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Home My WebLink About258 BOWLING GREEN DR - Building Permits� PFOJEC�AOOflE55: z,8 B�y,rLING GREEN DR JOiNNEH'SNPME: LEWIS JUSTINE TR AODflESS: �SS B`UWLING t�kEEN DR COSTA ME5A,CA 92626 AflCNIENGINEEN: S 4 8 — 5 5 6 g nooaess: flEG.NO.: uxir: uxiT: PEflMITfEE: CRANY. HROS ROOFING CO ( 714 ) 548-5569 nooRess: 126 COMMERCIAL WAY LICENSEO CONTflALTOfl O WBA IUNME5e0�y aflirm �hat I am licensetl un0er p�ovisio9n5 of�hzap,er 9(commencing wi�� Section 7000� ol �ivison 3 of �he Business antl PmtesSions Cotle. a my license is in fullforce antl ellecl. IC.: /� STpTE LIC.: CU155: � y05993 9086 C39 �yXP; 06/95 ��ate' -J'_f-- 3— �� $ignaWre'. _ _ // NEHS' COMPENSATION OECLAFATION: I her a� that I have a e ilicate o consent to -insure or a certificare oi Workers' ensa�ion Insurance, or a cehihed copy I o� ( �ion 3800. La�. C). aoucrNo.: Zg5-94UNIT EXP.DATE: OZ/OL/9S COMPANY: �TATE FUNI�, eniliea coDY is hereby fumishetl. Lx Ceriifie� copy is IileO wii� �he ci�y 9uil0ing Division. Oa� /� 3 — 9� A�Glican�: �kl�-rt- � "?�� EMPTION FHOM WOPNEflS' COMPENSATION UECLANFTION: (This section neetl not be completetl ii the permit is for one hunUrea (5100) or less�. I certify �hal in the pedormance of �he work for w�ich ��i50e�mit is issuetl, I shall nat employ any De�on in any manner so as [o became sublect �o ��e Workers' Compensa�ion Laws o� Califomia. �ate: 5ignamre: NOTICE: I�, a��er making this declaraiion, you shoultl hecome suble�t Io ��e Wo�keK Compensation pmvisions ol the la�or Code. you mus� Iorinwiih comply with su4h pmvisions or �hi5 permil shall be tleemetl revoketl. CONSTPUC710N LENOINC AGENCY: I herehy aflirm thal Ihere is a constmction lending agency for the DeAormance of ihe work for whic� ihis permil is issued �Semion 3097, Civ. C�. LENOEN: ADOflESS: OWNEP BUILDEH DECNNATION: I herehy a0irm thal I am exempt irom ihe Coniractors' State License Law far tAe following reason (SeCtion 7031.5 Busine55 and Pmie55i0nal CoOE� pny tiry oi counry which require5 a Dermit �o ConS�mCi, aller, impwve. Oem0lish, or �eDair any s�mtlure. prior ta i�s issuance. also requires lhe aDDlicani lor such permit b �ile a signetl sla�emeni �hai he/she is licensea pursuam m Ihe Dmvisions of ihe Conlractors' State License Law (C�apter 9(commencing with Section 7000) ol 0ivision 3 of t�e Business anA Ro�essions Code) ar Ihal he/she is exemp� ��ere�mm ana Ihe basis lor the allegetl exemp�ion. Any viola�ion o� Sec�ion 703L5 by any applicanifor a permii sublects ��e applicanl to a civil penal�y of no� more Ihan five hundreJ tlollars ($500). i, as owner of the DmDeny or my employees with waBes as t�eir sole compensation, will Aa Ne work, an0 the '❑ s�mcmre is not intenaea or ollereA for sale (Section 7044, Business antl Pmiessional Code: The Convactors' State License Law does no� apply lo an owner oi a D�opeilY w�o OuilOs or impmves �herean, antl who tloes such work himsell/herselt or Ihmugh �is or her awn employees. pmvidetl tbat such impmvemen�s are no� intentletl or offeretl �or sale. II, however the huilAing or impmvemeni is saltl wit�in one year o� complelion. �he owner will have Ihe 6urden of Oroving �e/she tliU not builtl or impmve iDr �he pUrpose ol Sale�. I, as owner of ihe pmDeny, am e�clusively conbacting with Iicense0 contractors to constmct the pmject (Section 704d, Business ❑ antl Pmiessions Code: TAe Contracmrs 5�ate License Law Uoes not appry to an owner of property who builas or impmves ihereon and wAo conVacts �or such pmlects wi�h a comracmr�s) license pursuan� �o �he Contrac�ors' S�ate License Law�. I am aware Ihal pmo� o� Iheir Worker's Compensation insurance shoultl be pmvided �o me. � I am exemD� under Sedion. B. 8 P. C. lar Ihis reason: Da�e: Ownec lao hereoy cenity Natl am aware of ana unAe�s�anOthe requiremenis of Calibmia Healtn and Safety Cotle Sections 25505,25533,an0 25534 and tha� I or any future builtling occupanl will/will noi (circle one) need to comply wi�h saia state codes antl �he requiremen�s �or a permit lOr wnS�mC�ion or moAi�itation iwm �hE Air �uali�y Management �istriCi. flesitlenlial tonstmtlion applica�ions are exempl lwm Ihese pmvisians. Daie: qp0licanL I hereby ceriity Inal I �ave reatl Ihis applicalion antl slate tha� �he ove in�orma�ion is correcL I gree �o comply with all ci�y and coun�y ordinances antl sla�elawsrelalingio buil0ing conslmciion and he�au��orize reD�esen�a�i is cily�a en�er uDon�he above-mentionetl J//- 3-9� License or Social Security p: 164Y46 Wlnte—BUJaing�, Green—Cotle En�orcemenC Canary—Applicant: Pink—Revenue: Goltlenrotl—Assessor CITY OF CGSTA MESA = BUILDING PERMIT PERM NO• B 06974 PEkMIT NO; B Q69797 PLAN CHECK NO; N GOVT; N SUPP: N CONSTRUCTION TYPE; V—N PERMIT TYPE; STR PURPOSE; ALT JOB DESCRIPTION ; T/OFF 6 REROOF W/COMP S BUR SQ FT: 5,773 CLAIM VALUE: 5,773,00 CALC—VALOE: 5,773.OU GRO[lP OCC: R-3 /M-1 COMMENTS: SMOKE DETECTORS AEQUZRED PER 91 UHC. REAOOF 3000SF RESIDENCE if 9E iE if iE if jt if iF if 3f if if 94 if *�1F �7f-# iE iF �If iG jE �E it a! if it 1t iP it if iE it 1f 1f if i: iF if �f af iF iF if M if if if %iF i: if if if if iR iE ik iE it if iE if a! N� if if� 9E iE N� �lE if if iE 1F at+f Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ D1AIN HUILDING ---------- --------- ACCESSORY BOILDING --------- FRNT: FT IN REAR; FT IN FANT; FT IN REAR; FT IN LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN PARKING REQ• PROV: PARCEL: 19139124 ZNE: REF NO; PLANNING NOTES> j.. it aF k aE it iE if if ik if if iF ft iF 1F it it if it N if �t if it ik i! iE iE 1t if ie iE if �F if iE iE iE if it iE iE if if if if if iE if iE iF 1t iF iF if k iF it iE if iF af if if jf iE jf if.aE �f jE if if if� if i� iE if if D E V E;L U P M E N T S E R V I C E S R E Q U I R E M E N�T 5 20NING APPROVED HY DATE: BUILDING APPROC'ED HY ; DATE; � Q APPLICATION ISSUED BY; DATE: �t*it**�t*��r*i�****�tit�t�r**�r �irir+t�-itr*ar* ! \� 41tiFiEitiFitifitifififiFiFikMifrififititifitit±lifffiEffifiFififiFififiFiFikritiFiflfif3fifjE�EMriFM1fM�1EiFiFititaEitirificrififikiEl! ii ifiEifiF LEGALIZATI013:N F E E S U M M A R Y STRUCTURAL SEGMENT;Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GP.ADING PERMIT 81,00 ,58 SMIP/NON—RES PLAr� ISSUE FEE � ?�UiI,TaIt��—t12t+—� pLAN12'1' Is�tt� PLAN—t_HECK TpTAL " PAID DUE TCl`i�L�----:'' n1.Sti 0.00 t).Op 81,58 �81.5b ,0� AEVENUE DIVISION TOTALS--> COLLECTED; 81,58 OVER/SHORT; ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIPlTOT GRADING PLAN—CHECK 81,00 ,58 if ak if if±f af if iE iE if jE it if i4 ik if iF if iE if iE iE if it iF it iE if if if if * iF jE iE 3f �1R jf iE iF 1F iF if it it if iE iE iE jf M if +f iF *� iE jf iE jF iE jf iF �f iR iE at if 3E �E iF iE if if iE jf iF �lE iF I N D Z C' Z D U A L F E E B R E A K D O W N�' TYPE QTY D E S C R I P T I O N UNIT COST � TOTAL COST SFR 5773 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 5,773.00 END OF FEES ' .r ! ` �,F DI OOi711[u"'0�1711il� Tl.a'� 31.J� GATE: 1J/Q3%'�'4 '(Ilic'; ZO:I4 � CONSTHUCTION AND PLANNING � .' PO�& SPA j ' � APPROVALS Permit# `Jate inspecto� qppROVAI.S Permitak i Date Inspector s � l. Temporasy Eleccricat Service or Pote 52. Pooi & E4uipment Location � 2. Soil Pipe�Undigmd. • �, � 53. Steel Reinforcement 3._ Electrical Conduit Utility-Undrgrnd. ' 54. Forms 4. Electricai Conduit-Undrgrnd. _ 55. Electrical Bonding '5. Steet Re�nforcemenY 56. Rough Plumhing & Pressure Test � '6. Electritai UFER Grnd. � . 57. APPROVA� TO COVER�GUNITE 7. Footings ' ' 58. E�ectrical Conduit�Undrgrnd. B: Foundation ,' � � ' 59. Gas Pipe, � Undryrnd., Tesc , ( 9. NJater Pipe-Undrgmd. , � 60. Backwash Cin2s, P�Trap. C� Undrgmd. ` 10. Structural P�oor SYsiem " 61. APPROVAL TO DECK �� i i. PropertY Sewer �ine & House Connec.io� 62. Backwash & Receptor-Finai 12. Sewer Cap -. , , 63. Heater & Vent�Final • 1 73. Roof D�ains rr . . 64. Plumbing System - Pinal ! 14. Rough Plumbing � � 65. Electrical-Final 15. Rough Electrical-Conduit 66. Sotar System-Fi�al I 16. Rough Electric Wiring 67. Fencing & Access Approval � 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Fiough Electricai-T Bar Ceiling 69. POOLlSPA SYSTEM1AS FINAL 1 19. flcugh Heati�g & Air Conditioning FIRE DEPT. IiEQUIREMENT � 20. Rough Fastory Fireplace � � � - APPROVALS ' Permit # �. 21. Ducu,in Structure . ., -. � 70. Underground Hydro � 22. Ducts, Ventilating- . ' ' 77. Product Pipiny GGas ❑ Oii 23. Gas Pipe�Rough &Test , , '7,2. Underground Flush'. -� 24. Roof 'rraming �.. • •� ; -' 7,3. Underyrnd. Storage Tank O Gas ❑ Oil 25. floof Sheathing �. 9' 74. Overhead Hydro ��- �� 26. T-Bar��,Ceiling (Structural7 & Monocoat ' � 75. Dry Chemical " D. Frame and Flashing �' , ., ; . � . 76. Dry Standpipe - _ . � � 28. Lathing &�Siding . . . � � �� • 77. .FIXED SYSTEM�FINAL ' 29. Insulation� ,; ' .. " " � . � . , 7g, �FIRE PREV. FINA�. . 30, Dryrvall Nailing � • HEALTH DEPT. REQUIREMENT 31. PlaSter Brown Coat' , ' � 79. FINAL INSPECTION � � 32. Elzctrical'Power Meter�Final '� 80. �FOOD CERTIFICATc lSSUED 33. final�Electric � � ' � Notes: . , I 34. Finai�Neating & Air Conditioning ' � � _ � . • j 35. Finai Gas Pipe-Test � �� i 36. Hood'o� Canopy � • - ' � -�-_� 37. Final Factory Fireplace ' � ' � 38. Final Ptumbing . . . , • � , -- -'i_� i 39. WatecService�Final. ' • � 40. Gas Service-Final ,. . � „ 41. Solar pomeetic-Pinal - �� ' ' � ` i 42, Backflow Preventer . � , . . 43. Backflow Irrigation � . � ' 44. Landscape irrigation Systzm .- , . . G l�� I �� 45. Sound Attenuation �� - • ' � � �' /` . . . . G �C` '� l2Gt� 46. HandicaP Regulations . � �� .' , � . 47•. FINAL STRUCTURE & BUILDING � -/� �� 46. FINALPLANNING _ � . 49. E�ectr.ia Re�ease to Edison �' • ;; 5Q. Gas Retease to Southern Caiifornia Gas Co � �" . - ' . � 51. CERTIFICATE OF OCCUPANCY`� - No. Dace Applicant to fill in a11 spaces witnln heavy bortler lines antl sign all aoG�oo/�ate declarations. CITY OF COSTA MESA � � c MIT NO. TRACT NO', LOT NO: -BIDG. NO. CONSTRUCTION PERMIT �� Sn S ' � x-' ' Arch/Eng. ' � License No. Address � TYPE OF CONSTRUCTION V/ 'D 7� ❑ NEW ❑ ADD ❑ ALTERATION - . ❑ REPAIR ❑ CONVERSION ❑DEMOLISH ' O OTHER DESCRIPTION OF WORK O I hereby atfirm that I am licensetl untler provisions of Charter 9(com- mencing with 5¢ction 7000) of Division 3 of tha Bu51ne55 antl � Protesslons Code, an my Ilcense is In fu❑ force antl effec[. LI<ense Class �- { � Llcense No. �sS Date�'"^zrt-��^ Si9nature ✓�'��° f�-�-- �� - WORKERS' COMPENSATION DECLARATION I hereby affirm Ihat 1 have a certiflcate of consent to salt-insure or a certiilcate ot Worker5' Compensation Insurance, or a certifieE copy ereot (Sectiory,3$ �, Lai . C.). ^, �vA ✓� r �, ,l_. Icy No. y�f" '-G Company � � �� Certifietl copy Is hereby furnishea. . ' Certitietl copy Is file� wlth the clty Builtling Division. E%EMPTION FROM WORKERS"COMPENSATION DECLARATION (This )section neetl not be tompletetl it the permit is far one huntlretl S$ter�(fy thats�n Ihe performance of the work for which this permit Is ISsuetl, 1 ihall not employ dny p¢r5on in any mdnner so as to become subjett to the Workeri' Compensation Laws of California. Date Signature NOTICE: If after makin9 this tletlaration, you shoultl become'subject ' to the Workers' CompenSaHon provislons of the �abor Cotle, you must tor[hwlth comply with such provisions or this permit shall be tleemetl revoketl. . . , CONSTRUCTION LENDING AGENCV I hereby�affirm that Ihere is a construction lentling agency.tor the per- tormante.ofitha:work for which�this permiLis�issuetl (Section 3097, Civ. C.). ' - ' ' . ' Lentler's Name Lender'S Atltlres5 � OWNER BUILDER DECLARATION ' ' I hereby aTfirm that I am exempt fromlhe Contractor's License Law for the following reason'(Section ]031.5 Business antl�Professions Cotle: Any city or county whiGh r¢quire5 a permit to con5truct, alter, improve, tlemolish or repair any structure, prlor to its issuance, also're-� qUires the appliwnt tor suth permit to /ile a Signetl statem¢nt that he Is IlcenSetl pur5uant to th¢"prOvi5iOn5 0/ th¢ Con[rdC[or's LiC¢ns¢ Cdw (Chapter 9(commencin9 with Section 7000) of �ivision 3 of the - einess antl Prolessions Cotle) or tha[ be is ezempt therefrom antl the- � for the allegetl exemption. Any violation of Section 7031.5 by applicanY for a permit subjects ihe'applicant'to a civil penalty �ot more tnan five huntlretl tlollars (g500). � I, as owner ot tM1e property, or my employees witti waqes as their sole compensation, will tlo the work, antl the structure is not intentletl or offeretl for sale. (Section ]044, Business and Professions Cotle: The CoMractor'S License LSw tloez no[ apply to an owner of a property who bulltl5 Or ITproves tM1ereon, antl who tloes such work himsel( or throu9h his own employees, provitletl that such improvements are not Intentletl or otfe�etl fo� sale. If, howeveq the builtling o� Improvement Is soltl within one year ot. completion, the owner wili have the burtlen of proving he tlitl not builtl or improve for the purpose of sale). ❑ I, as owne� ot the property, am 2xclusivety cont�actin9 �+�th licensetl contractors to consVuct the project (Sectlon 7044, Business dntl'Profe55io05 Cotle: The- Contractor's LlcenSe Ldw tlo¢5 nat apply to an owner of property who builtls or improves therean, antl who con- tracts irom 'such projects witn a contractor(s) IlcesneC oursuant to the Contractor'S License Law). ❑ 1 am exempt untler Section B. & P. C. for this reason Date Owner I h¢r¢by certify[hdt I hav¢ r¢atl this appliGation antl state that thE above information is mrrect. I aqree to mmply with all city antl county o�0inance5 antl state IawS �elating to constructlon, antl hereby authOrize representatives of [his city to enter upon the above mentlonetl pro0erty tor�}'r��Spectiop purpyses. Si9nature /�Y/�%l-A�'-c�- /.'l -/�'"s1-at oate �%',�+1' �� TYPE OF PERMIT ❑�GRADING ❑ FOUNDATION ❑ STRUCTURAL O TENANT ❑ ELECTRICAL E�PLUMBING ❑MECHAI ❑ OTHER PROJECT DESCRIPTION . SQ. FT. OCCUPANCV_CONSTRUCTION TVPE VALVATION ZONE GftADING CU. VOS. ACRES PLUMeING BATHTUBS TOILETS LAVATORIE$ KIT.SINK$ . ` SERVICESINKS � FLOOR SINKS � DRINKING FOVNTAINS INTERCEPTORS SWIMMING POOL WATERSERVICE ' GASSERVICE PLAN CHECK SHOWERS URINALS DOUBLELAVS DISHWASHERS FLOOR DRAINS CLARIFIERS PTRAP ALTERATION - OUTLETS BTU OUTPVT " - SEWERCONNECTIONS- '� SOLARTANK ' COLLECTORS"- SOLAR PIPING SYS. � ISSUE FEE MECHANICAL PLAN CHECK HEATING SVSTEM 0-300,000 BTU_ AND OUCTING' 300,000 � BTU _ REFRIGERATION 0-100,000 BTV_ SYSTEM 500,000+gTU_ BOILERS BTU SVSTEM REPAIR,ALTERAT,ION EXHAUSTSVSTEM MULTIPLE � ISSUE FEE 5fa78 5/10/82, .�'r , :�,y - ... _ A.P. REAR VARD (TO P/L) PKG. SPAC E R EQ. STREET WIDTH� IAL CONDITIONS: ELECTRICAL " " P�aN REF. PROVIDED PARK FEE ' GENERATOR Q-1 KW_ 1-10 KW _ TftANSFORMER ' ' APPL'IANCE 10-SOKW_SO+KW_ MOTORS � 0-1 HP_1d0 HP _ (INC.SO�AR) 10-50HP 50�+HP_ ' FIXTVRES OUTLETS SWITCHES ' GAS TUBE SIGNS ' POLE LIGHTS ' ' ' �.. PANELS MAIN SU SERVICE' AMP � 5.0� �TL� ISSUE FEE ',� - APPL•ICATION P.PPROVED BV � DHTE SUMMARV OF FEES �� . BUILDING PERMIT S SMIP 8� PLAN CHECK $��'� , � PERMIT ' �� PLUMBING $ �• Y`�L' �SSUANCE $ � GRADING' $ PLAN CHECK E . ELECTRICAL $ ' " a PLAN CHECK $ MICROFILM $ � - TOTAL FEE $ �' �� MECHANICAL $ - P�AN CHECK LESS'AD- ' _ 3 VANCE�C $_ CMP OB65-46 White-Builtling; Canary-Applicant; Pink-Accounting; GolEenrotl-Assessor � / �;�-9�y r�,- .1,��rp,��>7"io.�J .n FINAL FEE $ � ��` CONSTRUCTION AND PLANNING ' .' r�.� POOL & SPA " • � . , APPROVqLS Permit# .�% � Date Inspe�tor qPPROVALS . • Permit# Date' Inspector 1. Temporary Electrical Service or Pole � 43. Pool & Equipment Location � 2. Soil ipe:Undrgrn� ' • 44. Steel Reinforcement � 3. � Electrical Conduit Utility-Undrgrn - 45. Forms � - � � ,4.., Electrical Conduit-Undrgrn 46. Electrical Bonding � tee em orce • 47. Rough Plumbin & Pressure Test - 6, Electrical UFER Grn 46. APPROVALTO COVER-GUNITE 7. Footings 49. Electrical Conduit-Undr rn 8. . Foundation - • - 50. Gas Pipe, ❑ Undr m, Test � � . 9. : Water Pipe-Undrgrn 51.- Backwash Lines P-Tra ❑ ndr rn - - 10. Structural Floor System 52. APPROVAL TO DECK 11. Property Sewer Line & House Connection � 53. Backwash & Rece tor-Final � ' 12. Street Sewer Connection �� ' 54.- Heater & VenDFinal 13. Rough Plumbing 14. Rou h ElectricConduit - -�56. Electrical-Final � • � � 15. Rou h ElectriaWiriri � � � - 57. Solar System-Final - � � 16. Rou h Heating & Air Conditioning • Fencing &�Access Approval � 17. Ducts, in Structure '� � ' 9• APPROVED FOR PLASTERING � 18.- Ducts, Ventilating . . - , ' 19: Gaspipe-Rough&Test 60. POOL/SPASYSTEMSFINAL , ' � 20. Roof Framing � 21. Roof Sheathin - � � '' - � � � 22. Frame and Flashin NOTES: _�� . y Z 23. Insulation ' 24. Lathing & Siding - � - 25. Drywall Nailing - - �� - 26. Plaster� Brown Coat - 27. Electrical Power Meter-Final � � • � ' � � 28. Final Electric - � � ' � 29. Final Heating & Air Conditioning � -�30. Final Gas Pipe-Test � � 31. Final Plumbing / - -9,L " 32. Water Service-Final 33. Gas Service-Final 34. Solar pomestic-Final 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. CERTIFICATE OF OCCUPANCY � No Date :r. - �'� u"; r{Gc ;r:-v � '.v� y^Fg4! owNea�K . •a r.,.` � ��CO] . JOBADDRESS Q5( � GENERALCONTRACTOR H8I � _` LOT 5]. � '; GROUP I & J � �', '/ ` INSPECTIONS' � Footing Trench � � Foundation Fo�ms and Grade to � � ..r��, 1 r I . .GE:PARK�_ ,�1. o'AT '' -]f2,_ !. � � E��>- � � f" ' - : •n�hw:. ' �' I I - ( , � � . ,. � \ �� BUILDINGPERMITNO. C)ZZ 3 � 1' n \�.G v _ ; ,..�,� i t, _ R; ir Construction va�ue'a',,:T2 1�00.00 , � , BLOCK ��TRACT � R t�' / ,., . ;-=r:�. . TVPE( ' V �ZONE ` FIREDISTRICT LL%OZ e � PERMITS ISSUED �� DATE' SUBCONTRACTOR i / . � -. DATE I NUMBER � �' Rough Framing lJ,y$' b%10 / •�� Plumbing, Rough to Slab v V -i5 - � Plumbing, Rough Complete �t �.,$ .> r _ � Temporary Pole AP 2 1957 !rrp �i . Wiring,Rough �l•-l.L-�j � ` Heating, Rough lvLG,�j "� Heating, Final �N,L �p� s' S �BE'wer, House L Seweq St. }7'1 � S ��3',r% SepticTankorCesspool � � t Lathino.ln Out ! .i7c�� /� Plastering Plumbing, Final, Fixtures Plumbing, Fin.al Gas Test Wiring, Final Occupancy FOFM 210 .3M �O�'v3 $ 6 �.s� .�� .. �. � - ... " l - , ,.yY, •�^ �4 a 01 COSTA MESA BUILDING DEPARTMENT P. O. BO% 31� - � GOSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN ew�oiNc ADDRE55 OWNER C MAIL ADDRE55 arv SAN ARCHITECT OR ENGINEER COSTA MESA. CA�IFORNIA i C�C PdRK Nll _ �i LEGAL LOT DESCRIPTION NO. A.P. NO. SIZE O OF LOT L15E OF E%ISTING BLDG. $EiBiCK LINE FRO CENTEF OF STREEi SIDE YARD RIGHT y IEFT DESCRIPTION OF WORK, � HNA, CALIF. T�o� KI 5c LIC. NO. / � / /d c_iry �ic4�i23 ��'�we� NO TEL. NO. 5 � BLOCK ' TRACT � �'�. NO.OF BLDGS.. � �' I I� 1`IOW ON LOT � 5O REAR YARD 3�J ftEPAIR BIIIL�ING SRE � C E%TERIOR WALL GOVERING ' USE OF NEW ALTERATION I qDDITION MOVING I OHMOLISH NO.OF ROOMS STORIES " ' ROOF COVEftING • � � �_��ii�� FEE RECEIVED �(V� �. ..�� , i c�'� � ..� �� FINANCE DEPT. APPLI�(lOPJ�S�S{aERMIT BUILDING FOR OFFICE USE ONLY ftECEIPT NO. ��t �¢� V fi IECEIVEO BY � OATE RECEIVE� 04TE ISSUE� � BUILDING / ADDRE55 COSTA MESA. CALIFORNIA APPROVED BV STATE TMnT TME iIBOVE i5 COFRECT AND l�GREE TO COMPLV WITM nlL CITY OFDINANCE$ ANp ST4TE Li�NS REGULFTING BVILUING CONSTRUC- T�o�. , VALLJATION SIGNATLJftE OF CO L L EG E PAR K NO. 3 PERMITTEE �12�4��, ED AGENT � � PLA DATE CORRECTIONS PERMIT FEE $ PLAN CHECK $ TOTAL FEE $ � yDM3