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Home My WebLink About292 BUCKNELL RD - Building PermitsAVP�icant to fi11 in all spaces within heavy bortler lines antl sign a11 , e aeclarations. CITY OF COSTA MESA P RMIT NO. TRAGT NO: L T NO. � BLDG. NO. CONSTRUCTION PERMIT �E- �� S 2('�G i-i-� Arch/Eng. License No. Address ContractOr�'Q �� ' Phone I herebypffirm that'I am �licen5etl untler provisions of Charter 9(com- mencing with section -�OOOy of Division 3 of tne Business antl Professions Cotle, antl. my.ticense is in full torce antl effect. License Class License No. Date Siqnature "'7RKEF5' COMPENSATION'DECLARATION neby affirm that I have a certifiwte of mnsent to self-insure or a :ifiwte of Workers' Compen5atlon Insurance, or a certified copy ..�ereof (Section 3800, l•ab. G.). Policy No. ' Company ❑ Certlfied copy is hereby furnishetl. ❑ Certlfietl capy,is ffletl with the city Builtlinq Division. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thls section neetl noYbe completetl it the permit Is for one hundretl ($300).or less). .- �. . _ I cerLry that in the performance o the work tor which this permit is Issued, 1 shall not empldy any pe n in any manner s s to become subject to_the Wor ers' Compens lo �aws of Californl .� I Date �Signatur � NOTICE: Jf after rpaking fhis'd aration, you shoultl beco e subject to the�Wo�keis' Compensatlon�A ovi510ns of [M1e Labor Cotle, you must forihwith romply wi[h suGh provi5ions o� this pe�mit snall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV I hereby affi�m that there is a cOnstruction lentling agency for Ihe per- formdnce of the work for which this permit is issuetl (Section 3097 Civ. C.). '— Lentler's Name Lentler'S Atltlres5 OWNER BUILDER OECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reazon (Section 7031.5 Business antl Grofesslons Cotle: Any city or county which require5 a permi[ to construct, alte�, impwve, tlemolish or repair any structure, prior to its issuance, also re- •iires [hE ap{.licant for such pe�mit to file a Signetl statem¢nt that M1e licensetl pu�suant to the provi5ion5 of th¢ ContraCtor's LicenSe Law .hapter 9(commencing wi[h Sectlon 7000) oi Division 3 of the dusinEss antl PrWessions Cotle) or that he is exempt therefrOm antl the ba5i5 for the atleged exemption. Any violation of Sec[ion �031.5 by any applicant for a permit subjects the applicant to a civil penalty � of not more tM1an five huntlretl tlollars ($500). I as owner of tne property, or my employees with wa9es as their o �compen5ation, will tlo the work, antl the structure is not intentletl or otferetl lor sale. (Section 7044, Business antl Professions Code: The Conbattor'S License Law tloes not apply to an owner of a property who bulltls or imp�oves thereon, antl who tloe5 such work himself or tltwuglt his own employee5, provitletl that Suth improv¢ments are not intentletl or of(eretl for sale. If, however, the builtling o� impwvement is soltl wlthin one year of completion, tM1e owner will have tne burden of proving he tlitl not builtl o� improve for tM1e pu�po5e of sale). ❑ I, as owner of She property, am exclusively cont�acting with licensetl contractors to con5truct [he project (Section 7044, Business antl Professions Cotle: The Contractor'S License Law tloez not apply to an ownei of property who builtls o� imp�oves thereon, and who con- tract5 f�om such projects witn a contractor(s) licesnetl pursuant [o the Contraclor's License L.aw�. ❑ I am Cxempt untler Sec[ion B. & P. C. fo� tnis r¢ason Date Owner I hereby certifythat I have reatl this application antl stale that the above informalion is correcL 1 agree to comply witM1 all city antl county .a��ances antl state laws relatin o consvuction, antl hereby authorize represen(2�ives of thi5 tity t/en er upon [he above meq[ionetl propertJ ibr inspnc�/purp e5. � � �� Si9na[u�4 1 �� Date Orivers' License or 55 >k TYPE OF CONSTRUCTION �NEW ❑ A�D ❑ ALTERATION ❑REPAIR ❑CONVERSION ❑DEMOLISH ❑ OTHER ❑ESCRIPTION OF WORK TYPE OF PERMIT ❑ GRADING,_,( ❑ FOUNDATION ❑ STRUCTURAL ❑ TENANT �l ELECTRICAL �PLUMBING ❑MECHAN /\ ❑ OTHER PHOJECT D�E/SCRIPTION . SQ. FT. "/��O OCCUPANGV�^o o�VCTION TVPE V ALUATI ON J�2[L✓(L��ZONE GRADING CU. VDS. ACRES REMARKS: PLUMBING BATHTUBS TOILETS LAVATORIES KIT. SINKS SERV ICE SINKS FLOOR SINK$ DRINKING FO T INTERCEPTOR SWIMMING P WATER $G� ICE GAS SERV ICE WATER HEATERS SEWER CONNECTIONS SOLARTANK SOLAR PIPING SYS. ISSUE FEE MECHANICAL PLANCHECK SHOWERS URINALS ' DOUBIE LAVS DISHWASHERS SUMPS ,FLpt)R DRAINS CLARIFIERS PTRAP ALTERATION OUTLETS BTV OVTPUT COLLECTORS PLANCHECK HEATING SVSTEM 0-100,000 BTV ANODUCTING 100,000+gTU REFRIGERATION 0-100,000 BTV SVSTEM 100,000+gTU BOILERS BTV SVSTEM REPAIR,AITERATION EXHAUSTSYSTEM MULTIPLE ISSUE FEE CMF OB6Y46 White-Builtling; Canary-Applicant; Pink-Accounting; Goltlenrotl-AssessOr 6803 6/04/82 A.P. � ZONE REAR VARD (TO P/L) PKG. SPACE REQ. STREET WIDTH ZONING APPROV ED BY SPECIAL CONDITIONS: ELECTRICAL REGULATIONS P�NG. REF. � PROVIDED PARK FEE $ PLANCHECK GENERATOR 0-1 KW_1-30 KW TRANSFORMER APPLIANCE 10-SOKW_SO+KW MOTORS 0-1 HP_1-10 HP (INC. SOLAR) 10-50 HP 50 + HP FIXTURES OUTLETS SWITCHES GAS TVBE SIGNS POLE LIGHTS PANELS MAIN SUB SERVICE AMP ISSVE FEE APPLICATION APPROVED BV (J SUMMARY OF FEES BUILDING PERMIT $ VLAN CHECK E PLUMBING y� P�AN CHECK $ ELECTRICAL $� PLANCHECK $ MECHANICAL $ PLAN CHECK $ IB.OD TL• DATE SMIP E_ PERMIT ISSUANCE $_ GRADING $_ $_ MICROFILM $_ TOTALFEE$_ LE55 AD- VANCEPC $_ FINALFEE §� �� CONSTRUCTION AND PLANNING POOL & SPA - � �� APPROVALS Permit # ��3�Qr Date Inspector � pppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment-Location �=�L�-h 2. Soil ipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit.Utili.ty-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn � 46. Electrical Bonding 7_i�_� . tee ein orce 47. Rough Plumbin & Pressure Test ��-3 • 6. Electrical UFER Grn � 48. APPROVAL TO COVER-GUNITE 7. Footings _ - 49. Electrical Conduit-Undr m �=�_ - C 8. Foundation 50. Gas Pipe, ❑ Undr m, Test 'L( �-�� 'L° � 9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra � ndr rn � 10. Structural Floor System 52. APPROVALTO DECK . ��Fs Qn 11. Property Sewer Line & House Connection � 53. Backwash & Rece tor-Final ' 12. Street Sewer Connection 54. Heater & Vent-Final �� - � 13. Rough Plumbing 14. Rough Electric-Conquit 56. Electrical-Final '7� i .-� ^L 15. Rough Electric-Wiring 57. Solar SYstem-Final 16. Rough Heating & Air Conditioning � Fencing & Access Approval _�_ � 17. Ducts, in Structure 59. APPROVED FOR PLASTERING 76. Ducts, Ve�tilating 19. Gas Pipe-Rough & Test ' 60. POOL/SPA SYSTEMS FINAL �./�`j _�3 e e 20. Roof Framing �� 21. Roof Sheathin � � Q 22. FrameandFlashin NOTES: 0 c..,,Q_ /`"� g�..Y�L 23. Insulation 24. Lathing & Siding ' ' - 25. Drywall Nailing ' 26. Plaster Brown Coat 27. Electrical Power Meter-Final 28. Final Electric � � 29. � Final Heating & Air (`qnditioning 30. Final Gas Pipe-Test 31. Final Plumbing � 32. Water Ser,yice-Final ' � 33. Gas Service-Final 34. Solar pomesticFinal - 35. Landsca e S rinklin S stem 36. Sound Attenuation � 37. Handicap Regulations � 38. FINALSTRUCTURE&BUILDING 39. Special Requirements Completed 40. Electric Release to Edison � 41 . Gas Release to Southern California Gas Co. 42. CERTIFICATEOFOCCUPANCY No. Date � � �� N �� , �C _ � I . � "(�,�.0�� VN'DC'iLEi'R-C7JNiri � I' 13�b�Ro�.. � �ED12bc +t��e � � ' ' � , ` � Po,.� �.-�L l�o�� o � .; -- � - �� , , Z �� _ _ �" I .: ��,�� .- �4o4,e�,1 Gr� �\V`ti� \'�-H � �^ Sl,,a ,.� �. G' �"85 '�oo -2 %• , ._�---- f�ii PROVED S�COSTA MESA Mechanical Section Division THE �SSUANCE OF A PERMIT BASfD UPON PtANS T� SPECIf:CATI.^t7S SNRLL N0T PRcYENT THE BWLDINC OFF y1N �� FROM iHEREAFfER REQUIRINGTHE CORRECTIDN Of E �-0g,M IN SAIU PLANS AND SPECiFICATIONS LR FROM PNEYfP � BUILDING UPERATICNS BEING CARRIED ON THEREUNDER I IN YIOIATiGN 6F 1HiS CODE OP Of ANY OTHER 4ADfN OF THE CITY, fOR INFGkMA710N CALL 754-SD3 K,z-��..—r.� g", �25�00o r3rv t+�-i�� -�. I.o ��v P��P to.� ,�.w�Ps. , �p, ��Z�'�C, � �o��D Co�JDv � � _i7f�d)fiR.G1R S. �ca-S 1,.tn31s� rv ��" UN'b�ciE.aoun}D �C-1 �-�r Ov�tx-�c.`c�9 ��$O� l..�n.�� 3 � E�—t-T�-•,e, vv1 ��'�— � St cz-� , ��r , 2. �om�-,� /3-� a.- 1.�s-n`2 /- /��Xa-7�'L l� z.� Nl7 '� 2.yv w �+`1 S-�a-a�"� � J AOV��ant to 11I1 (n all spaces within heavy bortler lines ana si9n all ao CITY OF COSTA. MESA P RMIT NO. , / TRACT NO. LOT ` COtVSTRUCTION PERMIT ��' � ��CS�/7 Addrefs License No. Address Contractor Q � Phone LICENSED CONTRACTOR OECLAf2ATION 1 hereby altirm th:t I am II<ensotl unticr Orovltlons oi Cnarter 9(com- mencing wilh sectlon 7000) ot Divislon 3 of Ina Busineit antl PfOfU5TI0�5 COtl¢� dOtl rtly IIC@�58 IS In fUll }OfCe d�tl <HGtf. License Class LicanSe No. Date Si9nature �+nRKERS'COMPENSATION DECIARATION reby affirm that I have a certlficate ot consent to self-insure or a fiwte of Workers' Compensatlon Insuranca, or a certifietl copy weof (Section 3800, LaG. C.). Policy No. ComOany ❑ Certlfietl copy is hereby (urnisheG. ❑ Certifietl copy is tiletl with the cily Builtling DivisiOn. E%EMPTION FROM WORKERS' COMPENSATION DECLARATION (This sectlOn ne¢tl not be complatetl it tha permit i5 for one huntlretl (5100) or less). I C¢rti(y thdt m the petfa�mance o/ t�e work for which this permit i5 ISsuetl, I shall not emPioy any person in any mannet so az to become SUGjeGt t0 the Work¢rs Compensatlon LawS ol Cdlifornia. Date Si9ndturt NOTICE: It a1te� making th15 tlecldrdUoO, y0u shOultl b¢Com¢ suDj¢ct to lh¢ Work¢rs' Compensation provisions ot lhe Labor Cotle, you must forthwlth comply wI[h zuth provi51on5 Or this permit shall be tle¢metl revoketl. CONSTRUCTION LENDING AGENCV I hereby atfirm that there is a<onztruction Ientling agency tor [he per- formantt of the work for wmcn tM1is permit Is Issued (Section 3097 Civ. C.). Lentler's Name �entler's Atltlress OWNER BUILDER DECLARATION I hCrCby aHirm tnat I am exempl bom th0 COntrac[or'S License Law tor th0 f011Owing feason ($¢ctlon ]031.5 BUSIne55 antl Prote55iOns Cotle: Any cily or county whith r¢quiros a p<rmit to construct, alter, Impwve, tl¢moiish o� repai� any St�ucture, priOr t0 iti issuanG¢, aim re- -•d�M lhC d0411CdOt t0� suth permit to file a si9�etl s[atement that he I�'u5inezs antl PrWMsionS COtlO) or th0t ha I58%Qmpl thGrGirOm anG [h0 basis /or the allegetl exemption. Any violatlon of 5ection 7031.5 by any appli�nt tor a permit suG�ects tbe appliGdnt to a Civil pCnalty f nol more than livc hunaretl tlollars (E500). I a5 owner of the propetly, o� my amployecs wilh wage5 as lh�ir o �compen5alion, will tlo lhe wOrk, nntl lha Sl�ucture I5 not Intentletl or olferetl for sale. (Sectian 7044, Businasi antl Pro(e5sion5 Cotle: Tho Contratlor'S Ucen58 Ldw tl005 not apply t0 an ownGr o/ a prOp¢rty wh0 builtl5 or improves thoroon, antl who tloe5 such wo�k himselt or ihroU9h hls Own ¢mployees, prOvitlCtl tnat such improvem¢nts arC nOl In�entletl o� oftetetl for Sal¢. 1/, howeveq th0 builtling or improvemnnt Is soltl within one year of complCtlon, lM1e owner will have lno burtlen of Oroving he tlitl not builtl or improvo IOr lhe purposC oi SaIC). ❑ I, a5 own¢r Of tnc propCrly, am exclusiv¢ly contracting with Ilcensetl contractors to construct tne projotl (Section 704a, Business antl Grotessions Cotle: The Conlractor's LiCOnso Law �oes not apply [o an owner of properly who builtls or ImprOveS lhereon, antl who con� iratls irom such projecl5 with a cont�actor(S) IiceSn¢tl pursudnt [O ihG Contracto�'S License Law). ❑ I am ezempt untler Section B. 8 P. C. for tnls reason Date Owner I h¢rlby cerlify [nat I have reatl tM115 applicd[ion antl sta[e [hat Ihe above intormation is correcl. I agree t0 comply with all cily antl county ortlinances anC slate laws relalin9 tp consVuclion, antl hereby aulhoril0 rmresenta[iaes of lhis citv to Idnte� uoon .the above men[lonetl Ceclantions. TVPE OF CONSTRUCTION � NEW ❑ ADD ❑ ALTERATION ❑ REPAIR ❑ CONVERSION ❑DEMOLISH ❑ OTHER DESCRIGTION OF WORK TVPE OF PEHMIT ❑ GRADING�/ ❑ FOUNDATION ❑ STRVCTURAL ❑ TENANT .�0 ELECTRICAL RIPLVMBING ❑MECHAI �� ❑ OTHER PROJECT D{.E�SCRIPTION SQ. FT. ^,-�'d OCCVPANCV_CONSTRUCTION TVPE VALUATION ZONE GRADING CU. VOS. ACRES PLUMBING PLAN CHECK BATHTUBS SHOWERS TOILETS VRINALS LAVATORIES DOUBLE LAVS KIT.SINKS DISHWASHERS SERVICESINKS � SUMPS �LOOR $INK$ FLOOR DRAINS DRINKING FOUNTAINS INTERCEPTORS SWIMMING POOL WATER SGRVICE GAS SERV ICE SEWERCONNECTIONS SOLARTANK � SOLAR PIPING SYS. ISSUE FEE CLARIFIERS PTRAP ALTERATION OUTLETS 1 BTU OUTPVT MECHANICAL cLAN CHECK HEATING SYSTEM 0-300,000 BTU _ AND DUCTING 100,000 + BTU _ REFRIGERATION 0-100,0008TV_ $YSTEM 100,000 * BTU _ BOILERS BTU SVSTEM REPAIR,ALTERATION EXHAVST SYSTEM MULTIPLE Signature 't - Date"' o��ers• �� e se o. ss �� ISSUE FEE e CMF 0865-46 White-Builtlin9: �nary-AOP��ant: Pink-Accounting; Goltlenrotl-Azsessor 6862 6/04/82 A.P. � ZONE REAR VARD (TO P/L) PKG. SPACE REQ. STREET WIDTH SPECIAL CONOITIONS: 'ELECTRICAL PLNG.REF. nnoviOED PARK FEE 5 PLAN CHECK ER 0-1KW_1-lOKW 10-50 KW_ 50 + K W MOTORS 0�1 HP_1-30 HP _ (INC.SOLAR) 30-SOHP 50+HP _ FIXTURES OVTLETS SWITCHES GAS TUBE SIGNS POLE LIGHTS PANELS MAIN SUB SERVICE AMP APPLICATION APPROV ED BV SUMMARYOF BUILDING PERMIT § PLAN CHECK S�� PLVMBING E�'vV PLAN CHECK 5 ELECTRICAL S� PLAN CHECK b MECHHNICAL E PLAN CHECK S 15.50 TL � L � DATE SMIP E PERMIT ISSUANCE $ GRADING E E MICROFILN $ TOTAL FEE E LE55 AO- VANCEPC $_ FINAL FEE S /s� / CONS7RUCTION AND PLANNING t �� - - POOL & SPA � _ � ... � • � APPROVALS Permit#_��38�Y Date Inspector qpPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole ' 43. Pool & Equipment Location 2, Soil ipe-Undrgm 4. Stee� Reinforcement 3. Elec[rical Conduit Utility-Undrgrn 45. Forms 4. Elsctrical Conduit-Undrgrn 46. Electrical Bonding . [ee ein orce 47. Rou h Plumbin & Pressure Test 6. Electrical UFER Grn 48. APPROVALTO CAVER-GUNITE 7. Footing: 49. Electrical Conduit•Undr rn 6. . Foundation 50. Gas Pi e, � Undr rn, Test 9. LVater Pipe-Undrpm 51. Backwash Lines P-Tra n ndr rn 70. Structurel Floor SYstem 52. APPROVALTO DECK 11. Property $ewer Line & House Connection 53. Backwash & Rece tor-Final 12. Street Sewer Connection ' 54. Heater & Vent-Final 13. Rough Plumbing 14. Rough Electric-Conduit 56. Electrical-Final 15. Rough �lectric-Wiring 57. Solar System-Final 76. Rough Heating & Air Condi[ioning • encing & Access Approval 17. Ducts, in S[ructure APPROVED FOR PLASTERING 18. Ducts, Ventilating . 19. Gas Pipe=Rough & Test 60. POOL/SPA SYSTEMS FINAL 20. Roof Frgming - 21. Roof Sheathin NOTES: o r 'f - (�-"`� �-��.Yb"L 22. Frameand Flashin 'a�- 23. Insulation 24. Lathing & Siding 25. Drywall Nailing ' � 26. Plaster Brown Coat 27. Electrical Power Meter-Final � 28. Final ElQctric -/3' �'L 29. Final Heating & Air Conditioning 30. Final Gas Pipe-Test 31. Final PlUmbing �/ -�'y • 32. Water Service-Final � 33. Gas Service-Final � 34. Solar pomestic-Final 35. Landsca e S rinklin S stem 36. Sound qttenuation 37. Handicap Regulations � ' ' 38. FINAL STRUCTURE & BUILDING 39. Special pequiremenis Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATEOFOCCUPANCY No. Date . � I [ so 5.4�- . x,�.v�Z.. %5� "x 5 "�A� ao�r- °1 Y,, �', `•� �It � r ... � �. } . .: THESE VLANS MUST BE ON JOB Ai AlL TIMES KE NO CHANGES WITHOUi PRIOR APPROVAL DEPT. THE fSSUFhCE OR GRpNTING OF R PERMIT OR APPROVAL PIAyS AND SFECIFICATIONS SHALL NOT BE CONSTRUED BE A PERMIT FOR, OR AN APPROVAL OF. NNY VIOlATION ANY OF THE PROVISIONS OF THIS CODE. NO PERMIT PRE• 11NG TO GNE AUTHORIiY TO VlOLATE OR CANCE! THE �VlSIONS OF THIS CODE SHALL 8E YALID, FXCEPT IN SO 0.S THE WORK OR USE VYHICH li AUTHORIZES fS (AWFUI, THE ISSURNCE OF A PERMIi BASED UPON PLANS AND ECIFICATIONS SHALL N0T PREVENT THE BUILDING OFFICIFL �M THEREAFfER REQUIRING THE COflRECTION OF ERRORS SAID PLpNS AND SPECIFICA710NS OF FROM PRE4ENTING ILDING OPERATIONS BEING CARRIED ON TNEREl/NDfR WNEN YIOlATION OF, THIS CODE OR OF ANY O7HER OFOINANCE . THE CIT� S�RUCTURA! APP�F/OVA! ONLY fd�0'!'l5c '"- SEPARATE PERMITS ARE REQUiRE� • fOR ELECTRICAI, PLUUBING, ; HEATING, VENTlL�:TING AND � REFRIGERATION WORK f��a �rua�� #_/��- 3�'/ THIS NUi.1BER i'�'Sl f:i,COiA?ANY ALL INSPECTiO,! �tEQiJESiS FOR BUILDIPiGS 1'��: PtRSOt:S AftE TO � BE Et9PL0YED, V.� SU�GEST THAT THE �STATE OF Gall� OR.:A+ Dil'ISION OF INDUSTRIAL SAFEIY BE COFJSllLTED FOR ADOITIOM1'AL REQUtREf�P7iS. w . Y�CS A. SC.HAFc'TL a9 a C3ucKNe-zt. f7D, Co5 i R mr'Sq C/-�, �ALE / S4. _ ( �07' sPEcrPic,gr�an>s : • So��/l, �,pAT� STb2AE TAiv,e 80 4qc w,r� /SD /6, Q6z. i r-F VR� vt= • PuMP //S U.¢G � y�Q/q, S Pc�'79 ' �ONTTZoc.S - So��D STa't�" • Soto2 COLLEC?Z1�2S - Z - �! � x S' MouNr� ON E�F�rzaC�c 2ooF 50✓�i Y-iaC � 1.a C.� - w�-�41 A�xa.�.. a r, � A �a va - w� TH l50 lb, Qt.Z l c-F V'0. • 3/4Ip �-,pP��'� P�Pc • Sc'IVSo25 f37" [�octEQDa � 7X1 � �F�2A h c l�SP: /RLT Sllrn/, � IuATEYL NE74Tt'�'L i�0 Ui?f. 2, 500O2 STDl2qb� TAN!( I�uM G e� � C'ONT2o�S 3. �. - S�'x B'socc2 /-kT�uEZ.s APP2ox. SO Ib�. EA. w�NZ RooF QqFiEl.S 2�X 6� sPftcii�b ay" oc �� /� FT, • �•J}�Y� � �� . COSTA MESA BUILDING DEPARTMENT P. O. 80% 31'/ COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN ADDRE55 � puCiCiSe� [U+• COSTA MESA. CALIFORNIA IOWNER 1555 Placentia ARCHITECT OR ENGINEER ADDRE55 LEGwL oescair.ioN A.P. NO. SIZE OF LOT ISETBACI( IINE FROM CENTEF OF STREET t Beach, Cal. T�o: rff 6-3z $$7Ile LIC. NO. y98ID8 n�n COII$L• CO� CITY LI0. 141(. NO. B e NO. 9� 47 BLOCK TRACT 2OG ,OO�I�J NOW ON LOTS O SO REAR YARD GO�'^V�� DESCRIPTION OF WORK NEW p ALTERATION ADDITION REPAIR ' MOVING OEMOLISH 5 ZIE DING 1 7 — 69 ROOMS V STORIES 1 EXTERIOR WALL ROOF COVERING Hf.UCCO COVERING hot—mop 115EOFNEW .._..ei_—__ n _i1 �� . '- _1�' I �� ` _ 7,-r-,/. L' �I,,:,�.�, E;��T. �i ^^ 'C APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY RECEIPT NO. PERMIT^NC Lt ECiEIVLp 9Y �=Ei E^EI'E� �pnTE �55 lA 1Y•l B 6 �� COSTA MESA. CALIFORNIA APPROVE� BV CORRECTIONS STPTE THAT TXE R90VE IS CORRECT PNO AGREE TO COMPLY WITH ALL purpose of establishing a ermit fee on CITY ORDINANCEB AND STATE LA�NS REGULTTING BUILUING CONSTPl1C� T�o�. VALUATION SIGNATURE OF PERMiT FEE� S 3S• PEFMITTEE �S n�ry•oo �ry. % � � PLAN CHECK S � � eiirunancn er.rtir TOTAL FEE 5 �ii_ A v��