fo� a antl effact, or I THE PUPPOSE OF ESTABLISHING A PERMIT FEE ONLV: �
am exampt from the provisionz of the State California Business VALUATION
antl Profession de, D���sio �-- m
PERMIT FEE $ �
. �
Signatur f m
Permitt e � $%C� � PLAN CHECK S �
�JI..J
Authorize Sa9 LL
Be�t TOTAL FEE $ �
�•UWNtK
��+ JOB AC
��' GENER
:p -
\ I�
� SOIL
, � G r15
v WATER
J.S.
LOT TRACT FIRE
ROUGH PLUMBING
PROP. SWfl. LINE � HOUSE CON. �_
SPRINKLING SVSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONOITION�NG
TEMPORNRV SERVICE OP POLE
UNOERGROUND � POWER �
ROUGH WIRING
TPENCHES FORMS "I STEEI REINP.
BONO BEAM [� STEEL REINF
SHEATMING
FRAME ANO FLASHIN6
LnTHING - IN r� OUT n
PL�'�EP.BROWN COAT
5 1RAl. FINAL
H� .i, VENT., FEFRIG. AN� rl
PLUMBING, FINAL ANO GAS TE51
ELECTRIC, PtNAL
BUILOING. FINAL
DATE 7-2-74
SUBCONTRAGTOR