HomeMy WebLinkAbout3012 BUCHANAN WAY - Building PermitsCITY OF COSTA MESA
BUILDING DIVIS/ON
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754•5626
PERMIT NUMBER. E08-00331
PERMIT TYPE ELEC
APN: 14114123
STATUS: ISSUED
DATE ISSUED: 08/1312008
ISSUED BY: YH
JOB ADDRESS: 3012 BUCHANAN WY CM Suite/Unit:
Vicinity:
SCOPE OF WORK: ELEC7. SERVICE UPGRADE TO 200 AMP.
OWNER: KLIMASZEWSKI,RAYMOND
PHONE: 714742-0207 �
APPLICANT: KLIMASZEWSKI,RAYMOND
PHONE: 714 742-0207
CONTRACTOR:
Adqress: Unit
Ciry/State:
PHONE:
ZipCode:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $54.00
Reinspection Fee $0.00
TQTAL FEES $54.00
Address: 3012 BUCHANAN WAY Unit:
City/State/Zip: COSTA MESA, CA
Address: 3012 BUCHANAN WAY Unit:
Cily/Slate/zZip: COSTA MESA, CA
License No.
CELL:
_ ". ;
,,
NOTICE: The work authorized by this permit shall comply vrith all applicable handicap access requirements under Califomia statutes and related
re9ulations. (Ortl. No. 92-28, § 1, 12-21-92)
EXpIRAT10N: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSAEC7tONS: In order for the work authonzed under this permit to be considered legal, such work must comply with all applicable codes, artd all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this pertnit.
COoo INSPEC710NTYPE OATE INTRIRLS LOOEt INSVECTIONTYPE �� IN_TI7UL5
1818 Fixed Sys�em Final Fire Prevention 206 Final MechaniUl
1266 Pool Spa Final . 208 Final Plumbing ___�_/ �
200 Final Re-Roof 270 Final Electncal ���
�L21�L
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Faciory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupanty
WORKERS' COMPENSATION DECLARATIO�
I hereby affrm under penalty of perjury one of the following declarations:
❑ I have and will maiMain a certificate of consent to self-Insure for vrorkers'
compensation, as provided !or by seclion 3700 of the Labor Code, for the
pertormance of Ihe work for which this permit is issued.
❑ I have and will main[ain workers' compensation insurance, as requiretl by
section 3700 of the Labor Cotle, for lhe perfortnance ot the work (or which this
pertnit is issued. My vrorkers' compensation Insurance carrier and policy
numberare: �
Carrier:
(This serY.on neetl iro! be mmple(edAfhe peim� is valuedat are huntlretl tlollars (Sf 00J a less )
Policy Number:
❑ I certify that in the per(ormance of the work (or which Ihis 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 [hat if I should
become subject to the workers' compensalion provisions of Section 3700 of
Ihe Labor Code, I shall forthwith comply with these provisions.
Ap0licanfs SignaWre Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNORED THOUSAND DOLLARS
($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 licensetl under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of ihe Business and Professions Code, antl
my license is in full force and eHect.
Lic. # Class #
Comraclor's SignaWre
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn that there is a construction lending agency for the
peAortnance ot the v.ork fa wfiich this permit is issuetl. (Sec. 3097, Civi1 Code).
Lender's Name:
Lentler's Atldress:
SignaWre Dale
OWNER•BUILDER DECLARATIONS:
I hereby aKrtn thal under penalty of perjury that 1 am EXEMP7 FROM 7HE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
conshuct, alter, improve, demolish, or repair any slrucNre, prior to its
issuance, also requires the applicant for such permit to file a signed statement
that he or she is licensed pursuanl ro the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Pro(essions Code) or Ihat he or she is exempt [herefrom and
the basis for [he alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more Ihan
fve hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
comoensation, WILL DO THE WORK, and the structure is not intended or
ofteretl for sale (Sec. 7044, Business and Professions Code: The Conlrectors
License Law does not apply to an owner of propeAy who builds or improves
Ihereon, and who does such work himself or herself or through his or her ovm
employees, provided that such improvements are not intended or oRered for
sale. If, however, the building or impmvement is sold within one year of
completion, the ovmer-builder will have [he burden of provinq that he or she
did not build or improve for purpose of sale.).
�❑. I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to constmct the project (Sec. 7044, Business and
P,rofessbns Code: 7he contractws License Law dces not apply to an owner of
property who builds or improves ihereon, and who confracts for such project vdth
a contractw(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Cotle for this reason:
��i��Si e Dale
305]-46(3/0])
Owner ID verifed by d� � lic� ❑ Yes ❑ No ��
Driver's License No. ,/�? Expires: -%-�9
Venfcation o( Ovmership by (type of document, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
� I hereby certify that no excavation frve (5) or more (eet in depth in[o wtiich a
person is required [o descen4 will be made in connection with work authonzed
by this permit, antl lhat no building s[ructure, scaffolding, (alsework, or tlemolition
or dismantling thereot, will be more than thiny-six (36) feet high. (Chap. 32, Gry
2, M 2, Sec. 341, Ttle 8, Califomia Atlminis[2tive Code).
❑ As owner-buiider, I will not employ anyone to do work which would
require a permi[ (rom the Division of Industrial Safety, as noted above, unless
such person has a permit to tlo such vrork from the division.
Apphcam's SignaWre
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will ihe applicant or presenl or fu[ure building occupant need to file antl
certify a Business Plan for emergency response to release or threa[ened
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of the Califomia Heaith and Safety Code requires, with some
exceptions, that a Business Plan be fled with the Costa Mesa Fire
DepaAment by every business which has a1 any one time during a reportetl
year a quantity of hazardous matenals equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standartl tempera�ure and pressure).
2. Does or will the applicant or present or future building xcupanl neetl to file
a registration form for acu[ely hazardous materials? ❑ Yes ❑ No
(Section 25533 of Ihe California Health and Sa(ety Code, wi[h some
exceptions, requires regishation with the Costa Mesa Fire DepaAment by
each business vfiich 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 standartl
temperaWre 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
hazartlous materials)? ❑ Ves ❑ No
(Section 25534 of the Califomia Heatlh and Safery Code provides Ihat the
Costa Mesa Fire Department may require the preparation, certifcation and
filing with Ihe Fire Department ot an RMPP by businesses which are required
to regis[er acu�ely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or fu[ure building occupant require for
the work which is the subject of ihis application a permit for such construction
o� modifcation (rom lhe South Coast Air Quality Management District or from
any other air pollution control distnct or agency? ❑ Ves ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requested
intortnation be fumished on applications for non-residential building permits).
6. Will any part of lhe facility to be consWcted under this permit be wilhin
7000 teel from the outer boundaries of a school? ❑ Yes ❑ No
Qf yes", the faciliry must meet the requirement of Sections 25534 and 42303
of the California Health and Safety Code).
7. If a permit from the South Coast Air �ualiry Management DisMcl or other
air pollution control district or agency is required for the vrork which is Ihe
subject of this application, have all of the disclosures prescnbetl by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qt'yes", attach certificate ot compliance from the appropriate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury Ihe
information given above is correcL I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certiy under penalty of perjury that I have read this application and state that
Ihe information given is wrrecL I agree to compty with all state laws antl ciry
ordinances relating to building consiruction, and authorize representatives o(
the City of Costa Mesa to enter upon the above-descnbed properry for
inspection purposes. I agree not to occupy or allow occupancy of any building
aulhori d�h�permi/t/qp[ilfna � s [ion. � lO ,D�
A A
/ Sig re o1 Uvneqs) Date
Antllor Aul�onzetl Appht'anl Dale
0
PATIO COVER DETAIL 6/1/61
�STAT E—j��
SPACING SPA�
SIZE ' D� � rj; _
OVERHANCa � f `
RAFTERS: * ,
__. /� rnir7H �—SIOPED FOR DRAIN _
%.
� BEAM
�
STATE SIZE
3/� 6 % 2��-T-ST RAP
�
�
s
= POST-BEAM
� CONNECTION
.^
3/g K 5 logs 32% —�
Predrill Ledqer �
Predrill Exiatinq '/4-3 Deep
JOIST NANGER
or other approved methods
oi suppurt . tie.
AL L L UMBER DOUGL AS F/R
CONSTRUCT/ON" GRAOE
POST
�x �
SHO'-- W �ZE SHOW SPACING
SHOW LOCATION ON REVERSE SIDE,
r SLOPE 70 DRAIN —
e
� � ��.'`' .':PUODLE�D�'�.�SA�ND� �FILL'.
DROP PATIO FLOOR
� ` a
•�"'� Remove G.ass And Weeds Down To Notural G.ode
12� ' •
"� CONCRETE MIX 1:3:4 MAXIMUM WATER CONTENT
POST ANCHOR �1'���_.��.� 7i GALLONS PER SACK CEMENT.
Fo� Pipe Posf. EmDed r�Z� ' Provide 26 Ga G.I. Flashing At Wood Floor Const.
Pipe In Foorinp.
P�ovide Flmq¢ Or Weld Plcte Screwed Or Bolted To Frame.
FORM BU-�0
CONTINUOU
LEDGER
TYPICAL JOIST ANCHOR
NOTE � USE REVERSE SIDE FOR PLOT PLAN.
NO 1 t — ti I NO 2
FOR OPEN EGG CRATE fOR SOLID SHEATHING.
ALUMINUM OR PLASTIC SHINGLES OR BUIIT UP
ROOF COVERING ROOFING.
MAXIMUM SPAN SiZE SPACING MAXIMUM SPAN
17� 0�" 2x6' 12% I5� I�
I 6� 0` 2'z 6' I fi"/� I 3' 3"
I 5� O" 2'x 6' 24 % 10� 11
12" 0" 2'x 4" 12% 9� II"
1 I� 0' 2'x 4` 16°h 8� 8"
10" 0" 2'x 4" 24% 7� I"
NOTE: FOR PROPOSED OR FUTURE ROOM,OR WHERE PAT10
WAL�S ARE TO BE BUILT. USE N0.2 CHART ONLY.
WIDER RAFTER SIZE MAY BE INTERPOLATEO FOR
SPACING ONLY.
FOR PROPOSED OR FUTURE ROOM OR WHERE PAT10
WALLS ARE TO BE BUILT SUBMIT rOMP�ETE HOUSE
AN AODITION PLANS
COSTA MESA BUILDING DEPT.
77 FAIR DRIVE
834-5213
,� /�
C.Y _ - - .""
� ���� �
CITY OF COSiA MESA
ptp,NPifNG DEPT•
SUSIECT TO 8���'� flEPT' REG�
�'%ib � .�"^ j .��- � �-.
....... _ ..
...._
BY .......... DATE.......
ptRECTOR OF PIANNING
�?C/rt '�
I
q l
City
�
Building
THESE PLANS MUST BE ON JOB AT ALL TIA1
MAKE NO CHANGES WITHOUT PRIOR APPROV
OF DEPf. �
THE ISS�AM.CE OR GRAMTING OF A PER� R °ROYAL
OF PLA�S Al:D SVECIFICATIOi7S SN.1LL NOT BE CONSTRUED
TO BE A PER;.:IT FUR. OR Ai. APP,^,dYAL UF, ANY VIOlATION
OF ApY Of THE PROVISIOP:S 9f THIS CODE. NO PERMR PRE-
SllNtI�G � TO GIVE AIITHORIIY TO VIOLATE �R CANCEL THE
PRDYl5107S OF TNIS CODE �HALL BE VALIC, EXCEPT IN 50
fAR AS THE YJORK OR USE WHICN IT AUTHORIZES IS LAWFUL.
TtIE ISSUANCE OF A PERMIT BASED UPON PtANS ANO
SPECIfIGD0;i5 SHALL NOT PREVENT THE BUILOING OFfICIpL
FROM THERFJIF7FR REQUIRING TNE CORREC71pN OF ERRORS
IN SA�D PLANS RND SPECIFICATIONS OR FR6M PREVENTING
BUIIDING OPERATIOHS BEfNG CARRIED ON THEREUNUER WHEN
IN VIOlAT10N UF TNIS COOE OR UF ANY OTHfR ORDINANCE
OF THE CI7Y.
f�f2
. �� .�.���
��
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��RUCiURAL
SEPARATE PERMITS
�TIP1G, !`�f'T!�:TI
REFRIGERATION 1
��(��7`�a{� # T�
THIS ('Ui':.`.'"' ' ,
All INSPEC�lO�d
FOR BUILDItY,.S ..,�. c PE� S�
Bf EMPLO'lED, S+� SJ�ut51
STATE OF C �ff�;;YIA Di'�
INDUSTRIAL S FETY DE CONS
aDDIT10YitL �:EOUI ;EMENTS._
ONLY I
REQUIRED
•131hiG,
3 AND
_.. r�
' _ 7 t �� --�.
: "aj{ (/
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JOB ADDRESS
GENERAL CON
AP No. 141—
�INSPECTIONS
I soa
� GAS
W �TEN
ROUGN PLUMBING
�PROP. SWR. LINE
SPRINKLING SVSTI
MISCELLRNEOUS
�ON.
2
�ROOGN MEATING AND AIR CONq�TIONING
TEMPORRRV SERVICE OR POL@
UNOERGROIINO � POWER �
� ROUGN WIRING
TRENCHES FORMS STEEL REINF.
FLOOR $YSTEM
ONCE
SHERTHING
FRAME AND FLASHING
LATMING — IN n
NEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL RNO GFS T[5T n
BUILOING, FINAL
mc�ie� erniimcucurc
SUBGONTRACTOR
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4363a
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING .� _ . � D / I I
OWNER S4aeeJ L, �
MAIL
ADORESS r
CITV S�/4 /�'�L� S
cor+srnucnor+ � t A
LENDER
BRANCN AI r If
AODRESS � /A
I,TE��o Alw C� kY1Ota7h n�nL.
ADDRESS
CONTRACTOR NOtal 4�
ADDRESS ��
TEL.
CITV — NO. -�
STATE CITV IJOT
LIC. NO. O K LIC. NO. u�
OF LOT S� � NO.OF BLDGS
� X (. 3Q NOW ON LOT 0i
USE OF C `�
EXISTNG BLOG. S� K 1 � rG YN � f�e5 �
Separa[e pemilts arC required for
electric, plumbing and heating work.
USEbF BUILDING AND WORK TO BE PERFORMED
I hareby acknowlatlpe that I heva reatl thia applicatlon antl state
thet Me ebova InfotmaUon is ePrract and apree to comply with
all lew� repuletinp bulltlinp conRruction, end I ehell not employ
eny Darwn In rloletion of Me Workmen's compenution lew� of
Ma Sten of Celifornle.
I h�raby cenlfy that 1 em proDef�V ���an�sA ef e contreecor untler
the Smte of Californln euslnau P�tl Profaplone CoCe, Dlvlalon 3,
Cnaptor 9, enC that tueh Iic�nmf ara In tull faree entl offaet, or I
em exemOt from Ma pr alawre a Smta of Celifornla Businea
ena Pro}aulon� tl, Ivlalon , p rot 9.
Sipnature ot I
Pslmltta�
Authorized AOent
BUILDING
AODRESS
TRACT
APPROVED
"1 -9-77�A�y00 SF�;: *,:,:�10.5L
FOR STRUCTURAL PERMIT
_iyr— z3
/
DATE a '
)N NO.OF USE OF NEW /'//Ti0
�_� PU1N$ Z BUILDING CO�'E/
VARDSAPPROVED VARDSAPPROVED
MAIN BUILDING ACCESSOF±V BUILDI
ROM GL STREET)
,,�.,r Afl-�6t ?'o �ix�, �r
L. SIDE/! �,
REAR �/
DISTANCE BET.
MAIN BLDGS.
VAR. qW
C.U.P. gJb
APPROVED I/
THE AMOUNT SI
THE PURPOSE OF
VALUATION
aY
�aGD�
�o I Er �.� r.
BEf. MAIN &
ACC6S. BLO
DAl'E
3-9-77
�
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m
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N
VN UNDER VALUATION IS FOR m
'ABLISMING A PERMIT FEE ONLV: �
PERMIT FEE S � �
N
m
PLAN CHECK S m
0
� LL �
TAX 5 �
U
TOTALPAID E � �
'•,'•, OWNER ���� ��Hp�, DATE 4-z9-69
;,�JOB ADDRESS q012 Buchanan Way BUILDING PERMIT N0. �l$$
� GENERAL CONTRACTOR pwner-Builder DESCRIPTION of WORK Add to Existina Wall _
� AP No. 141-1�F1-23 LOT 21F TRACT 4395 FIRE ZONE VALUE $200.00 _
SUBCONTRACTOR
GAS
W ATER
ROUGH PLUMBING
PROP. $WR. LINE � HOUSE CON. �
SPRINKLING SVSTEM
MISCELLANEOUS
ROUGH NEATING AND AIR CONOITIONING
TEMPORARV SERVICE OR POLE
UNOERGROUN� � POWER �
ROUGH WIRING
TRENCHES FORMS � STEEL REINF.
FLOOR SVSTEM
BOND BEAM �' STEEL REINFORCE'j[J
SHEATHING �
FRAME AN� FLASHING
LATHING - IN ❑ OUT ❑
PLASTER, BROWN COAT
STRUCTURAL, FINAL
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AN� GAS TEST �
ELECTRIC, FINAL
BUILDING, FINAL
�
: �- `�0 I �8
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
For Applicant to Fill in Complete/y
ADOFE55
OWNER �
MAIL
Z ADDRESS
W W
o- U CITV
~ Z .CONSTRUCfION
za
O N LENDER
am
J � BRANCH
J N
m J ADDRESS
J m ARCHITECY
a OF ENGINEER �
U �
Q
w � ADDFESS
aw
W Z CONTRACTOR
J Q
m Z
J � ADDRESS
W w
� CITV
Z H
w � STATE
N Q IIC. NO.
�O SIZE rI%"
OF LOT
USE OF
E%I5TING BL�G.
F� SIZE OF
Z NEW B�DG.
U EMERIOR WP.LL
COVERING
J USE OF BUIIDI
a
a
Q
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VI horeby ock�OwletlBe chet I heve read this epPlication antl state
� thet xhe abo�e informetion is correct entl apree to comply wiffi
� all lews regu�aNng buildinB �ansvuetion, antl I shell no[ amploy
F any person i� ��olation of tho workman's compansation lewa of
y the Stete of Celifomle.
zI heroby cert�fV thet I em proparly Iicensatl es e contractor untler SQ. FT
the Stete ot Celitornie Businese and Professions Cotle, Div(sicn 3, THE AMOVNTS
Choptar 9, antl that su<h lieenms era in full torce entl efiect, or I THE PURPpSE OF
om euemp[ flom t�e prov ions of the $tato of alifornie Busineas VALUATION
antl Professio�s Cotle, D' is n 3, Chepter 9.
Signoturo of f-� , A �
Pormitroe S �//i// ,�
/ c� v (/
AuMorizatl ABO��
NO. O F
ROOM�
ROOF`
TE
TEL.
TEL.
NO.
y
. NO.
PERFORMED
APR 29-69cq;AO01544 �*****5.0�
APPLICATION FOR BUILDING PERMIT
:E�VEO ev DQTE RECEIVEp nnTF issw
BUILDING
ADDRESS `
TRACT
FIFE �
ZONE �
APPROVED
VAR. tW
C.U.P.qy+
APPROVED
NO. OF
PLAN$ '
APPROVEO
BUILOING
� �
E OF NEW
ILDING
VARDS Ai
&
�
O
IN UNDER VALUATION IS FOR ^
ABLISHING A PERMIT FEE ONLV: Q
i � �
PERMIT FEE 5 ]
m
PLAN CHECK $ `� E
0
LL
TOTAL FEE 8
owrrER KOLL, x. w.
JOB ADDRESS i012.�.i0�
AP No.
INSPECTIONS
OCCUPANCY
0
acana
TRACT ({
� Signature
DATE 5-25'b2
vALu� � 1427.00
FIRE ZONE D�SCRIP'I'ION OF WORK Blk W311
DATE I GROUP TYPE TTT ZONE
SUi3CONTRACTOR
� �- - :���o
� COSTA MESA BUILDING•SAFETY DEPARTMENT
P. O. BOX 917 C08TA MEBA. CAL�PORNIA
For Applieant fo Fill In Compiefely
-•-- -- ----._ -z i
COSTA MESA. CALIFORNIA
�
TEL.
� 6IZE
NO. OF lLD69.
66TBACK 4NE PROM
CENTER OP 9TREET REAR YARI
SI�E YARD ILEFT IRIGHT
DESCRIPTION OF WORK
NEW � ��I IIALTERATIDNI IADDITIO
NO. OF
WALL
F E ������.��
APA'( 2 5 13fi1 ",
FI�'Af�CE b��:
cifr aF cd�r� ��€sa
APPLICATION FOR PERMIT
BUILDING
,�c..,.� W,�y
���,, For Office Use Only `
RECEIPT NO. � f.+pat�I{��.
� i)�
REC§�� 0Y � ��asE-b2sl `�'�''S�IpZ
Sf
C.
D E'SS 3� I.�L�jO� �JI3)�+"• jd2/ �I/
COSTA MESA. CALIFORNIA
APPROVED
BY DATE �' as-6
ZONING „ �.��,,
ZONE�' I NO. oF �I U6E OF NEW !� '/�
eLANB BUIL�ING (�U'��/l�
LEGAL � ' / ly/J r'T �l �,/ �
DEBCftIPT10N � / �7� �
A.P.NO. � �I � "� �� ��
YARDS EVES
APPROVED ALLOWEO
<centert urve ar.� '""'
FRONT , �FT. 1 - IN.
R. SIDE /vi"�� � T FT. I� IN.
REAR���i v �JI-�'.
APPROVED /„ V A I
� GbC _. L�N 1� � � ..
� -�/( ( �� /
I HEREBY ACI(NOWLEG6E THAT 1 XAV6 READ THIB APPIIWTION }XE AMOUNT BXOWN UNOER VALUAT�ON IS FOR THE
NNU OTATE THAT TH6 A00VE 19 CORRECi AND AOREE TO COM- pURPOBE OF EBTAHLIBH�NG A PERMIT FEE ONLY.
PLY WITH ALL CItY OflO1NANCEe ANO eTAYE LAWB REGULATING
9u�tAINo CONBTR GTION. � ` (^^�. �� VALUATION ' �
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SIGNATURE OF PERMIT FEE $
PERMITTE . ���� � �
$ � O PLAN CHECK �
AUTHORIZED AGENT �
TOTAL FEE 3
•,
,�, : }6669
CGSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 COBTA MHBA. CALIRORNIA
-
For Applicanf fo Ffll In Complefely
TYPE OR PRINT
BUILDING 30� z gGCh L7n ���
ADDRE56
COSTA MESA CAL{FORNfA
OWNER y- d
MAIL J'� `
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USE OF
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DESCRIPTION OF WORK
NO.
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�JAN 1 1 �yb�
; \!F',�!CE DEPT.
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APPLICATION FOR PERMIT
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For Offiee Use Only
�ft6CE1PT NO P6PMIT NO.
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T' OqR R6CHIVED DA 8
/ //� . �-. 7 � �. "_ .
COSTA MESA. CALIFORNIA
ZONING
No. oP u8C OP NHW Srh'�Qti�
PLAN9 � I BUIIDINO y./�.. o'
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I XEREBY ACKNOWLCDOB THAT 1 NAVE R8A0 THIB MPLIWTION T�{E AMOUNT 6XOWN IINDHR VALUATION 19 IOR TX!
AND BTATe THAT THH ABOV! 18 CARR6CT ANO AGRlH TO COM- pURP08¢ OF EBTAlLIBXIN6 A PHRMIT FE8 ONLY.
PLY WITX ALL CIT' ORDINANCE9 AND 9TAT[ lAWB P80ULATINO
au�6nlNa cONernUrnoN. VA�UATION '7
81GNATURE OF /� �D n� PERMIT FEE $ J�
PERMITTB � /y r
S .� PLAN CHECK $ �/ 7 G
AUTFiORIZED AGENT
TOTAL FEE � �