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Home My WebLink About328 BUCKNELL RD - Building PermitsCITY OF COSTA MESA � . B!/ILDING DIVISION � F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • ww.v ci.costa-mesa.ca.us �,�� FOR INSPECTIONS CALL: (714) 754-5626 � PERMIT NUMBER: P08-00151 PERMIT TYPE PLUM STATUS: ISSUED APN: 14141106 DATE ISSUED: 06/12/2008 ISSUED BY; YH JOB ADDRESS: �328 BUCKNELL RD CM _� Suite/Unit: Viciniry: SCOPE OF WORK: REPLACE 40 GALLON GAS WATER HEATER WITH SAME 7YPE 8 fN SAME LOCATION. OWNER: MOCK, RANDAL C Address: PHONE: Ciry/State/Zip: APPLICANT: MAZARIEGOS, BYRON Address: PHONE: 1888 611-0328 Ciry/State/zZip: CONTRAC70R: AFFORDABLE WATER HEATERS AND PLUMBING Address: 24707 SAN FERNANDO RD PHONE: 66'I-259-7131 City/State: SANTA CLARITA, CA ZipCode: 91321 ARCHITECT: ENGINEER: License No. License No. 328 BUCKNELL RD COSTA MESA, CA License No. 627368 CELL: PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: PERMIT FEE: TOTAL FEES: $0.00 $35.80 $3 PHONE: PHONE: ' . ; •} - � - ��IREI� �A`t'� �� 3 ~ ,// � NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitomia statutes antl related regulations. (Ord. No. 92-28. § 1. 12-21-92) EXPIRATION: PERMIT EXPIRE$ 180 DAVS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work auNorized untler this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiretion of this permit. CODE/, INSPEC710NTYPE p� IM7171AL5 �Qpf� INSiEL1I0NTYPE plyg INfilALS 7616 Fixed System Final Fire Prevention 208 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Blotk/Re�aining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final BuildinglOccupancy WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalry of perjury one o1 the follovring declarations: p � have ana vrin maintain a ceninwte ot wnsent ro se�f-�nsure tor`workers' compensation, as provided (or by section 3700 of the Labor Code, for tha peAo ance of the work lor which Ihis pertnit is issued. I have and will maintain �wrlcers compensation insurence, as required by sectbn 3700 of the Labor Code, fa the peAortnance of the work fw wliich this pertnit is issuetl. My workers' compensation Insurance carner and policy number are: Carrier. �� ' (Tlris sacfqn neetl not Ee canpetetl/CI�e pem�K uw vaNM at me nurqieE tlo0arslS100) arless ) Policy Number. z��7�/� / � � [] I cerlify Ihat in the peAortnance of the work for which this permit is issued, I sha�l not employ any person in any manner so as to become subjecl to �he workers' compen el n laws of Califomia, antl a9ree that it I shoultl become subjecl ro the�w rs' compensation provisions ol SecGon 3700 of the labor Cotle 1 sha to �th � iply vriN these provisio G��- AGv Si na e Oa�e WARNING: FAILURE TO SECURE WORKERS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CADE, IMEREST, AND ATTORNEY'S FEES. LICENSED LONTRAC70RS DECLARATION: 1 nereby aKrm Ihat I am licensed under provisions of Chapter 9(commencing vrith Section 7000) oi Division 9 of ihe Business and PrWessions Code, and my license/ is in full force and eRect. / Lic. # wy � class tt � 3y� �� o �' i8 �ure Date CONSTRUCTION LENDING AGENCY: ❑ I hereby affum that there is a constructbn lending agency (a [he pBAortnance of lhe �ork for �+Aiich ttds permit is issueC. (Sec. 3097, Civil Gode). Lender's Name: _ Lender's Address: Da�e OWNER-BUILq�R DECLARATIONS: I bereby aKrm�a h�under penally of perjury tha� � am EREMPT FROM THE CONTRACTORx49CENSE-lAW fa�e (ollowing reason (Sec. 7031.5, Business and Pro(e ' s Code ;Any.a or counry which requires a permit to consWct, aiter, i � mpjis �� repair any strucWra, pnor to its Issuance, aiso requir the ¢,�ch permii to file a signed statement lha� he or she�is li L�'�ua�t �the provisions of Ihe Conl�actors LiGense Law (Cha Cmg� Section 7000) o� Division 3 of ihe Business and Pr ��lA � e or she is exempt therefrom antl thg basis for tha e @y violation ol Section 7037.5 by any applicant for a perrnit s ti)� pplica o a civil penally ol not more lhan fivB hundred dollars ($500).): ❑ I. as owner ol Ihe property, or my employees with wages as their sola compensation, WILL DO TME WORK, antl the slructure is nol intended or offered for sale (Sec. 7044, Business and Protessions Cotle: The Contractors License Law tloes not apply to an owner of property who builds or improves IhBreon, and who does such vrork himself or herself or through his or herovm employees, proviaetl that such improvements are not intended or offered tor sale. I(, however, the buildi� or improvement is sold vrithin one year of complelion, Ihe ovmer-builder will have Ihe burden of proving that he or she tlid not build or improve for purpose of sate.). ❑ I, as owner of the property, am EXCLUSIVELY CONTR4CTING WITH UCENSED CONTRACTORS to consiruci the project iSec. 7044. Bus�ness and Professbns Code: 7he conlractors License Law dces not appty to an rnmer of prtlperty wfio builds or improves Iherewi, and who contracts tw such project with a contracta(s) license pursuant to the Contractas License Laws.). ❑ I am exempt under sec. Business and Professions COAe for Ihis reason: 3057�d6 (3/07) Owner ID verifed by d��e. ,.�ncense. ❑ Yes ❑ No Dnver's License No. Expires: Verification o( Ownership Dy (type of document, i.e. - property tax bill or dee0): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: • ❑ I hereby cetlify that no excavation frve (5) or mae (eel m depth into v,fiich a person is requiretl lo descend. will be made in connection with work auttrorizetl by this pefmit. antl thal `w builtling Structure, scattdding, fafsework, or demolition or tlismantling �hereof, will be more Ihan thirty-six (36) (eet high. (Chap. 32. Grp 2. Art 2, Sec. 341, Ttle 8, Califomia Administrative Code). � As ovmer-builder, I will not employ anyone to do work which vrould require a permit Irom the D4vision oi Intlustrial Safely, as noted above. unless such person has a permit to do such work from the division. nvdka�rs sig�aw,� �ivision o! Industrial Safety Permit Numbec _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: t. Will the appliwnt or present or (uWre building occupant neetl to file and certily a Business Plan for emergency response to release or threatenetl release of a hazardous material7 ❑ Yes ❑ No (Section 25505 ot the Calitomia Health and Safety Cotle requires, with some exceptions, that a Business Plan Ge filed wilh lhe Costa Mesa Fire Department by every business which has at any one lime during a reported year a quanlity of hazartlous malerials equal to or greater than a weighl of 500 pountls, or a volume of 55 ga�lons, or 200 cubic feet o( wmpressetl gas at standarO lemperature and pressure�. 2. Does or will Ihe applicant or present or future building occupant need to file a registration form (or awtely hazardous matenals? ❑ Yes ❑ No (Seclion 25533 of the Calilornia Health and Safety Code, with some enceplions, requires regislration wilh the Cos[a Mesa Fire Department by each business which at any one time has on hand a quamiry of acutety hazarGous materials equal to or greater than a weight ol 500 pounds. or a volume of 55 gallons, or 200 wbic feet of compressed gas at standard remperaWre and pressure�. 3. Does or will the applirant or present or tuture builtling occupant neetl ro prepare an RMPP (Risk Management and Prevention Program !o� acu[ely hazardous materials)? ❑ Yes ❑ No (Section 25534 of lhe Califomia Health and Safery Code pmvides that the Costa Mesa Fire Department may require the preparation, certification and filing vnth the Fire Department of an RMPP by businesses which are required to register acutely hazartlous materials with the Fire Departmenl. 4. II an RMPP is presenUy required, has Section 25534 0f the Califomia Health antl Safery Code been fully wmplieC vrith? ❑ Yes ❑ No 5. Does or will the app�icant or present or fuWre building occupaN require for the work which is the subjecl ol this appliwtion a permit for such wnstrucGon or modification from the South Coas� Air Qualiry Management District or from any other air pollulion conlrol tlistnct or agency? ❑ Ves ❑ No (Seclbn 65850.2 of the Califomia GovemmeN Code requires thal the requestetl informalion be (umished on applica�ions (a rrornresidential building pertnits). 6. Will any part o( Ihe lacility to be construc�etl untler thi5 permit be within 1000 leet from the oute� boundaries of a school? ❑ Yes ❑ No (II yes", the �acility must meet the requirement of Sections 25534 antl 42303 of Ihe Cali(omia Health and Salety Cale�. 7. If a pertnit (rom the South Coast Air �uality Management Dislrict or other air pollution control dislrict or agency is required for Ihe work which is Ihe subject ol this application, have all of the disclosures prescriGed by Calitomia Health and Safety Code Section 42303 been made? ❑ Ves � No 8. Q( "yes", attach certifcate of compliance from the appropriale air pollution conlrol officer�. ' ' CERTIFICATE OF COMPLIANCE: I certify that under penalry of peryury the information given above is correct. I agree to wmply with all sUte laws and city ortlinances regartlin9 Hazardous Materials and Emissions. " Daie CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I ceAily under penalty of perjury Ihat I have read this application antl state that the intormalion given is correct. 1 agree to comply vrith atl state laws and ciTy ordinances relating to building construction, and authorize representatives of Ihe Ciry ot Costa nnesa ro enter upon the above-0escribed pmperty for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this pertnit until final inspection. Signalure� egal er�s) � ate �� ZJO Antl/orAu+ e Apd�nl Oa�e (714) 754-5273 • Fax (714) 754-4856 • wv+w.ci.costa-mesa.��DING PERMIT » FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 328 BUCKNELL RD Suite: Vicinity: Parcel Number: 14141106 ApplicanC MOCK, RANDAL C Address: 328 BUCKNELL RD COSTA MESA, CA Owner: MOCK, RANDAL C Address 328 BUCKNELL RD COSTA MESA, CA Contractor: Address: Zip: Arch : Address: Phone: Zoning: ISSUED BY: Phone: 714-241•8517 Zip: 92626 Status: ISSUED Applied: 11/21I2002 Issued: 71I27I2002 Phone: � , z�P: szszs EQ'pIR j1'�' 01l'� 9 Phone: License: Eng: Address: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. COVER WITH 30 YEAR COMP. INCLUDES ATTACHED GARAGE. Plan Check: $0.00 Permit: $97.25 SMIP Res: $0.50 SMIP Com: $0.00 Other. $0.00 Inspection: $0.00 Total: $97.75 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING ExisGnq: o NOTES: Rear 0-0 Rear 0-0 Re uired: 0 FEE SUMMARY Calc Valuation: Sa,000.00 Claim Valuation: 34,000.00 PLANNING & ZONING Left 0- 0 Right Left 0- 0 Right Proposed: 0 � r NOTICE: The work authorized by this permit shall compty with all applicable handicap access requirements under California statutes and related regulations. (Orc1. No. 92-28, § 1, 12-21•92) EXPIRATION: This permN shall automatically expire and become void if work is not commenced wlthin 180 days, or il work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetlone and finel epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration oi this permit. FOR INSPECTIONS CALL: (714) 754-5626 2A464618�00) W6AKERS'COMPENSAnONDECLARAnON: � 1 hereby aHirm under penalry W per�ury one of the tollowing tlacla�etfons: ❑ I heve and will malntein a certiflcate ol consent to self-Insure tor warkers' compensatlon, es D�o�itled 1 by sectian 3700 0l the Le6or Cade, for the peAormence ol Ihe wark for whiCh this permlt is Issued. ❑ I have en� will meintain workers' compe tlon Insurance.flg required by section 3700 of Ihe Lebor Cad r the pertarmance of the work fo( which Nis pertnit is issuetl. My workers' w`pep'1sa'�loIp �sure e r a d policy number erai . . ��I^l ',` n– Cerfler: 4_N Policy NumDer: .( �A A./\J�'�. (This ectlon need nof com f O fhe p rmi�5 ve/ued et one hundred do��ars ($100) or less J I ceniTy ihat in the pertormance ol the work for wNch ihis permit Is issueq I shall not em0loy any person In eny manner so es to become subject to tha workers' compensetlon laws at CaIlfOmla, entl epree thet II I should become sub�ecl to the workers' compensatlon provislons ot Saction 700 of thpe Lebor Code, I shall lo�hwith compty with Ihase provisi � � // j n 1 Appllcant Signature: �f�^s�R.-l' �/� Dete: 1—\ � �/ �t �1 —c�12 WAqNIN�: FAILURE TO SECURE WOa(ERS' COMPENSATIIXJ Q7VEMOE IS UNL4WFUL rWD SHALL SU&IECT M! EMPLOYER TO CRIMINAL PENMTIES FNDCIVIL FlNES UP TO IXJE HUNDRED TTIpUSAND OOLURE (5100,000�, IN ADDRIIXJ TO THE COST OF COMPENSATIpJ, DMMGES AS PROVIDED FOR IN SECTION 3108 OF THE IABOq CADE, Ir.TEREST, AND ATTORNEV'S FEES. LICENSEO CONTRACTORS DECLARATION: , I hereDy aflirm Ihat I am licensetl untler proNslons ol Chapter 9(mmmencing with Sectlon 7000) of DIvlslon 3 of the Business and Prolessions Code, an0 my Ilcense Is In full foma entl eflecL Llc. a Class» CoM�actofs Slgnaiure: Dete: CONSTRUCTION LENOING AGENCY: ❑ I hereby aNirm that there is a constructlon lending egenty for Ihe podormance of ihe work for which ihis permit is issued. (Sec. 3097. Civil Cotle). Len4efs Name: Lentlefs Adtlress: Signeture: Date: OWNER-BUILDER DECLARATONS: I heleby attirtn �hat under penalry ol perjury t�at i em EXEMPT FROM TME CONTRAC70RS LICENSE LAW for �he fallowing reason (Sec. 7031.5, 8usiness entl Professions Cotla: P.ny ciry or counry which requires a permit to consWcL alter, impmve, demdis�, or repair any sWcture, prior to iis issuance, also requires the epplicant for such pertnit to tile a s{gnetl statement that heAr sha b Ncensed pursueM to ihe proWsions W ihe Comrenors I}cense Lew (Chapier H(commancing with Sectfon 7000) of Division 3 of the 8usiness end Profess�onsCotle) or ihet he or she Is exempl Iheretrom end Ihe basis tor the ellagetl eaemption. Any violetion of Section 7031.5 by any epplicant for e permit subjects the epplicant to e Gvil penalry of no(more Wan INe �undred dallers (5500)J: - I, es owner ol Ihe ro *� ❑ p perry, or my emplqreBs Wlth wages es t�eir sUe compensatlon, WILL DO TME WORK, entl Ihe sirucwre Is not intendetl or oNered br sale (Sec. 7044, Business and Prolessions Cotle: Tha Con�ractors License Lew does not epply to an owner oi properry who builds or improves t�ereon, end who doas such work himself or hersetl or through his or her own employees, provitled ihat such Improvements are not intended or oNered for sale. If, however, the building or improvement is sold within one yeer ol completioq the owner-builder will have ihe burden ol proving that he or she tlitl not 6uild or improve for purpose of sale.). � ❑ I, as owner of �he property, am EXCLUSIVELY CONTRACi1NG WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Professions Code: The contraaors License Lew does not appty to an owner of pmpeny who builtls or Improves Ihereon, and who contracts for such project with a wntwcror(s) license pursuant to the Contracrors License Laws.). ❑ I am e:emp� r�s�ec�. jj Signature: —J—�--'^'�` Owner ID verified by advets Ilcense. Vedfcation ol Ownership by (type ot _ Business end Professions Code for this reeson: Date: ❑ No DAvers Licensa No. Expires: I.e. - pmperty te�c bill or tleetl): DIVISION OF INUUSTRIAL SAFET' PERMI7 CERTFICATION: ❑ I hareby ceRity thet no excavetlon live (5) of more feet in tlepth Into whlch e person is requlred ta descentl, wlll be metle In connection wiN work euthonzed by �his pertnit, entl thet no building 5trudure, scaNWtling, lelsework, or tlemoli�io� or tlismantling thereot, will be more Ihen thirty-sIx (38) feet high. (Chep. 32, Grp 2, Art 2. Sec. 341, Title B, Celltomia AdministretNe Catle�. ❑ As ow�r-builder, 1 w01 rwt empby enyone to tlo work which woultl �equire e permlt trom the Division ot Intlustrial Satery, es froted ahove, unlo5s such person has e pertnit to do such work from the divislon. Signa�ure: Da(e: Divis�on of Industnal Safety Permit Number. CERYIFlCATE OF COMPLIANCE AND AUfMORflATION OF ENfAY: I certily under penalry ot perjury that I have read this epD��on and s[ate ihat the infortnaUon gNen Is correct. I egree to compty with ell state laws and ciry ortllnences relaGng to building consWction, antl authodze representatives oi the Ciry ot Costa Mese to enter upon ihe abov0-describe0 pro or inspe,cption �puryoses�.,�I e�g,re_e n/o1I(0 occupy or ellow occupancy ol eny huilding euthonzedl/� this pqrm(it� until final insDecGon. �a,��.C/.�X �� CTC� � ��! Z� I V Z SlgneWre OI Legel Owner(s) Date AndfO� Aulhaizetl ApPlkant COOE t INSPECTIONTYPE 7616 FI:eO System Flnal Fira Preventlon 1266 Pool Spa Final ppp Flnel Re�ROol 201 Flnel BIaWRetelning Wall 202 Final Fectory Fire Pleco 203 Flnal Sign 204 Finel Domo�itlon Pdg IL�ELS COOE I INSPEGTION TYPE 206 Flnal Mechanical 208 Flnal Plumbing 210 Final Electncal 212 Final Fire Prevention 220 Final Plenning Approval 222 Final Sito 250 Final Building/Occupa�cy PaIE It�L4 September 4, 2003 CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-7200 DEVELOPMENTSERVICES DEPARTMENT BUILDING DIVISION NOTICE OF PERMIT EXPIRATION Randall Mock 328 Bucknell Rd. Costa Mesa, CA 92626-6139 PERMIT NUMBER (S) FOR: PROJECT ADbRESS: 602-01902 Re-roof 328 Bucknell Rd., Costa Mesa Our records intlicate the above listed permit(s) were obtained for property improvements or alterations at the above address. Per the 1997 Uniform Building Code, Section 106.4.4 Expiration, permits are valid for 180 days from the date of such permit, or the date of your last inspection for the project and additional fees may be required to finalize expired permits. According to our records, the permit(s) listed above have not had an inspection for a period exceeding 180 days. If you have a signed inspection card indicating an inspection was conducted within 180 days from the date of this letter, please contact this office so we may correct our records. A time extension may be granted if you intend to commence work and complete the project. Requests must be made in writing addressed to Ed Petros, Chief of Inspection, at the above address, detailing circumstances and listing an estimated date of completion. If you need to request an inspection please call our Inspection Request Line at 714.754.5626. If you do not contact this office within 10 days, your permits will expire on September 19, 2003. If you have any questions, please contact the Building Division at 714-754-5273, between 8:00 a.m. and 4:30 p.m., and a staff member will be happy to assist you. The accuracy of records affecting your property is our goal and we appreciate your working with us to resolve this matter. Sincerely, � _ � I � Mary Jane Weidenkeller Office Specialist II Building Division (714) 754-5273 • Code Enforcement Q14) 754-5623 • Planning Division (714) 754-5245 FAXp14)J544856 • 7DD(774)754-5244 • �w�w.ci.costa-mesa.ca.us CITY OF �^STA MESA PROPERTY DETAIL� 'EPORT Owner: Mock Randal C Resident: Mock, Randal Site Address: 328 Bucknell Rd City/Zip: Costa Mesa / 92626-6139 Parcelld: 141-411-06 Location: Costa Mesa City Neighborhood: Unknown Wealth Code: 0.0 Legal Desc.: N Tr 2882 Lot 8 Zoning: Unknown Subdivisian: Unknown Usage: Style: Conslruction: Year Built Stories: Bdrms: Baths: Heating: Cooling: Irc LoU Terrain: Water: Sewer: Sqk tst: Sqft 2nd: Sqft Bsmt Sqft Total: 122: Single Family Residential Unknown Unknown 1959 1 3 2 Full Unknown Unknown Unknown Unknown Unknown Unknown 1555 Market Value: $307,544 Assessed Land: $233,838 Assessed Bldg: $73,706 Assessed Total: $307,544 Percentlmproved: 24% Delinquent Taxes: Sale Date: Sale Amt.: Deed Type: Volume & Page: Seller: Title Company: Multi-Parcel: Feb-27-2001 Quit-Claim Deed Chadderdon Roger No 328 Bucknell Rd Costa Mesa, CA 92626-6139 Phone: (714)241-8517 Phone: (714)241-8517 Tax Address: 328 Bucknell Rd City/Zip: Costa Mesa / 92626-6139 Own.Occ.: Yes School District: Newport-Mesa Unifed Census Tract 063905 Year Listed: <1993 Ttl. Rooms: 6 Bsmt.Type: Unknown Bsmt. Fin.: Unknown Gar. Type: Attached Garage Gar. - Cars: Gar. Sqft: Roof Mater.: Unknown Roof Style: Unknown Attic Type: Unknown Condition: Unknown Lot Dim: Lot Size: .143 acres Lot Sqft: 6229.08 sq.feet Gross Tax Semi Ann.: HB920 Credit Semi.: RB Credit Semi Ann.: RBA Credit Semi.: Homestead Exemption: Spec. Assmt. Semi.: Tax Semi Ann.: Mortgage Date: Mortgage Amt.: Mortgage Type: Volume 8 Page: Lender: Mortgage Term: Mortgage Rate: Blktop Paving: Concrt Paving: Carport: Deck: Patio: Pole Barn: Pool: Fireplace: Gas: Electric: Units: $1,721.95 $1,721.95 Feb-27-2001 $217,500 Conventional Unk. Unk. No Unk. Unk. Unk. No Unk. Unk. Golden Empire Mtg 2031 Unk. ! Fixed The information is deemed reliable but is not guaranteed. 2002-2003 Tax Year Copyright 2003 Haines Printed Aug-29-03 SOUTH ORANGE CA OWNER JOB ADDRESS 328 BUCkri�ll Rd. DATE GENERAL CONTRACTOR MOTr].11 Pu1S1f0T' VALUE $ 168.00 � AP. No. LOT 8 TRACT 2a82 FIRE ZONE DESCRIPTION OF WORK lOCkwall INSPECTIONS I DATE SUBCONTRACTOR Watcr Form 21Q-3M-4�59 in666 ' 1��€�i� COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 31] COSTA MESA. CALIFORNIA fOR APPL/CANT TO f/LL /N COMPLETELY TYPE OR PRINT BUILDING� ADDRE55 COSTA MESA, CALIFORNIA : ■ae� GITY ' �LG�� TNO.'-�� ARCHITEGT LIC. OR ENGINEER NO. AD�LEGAL SIZE I NO. OF BL�GB. OF LOT rvOw orv �oi USE OF EXISTING BLDG. $ETBFCK LINE FROM �, �/ � CENTER OF STREET � v REAR YARD (f l � SIDE VARD ILEFT RIGHT � DESCRIPTION OF WORK NEW ( ALTERATION I II ADDITION REPAIR I IIMOVING I IIDEMOLISH BUILDING NO.OF SIZE ROOMS STORIES EXTERIOR WALL IROOF � � � i� y l� 1 l[A/ �• I HEFEBY /�CKNOWLEOGE THAT I MAVE NEAD THIS APPLICATION ANU STATE THAT THE ABOVE IS CONflECT ANO pGfiEE TO COM- PLY WITH RLL CITY ONDINANCES AN� STAT hW9 REGUTATING Bl11LO1NG CONSTNU ION. SIGNATURE OF I�/ /'- � PERMITTEE ��'� � s � -��J.� � _ �=;:�;u.�_ � /a - a- 7 -s9 : !„ah�CE pEPT. v � ,,,,,, �� ncrq �1ESA APPLICATION FOR PERMIT BUILDING FOR OFF/CE USE ONLY I RECEIPT NO. I �/PE�t_[li t� V REC EO BY DATE PECEIVED OATE ISSIIE .��7� , I /e -a'7-� /O'aZ ILDING � DRE55 - COSTA MESA, CALIFORNIA ZONING ZONE(� NO.OF USE OF NI �,� J � t Plr�NS � BUIIDING YARDS REOUIRED (CENTER LINE STJ REAR `�"r Ff. IICII THE AMOUNT SHOWN UNDEN YALUATION IS FOR THE PURPOSE OF ESTRBLISHING A PERMIT FEE ONLY. VALUATI ON � 1 -, PERMIT FEE S $ �� PLAN CHECK $ - � TOTAL FEE $ �' • . .. - ." 9�� COSTA MESA BUILDING DEPARTMENT P.O. BO% 31] COSTA MESA. CALIFORNIA ' FOR APPLICANT TO FILL IN BUILDING ADORE55 ' 32� �(�`k21811 R(l. COSTA MESA. CALIFORNIA OWNER yx'Oj•Jjj Homes� TilC• AooREss 1555 Flacentia TEL. c�Tv N ort B ach Ca1 No. ARCHITECT S�e LIC. OR ENGINEER NO. ' AOORE55 �$j�e _tl�_rI._11L11 VOIl$li. 1i0. CITV LIC. 1F..L7 �Ec^� LOT DESCRIPTION NQ, A.P. NO, SET9ACK LINE iROM BLOCK �TRACT (,aa� No.or e�ocs. (� now oN �01 Q �O REAR VARD ZS��O�� SIDE VARD RIGHT " LEFT � DESCRIPTION OF WORK NEW ALTERATION ADDITION REPPIR MOVING �EMOLISH SIZIEDING 1571-43o ROOMS O STORIES 1 EXTERIOR WALL ROOF L COVERING 9t11CC0 COVERING 31O�IDOZI� USE OF NEW BUILDING reaidence an3 att. �ara�e � �� A��,�� ;� ,��_ FINANCE DEPT. GITY OF COSTA I�ESA APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY RECEIPT NO. PERMIT Np BUILDING ADDRE55 COSTA MESA. CALIFORNIA �V••� �� I I PLANS � / I... � v APPROVED BY OATE CORRECTIONS I HEPEBY ACKNOWLE�GE TnaT 1 n ve x[Po ln ] 9rrLICwIIVn nrvV ^ �(�y STATE THRT THE RBOVE I$ CORRECT FND /�6REE TO COMRLY WITH iLL rV�Cvw 0 establishing a permit fee oniy. CITV OFOINwNC � STATE LaWS REGULnT�NG BUIL�ING CONSiRVG norv. VALUATION PERMiT FEE $ 35�00 SIGNATURE F �Y PERMITTEE 15,62z�OO pLAN CHECK ?$ �`'SO $ .,,r,,,,e,-.�„ .,-�„r TOTAL FEE 3 S2•SO v°"'�