HomeMy WebLinkAbout280 BROADWAY - Building Permits<
` CITY OF COSTA MESA , •
° ' ' � BUILDING DIYISION
> �
� DEVELOPMENT SERVICES DEPARTMENT Bg$-00823 �
J. ' L :
��; PERMIT PERMIT NUMBER
(714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Jobnddress: 280 BROADWAY
Suite:
Viciniry:
Parcel Nunmber: 11721310
Applicant: CRANK, JIM.
Address:
Owner: DEWILDE, ANNABELLE TR
Address 280 BROADWAY
Zoning:
Phone:
2ip:
Phone:
COSTA MESA,CA Zip: 92627
Contractor: CRANK BROTHERS ROOFING CO
Address: 00726 COMMERCIAL WY
Arch / Eng :
Address:
Plan Check:
Permit:
Other:
Inspection:
COSTA MESA CA
Phone:
Zip: 92627
License: 408677
Phone:
Zip:
License:
SCOPE OF PERMIT
T/OFF INSTALL SHEATHING 8 REROOF 2400SF RESIDENCE
$0.00
$124.75
$0.00
$0.00
Total: $125.37
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existing: o
NOTES:
Rear 0- 0
Rear 0- 0
Re uired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
LeR 0. 0
Pr000sed: 0
Stafus: ISSUED S1A7k
Applied: 05112/1998
Issued: 0511211998
Calc Valuation: So.00
Claimed Valuation: ss,ie�.00
Right 0. 0
Right 0. 0
EXPIRATION: This pertnit shall automatically expire and become void it work is not commenced within t80 days, or il work is suspended or abandoned
for a period of 1B0 days.
INSPECnONS: In ortler tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
reQulred Inspeatlone and flnal epproval must be oblained. Failure to obtain inspecllons and final approval will result in the expiration ot this permit.
FOR INSPECTIONS CpLL: (714) 7545826
WORKEpS' COMPENSATION DECLARATION:
I hereDy affirtn under penalry of peQury one of the following dedaretions:
❑ I heve antl wlll malnteln e ceNlicate o1 cansem to self-Insure for workers' cwnpensatlon, es proNdetl for by sectlon 3700 of t�e LeDor Code, tor Ne pertormence of t�e
' vrork tor which Ihls permit is Issued.
❑ I have end will melntein warkers' canpensation Insurence. es requlreE by seclion 3700 af the Lebor CoOe. tor ihe peAortne�e o1 1ho work tor which ihis pormit is issuod.
My workers' compensetlon Inwrance cartier entl pollcy numDer ere:
Certier: Policy Number.
(mis sectlon naee not ee oompletee u tne pe�m/t rs ve�ued er one nundred dollers (S I00) w/ess.)
❑ I cenify thet In Na peAormanca ol Ihe wark lor hich this permlt ls issued, I shali nat employ eny person in eny manner w es to become subJect �o Ihe warkers'
compensetlon 1of Cellfomla, en0 , ee Ihat I I should become suaecl ro the workers' compensetion provlslons at Sectlon 3700 ot t�e Lebor Code, I shell forthwit�
comDN'�� N e provisions. � _/ 2_^�
`� ApplicaniSignaNre� Date: 7�
WFRMNO: FAILU SEWRE WO (ERS' OOMPENSATION COVEMGE IS UNUWFlIL AND SHFLL SUBJECT AN EMPLOYER TO CRIh4W�L PEW�LTIES M1D GVIL FlNES UP TO ONE HUNDRED
TFqU.4WD (St00.000�.INADIXiIONTOTMECOSTOFCOMPENSATION,DAMAGESASPROVIDE�FORINSEGTON3)O60FTHELABOFiG�ODE,IMEqE$T,ANDATTORNEY5FEE5.
LICENSED CONTRACTORS DECLARATION:
I hereby effum ihat I am licensed u r provislons at Chapter 9(commencing vrith Section 7000) of Divislon 3 oi the Business and Prq}e,�slons Coda, end my Ilcense is in tull
rorce ana etted. uc. a Cti �!'J �6 '7 � qass s G 3/
--�- Coniractofs SigneWre:�=�--�� Date: �= / �-- �
�
CONSTRUCTON LENDING AGENCY:
❑ I hereby effirm ihat t�ere is e constructlon Iending egency br the pertortnance of the xrork for whlch t�is pertnit Is Issued. (Sec. 3097, CMI CoOe).
Lendefs Neme: Lenders Address:
Signature:
OWNER-BUILDER DECLARATIONS:
Dete:
1 hareby ettirm �het under penelry ot perJury ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reeson (Sec, 7037.5, Buslnes� entl Prolessions
Cotle: Any Gry ar wunry which repulres e permlt to construct, elter, improve, demolish, or repalr eny structure, pdor to its Issuance, elso requires t�e eppllcant for such pormit
ta file a signed stetement Ihet he or she Is Ilcensed pursuant to Ihe D�slons ol Ihe Contractars License Lew (Chepter 9(commencing wlih Sectian 7000) of DlNslon 3 ai t�e
Busineu antl Professions Code) or thet he or ehe is axompt Ihereirom entl the Dasis tor the elleged e:amption. Any violetian of Section 7037.5 by any epplicent for e pertnit
sub�ecGs me epplicent to a civil penalry ot not more than tive hundred tlWlars ($500).):
❑ I, as owner of t�e property, or my employees with wepes as t�elr sWe compensatlon, WILI DO THE WORK, end the struqure is not Intended ar oHeretl for sale (Sec.
7044, Business and Professions CoGe: The Conirectars LJcense Lew tloes not eppry to en owner of property who builtls or improves thereon, end who does such work
hlmself or herselt or t�rough his or her own employees, provided Ihat such Improvements ara not intentletl or oHeretl for sale. If, however, the bulltling or Improvement Is
sold wlthln one year ol completlon, Ihe owner-Dulltler wlll �ave the burtlen ot proving ihat he or she Gitl not build or impmva tor purpasa ot sele.).
❑ I, es owner N the properry, am EXCLUSIVELY CON7RACTING WfTF1 LICENSED CONTRACTORS to construct the prqect (Sec. 7044, Buslness end Protessions
Codo: 7Te conireciora License Law tloes not eppty to en owner ot properry who builEs or improves thereon, and who contracts lor such pro�ect wlth e contractor(s)
liCense pursuaN lo the Cantrectors LiCense L6wsJ.
❑ I am exempt under sec. Business en0 Professions Code tor this reawn:
Signeture: Date:
Owner ID verified by drlvers Iicenw. ❑ Ves ❑ No Drivefs License No.
Vedllcation of Ownershlp 6y (type of documenL I.e. - property tex bill or tleed):
DIVISION OF INOUSTRIAL SAFETV PERMR CERTIFICATION:
Expires:
❑ I hereby certily that no excevation INe (5) or more feet in depth into whkh e person is reQulred lo tlescend, wlll be made in wnnectbn wIN work euthorizotl by lhls
pertnit, entl Ihet no bulldinp structuro, sceltoldinp, felsework, or demolition or dlsmenLing thereol, will �e more lhen ihirty-sia (36) feet high. (Chep. 32, G�p 2, An 2, Soc.
3at, Title 8, Califomia AdminlstretNe Catla).
❑ As owner-builder, I will not emplay anyone lo do work which woultl requlre a pertnli trom Ne DMsion at IndusMel Safery, es notetl eDove, unleu such Derson hes e
pertnit to tlo such work trom the Alvislon.
Signeture: Date:
Division ot Intlustrial Safery Permit Number:
CEHTIFlCATE OF COMGLIANCE AND AUTTIORIZA710N OF EMAY: I ceriity under penalry ot perjury that I heve read �his epplication entl stete thet ihe Inlormetion given is I
correct. I egree lo comply with ell stete laws end ciry ordinences relatlng to huilding consiruc�ion, end euthodze representaiives ol the Clry of Costa Mesa �o enter upon the
ebove-deudbed property for InspecUon purposes. I epree no� to oaupy or ellow ocapency ot eny bullding euNorized by Ihis pertnit unGl Onal inspoIXion.
COOE I. QISPECiqNME
1616 Fixed System Finel Flre Preveniion
1266
200
zoi
202
203
204
2ubd8
Paol Spe Final
Final Re-Rooi
Finel BIocWR8I01ning Well
Finel Fectory Fire Plece
Flnel Sipn
Flnel Demolltlon
GAg It�dlS
-L6 �
Dat
S-i 2 - 9 �
Date
COOE� INSPECTIONTYVE
206 Finel Mec�anlral
208 Final Plumbing
270 Final Electdcel
212 Final Fire Preventlon
220 Flnel Planning Approvel
222
250
Final Slte
Finel BuIlGing/Occupency
��7.\i�l:nur.1�
�
�
BUILqNG: z8O BROADWAY
��� DEWILDE, ANNABELLE TR
ADMiE55: ZSO HROADWAY
COSTA MESA,CA 92627
�PPL. MAIIING ADUHE53:
pqCXRECT OH EN(tlNEEN:
ANCH.ON FNC.'S ADDXESS:
CONIIIRCTOfl'S NAME:
coxmacroxsxuuxc
�ooxEss:
uc. rro.:
uc. ra.:
u"T: CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: P 075367
PERMIT NO: P 075367 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION : ADD LAWN SPRINKLER HEADS TO EXISTI�IG SQ FT:
IINT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: /
UNi:
LICENSED CONTPACTOHS DECLAFATION: I hereby aflirm untler peneXy W perjury Ihat I am licensatl unEer pansiore M Chepter 9
(mmmendnB �h Seciion )000) oi Drvisun 9 0l lhe Busirwss arM Prdesaiana Code, eM my license is in lull brce eM eMae.
CITY LIC. NO.: LIQ CLASS: LIC. NO.: E}(r :
OWNEN BUILDEF OECIANATION: I hereby eifirm under penally of perlury t�et I em exemq trom tM Convmare License Law Iw ihe
lolbwing reeson (Setlion 9031.5 Businma and Pmleasions Cade: Any cily a counly which 2qui�es e parmA �o cons�mcl, el�er, imprave,
Eemols�, or repair eny s�mclure, pnor io ns esuence, also requiras Iha eppli�ant /or euch parmil lo file a signeE stalemaM ihal M or she
is IicensaE pursuanl lo �he prwisions of ihe Convedors Licansa Lew �Chepter 9(mmmanoirg xilh SerAion ]000) M D'veion 3 M the
Business end Profeaeuns Coda� or Nat he or sha is exempt Iherelrom and iha beais Iw the ellegad examptbn. My videtion d Sedon
J031.5 by eny applicanl for e permB subjede the applicenl lo e civil panelry of � mae ihen i've huMred dollers �$50�]).
�] �. as owrar m ma vrovany or mv �aM�s wnn weeas %� ma: va�e mm�»osmion. win eo me woM, ene ine swamre e oa ima�aaa
aaHaredforaeb(Saction)OC4,Businemand PrWesaianaCatle:ThaContrenore LicenaeLewdaesrwtepptymenawnerd propary
who W ilAs or im W�'es iherean, end who does such work MmseM or harseM a thraugh ha a har own amployaes, providetl ihet such
improvemants ere ra� intended a oHereE for aale. X, however, lhe buiNing w vnpravement ia saN wnhin ona yeer d mmdatun, IM
ownerbuiker xili have Ihe buNen d proving he or sha did rw� build or improve for ihe W�e of mle�.
� I, es vmer N the propeM. � exdusivety romredirg with IicenseE comreclors lo conavud iha vrol� (�� ��. Buain�e vM
Pmleaiona Code: The Conirectan Licenae lew daen nm epqy lo en ovmer d propenY �o buiNa or improvea �hereon end who
conVecU br such prol�s ��h e cvnvatlor(s) I'r»nsed Pursuanl lo tha Conlredore Liceme Lew).
� I em azempt under Seclion/: B. 8 PL., i« this reeson:
Oate: �/ ��—�1 Owner:�i�i��w
I do hereby cerlity Ihat I am ewere W and undersiend the reyuiremama d CalAomie Flaellh entl Safety COEe SeGbns 25505, 25533, e�M
255�C, end thei i or eny fulum buildi�p oaupent will / will nai (drele are) nead Io comply wnh aeid etete cadea eM the requireman�s br
epartniltwmnsWctionormodifirationhomtMA'v uaTyl�aragementDimnd.RasidaMielwnslruqbnappticelionsereeaemqiromihesa
a�m�a.
Daie: APolcenl:
WONKEN'S COMPENSATION DECI�NPTION: I Mraby elfimi uMar penelly W peijury oM d iM idlovnng dedvetona:
� 1 have end xiY meimen e cenXicete ot consenl to sell-inaure fa workers comperwe�ion, ea provided br by Sadion 3)00 d the Lebor
COl�O� iOf ��18 �IBIiIX111011C0 O� IM1B MVIi( iOf WM1ICM1 1�118 pBflllll 18139YB'�.
� I hev end wil main�an vrokere rompanwun insurenoe, es required by Sedim 3)00 d the Lebw Code, M iM parbrmence d Ihe
work for whiM ihis permX is issueE. My waken' campanaetion inwrance cemx eM policy number ere:
c�.:
Pdicy Number:
�mr::an;� ��d �or ne �omciarad x me v�x �: �o. o�a nuneree aawrslsroal a ia.vs.�
❑ I cetlAy �hal in Ihe pedormerrce d Iha woA Iw whch ihie pertni� is iasue�. 1 shell nd employ erry pe�mn in eny menner eo es m
become nubl� to iha workers' compenmtion lewe ol Celibmie. eM epree thm il I ahould become wbjed to IM1e xorkers
compensalion qovisions d Senion 3]OO IN iM Labor Code. I shell lonhwnh cwnpy xilh IM1oea provisiom.
De�e: Applicent:
Warninp: Fellun ro axuro workero' compenaatlon eovwaps b unNwNl, entl shell aW�ecf an emp/oysr ro etlMnsl pena/tlu e�M
elvll Hma up ro me hweroOOrouanM r/olbrs (StoO,o�oJ, In edrlltlon ro th� rost o/ comperuatlon, tl�m�pei u provltlsA ror In
Sxtlon 9]O6 0/ Me LaDor Cotle, InMrsaf, mtl attorneyl lsu.
CONSTPUCTION LENDINO AGENCV: I hereby eifirtn uMer penelry N perryry the� �M1era ia e mnatmdion IeMinB agency tor ihe
perlormence W Iha vroM br wfiid� the permA ia esued (Sedpn 3091. CN. C).
LENDEN'S NAME:
LENpEH'S ADUNE55:
I cenity thet I heve reed this epplketion enA ¢�e�e thet ihe ebova infarmmion is mrteU. I egrae m wmpy wilh ell dy end county oMinencm
eM s�ale lews reie�ing lo building conavumon end hereEy author¢e reprasentetivee of Ihis dly to entar upon Ihe eDove-mambned piopeery
lorinspadian purposes.
ANNABELLE DEWILDE
Pnm Name
�
j�NN(�F3r!-L_F_-�r_ w��6�� 0�,1�-�S-9S
Signawre M Owner/ApenUPpplicenVGonVada
(5151d6 WP) Whne-9uilEinp 8 5ffiery; Green-Fle: Canery-Applicem; Pink-Revenue; GOIEenral-rlsaeaor
COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
�*at���****�*��at***�*����**if*it��+���t**�*�*���t�**��*�**��*******�***�ieit*�*��*x*at*�-
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
----------- MAIN BUILDING -- ------ -------- ACCESSORY BUILDING ---------
FRNT: FT Irl REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 11721310 ZNE: REF NO:
PLANNING NOTES>
% �l
iE 9f jE 3F 3E 1E �E fE 9E �E �E iE dE iE dE 9E 9ElE iE 3E 3E 3E jE iE iE 3E dE iE iE iE �lE iE 9E-%iE iE ik if iE 9f 3f iE �IE 9E 3E 3E 9E 3E iE 9E 9E if jE iE iE if if iE iE iE dE dE 3E �E iE iE iE jE iE ik iE if',E jE 3E iE 3E �E iE
D E V E L O 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
ZONING APPROVED BY .
BUILDING APPROVED BY :
i
APPLICATION ISSUED BY: �—�ci'c
�)E iE 3E 1E 1ElE �E iE iE iE iE 9E 3E 3E �E 3E fE iE dE 3ElE fE
LEGALIZATION:N F E E S U M M A R Y
BLDG PMT PLUMHING ELECTRIC MECHANIC
PERMIT 7,00
258
DATE:
_ DATE: j��
DATE: �I 21 � °I�
i�ii-�FiEiE3E3EiFififjE�EiE iEiF
STRUCTURAL SEGMENT:N
FIRE SMIP/RES GRADING
�I��J7I�LI`C���F�
PLAN .
ISSUE FEE 20.00
BUILDING—DIC'—> PERMIT ISSUE P�;AN—CHECK TOTAL PAID DUE
TOTALS----> 7.00 20.00 , 0.00 27.00 27.OU .00
REVENUE DIVISI6N TOTALS--> COLLECTED; ?7,00 OVEft/SAORT; ,00
pt�14� p�qT pt.��M#tt��x ��,�¢;`��.js" �$t;TIANI�= FtR.E SMIP/TOT GRADING PLAN—CHECIt
2`7 , b 6 �
iE �E 3E �E iE iE �E fE iE iElE iE 1E iF 9E iE 1E iE 1E 1E 1E 16 iE 1E 9E 1E iE fE iE 9f iE 3E 1f fE iE 1E 7f jE 3k 3E iE iElF jE iE jE 3E 3flE iElE if jE 161E fF jf iElE 3E jF �E �E 3E 1ElE jElE if �E 3E iE if if 1E �E 3E �E 1E
I N D I V I 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
�
PLU i LAWN SPRNKLER SYSTEI�I ON 1 METER 7,00 7,00
END OF FEES
f
i
V
c�l ^::1�.. i.E>:;.:; s --- �-
6�Tr: " . .,, '''L�. . '.. .. -
'i' CON5TRUCTfON AND PLANNiNG P60� a� SPA � ((
APPROVRLS Permit# Date ! Inspector AppROVALS Permit# Date Inapector !
t. Temporary Eiecvicei Service or Pole � 52. Poot & Equipment �ocation
2. Saif Pipe�Undrgsnd. 53. Steel Pei�forcemeni
3. Electrical Conduit Utility-Undrgrnd. 54. Forms ?
4. Electrica( Gonduit-Undrgrnd. 55. Electricai Bond�ng
5. S#eel Reinforcement 56. fiough Piumbing & Pressure Tesi j
6. Eleclrical UFER Gmd. 57. APPRdVAL T0 COVEft-GIJNITE �
- 7. Pootings . 68. Electricai Conduit-Undryrnd. �
8. Foundatinr} 59. Gas Pipe, L; Undrgrnd., Test i
9. Water Pipe�Undr9rnd. 60. Beckwash lines, P�7rap, � Undrgrr.d. i
70. Structural F�oor SYstem St. APPROVRL 70 CECK � �
t t. Properry S�wer Line & House Connection 62, Backwash & Receptor�Fina! � �
72. Sewer Cap 63. Heater & Vent-Final
13. Roof 6rains � 64. Piumbing System � Final '
i
14. Rough Plumbing 85. Electrica6F(�ai
. 15. Rough Electricai-Co�duit 66. Solar Svstem-Finai f
1fi. Rough EIaOYric N,�iring 67. Penaing & Access Approval �
77. Rough\N:ringSign 68, APPROVEpFQRP�ASTERiNG �
i
78. Rough HeCiricai�T Bar Ceiiing 69. POOU5PA SYSTE�t9S FINAL (
19. Ro�gh Nezting & Rir Conditioning p3RE QEPT. REQUIftEMENT i
20. Rough Factory �irepiace APPROVALS Permit # � �
27, Ducts, in Struc2ure - 70. Undergrqund Hydro � �
22. Ducts, Veniilating 71. Produet Piping C� Gas � Oil
23. Gas Pipe-Rougfi & Test 72. Underpround Nush
24. Roof framing 73, Undergrnd.SiorageTank �Gas ❑OiI
25. Roof Sheat��ng 74. Overhead Hydro �
26. T�Bar Ce�iing {Structuratl & Monocoax 75. Ory Chemicai {
27. Frame and Ffashing . 76. Dry Standpipe
_ I
2$. Lathing & Siding T7. FIXED SYSTF�t1 FI��,4L (
29. lnsuiation 78. F1RE PREV. FINAI_
30. Drywall Nailing NERLTH bEPi. REQUiREMENT i
31. Pias.er Brown Coat 79. PlNA[. INSPECTIQti y� I �
32. Eleciricai Pewzr Meter�Final $0. FOOD CERTiFIGt�TE ISSUED �
33. Final Electf;c Nates: _�
� z -�'� ��.. � _.._.�.� .
3A. Fi�a1 HeaYing & Air Conditipning
35. Final Gas Pipe-Test ___ i^i ��
36. Hood or Canopy
37. Finai FacTorV �i�eR��ce � � v �
38. Final Piumbi�g ��, -�-- �`_ ----- -
39. Water 5ervice�FinaE
4D. Gas Service-��nal
47. Solar pomesiicFinai
-�.�
42. BackEiow Freventer �
43. BackfVow IrrigaTion
44. Landscape IrriGatio�� Syscem _ �
45. Sound Attenuation
46. Handicap Reguiations �
A7. F3NALSTRUCTURE&BUiLDING
48. FINAL P�ANNING
49. Electric Release to Edison -
50. Gas Aelease to uouthern Catiforaia Gas Co
59. CERTIFICATE QF OCCUPANCY
No. Dete
MARTIN, OLIVE B.
JOB ADDRESS
INSPECTIONS
OCCUPANCY
Form 210—SM-11-59 5-B P
DATE
FIBE
GROUP
SUBCONTRACTOR
DATE 9�2'60
BUILDING PERMIT
oF woftKAdd Kit. �o
TYPE V ZONE
PERMITS ISSUED
�, . (]�'L/�
J ' 11� Y S�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX S77 COSTA M�A. CALIFORNIA
For Applicanf fo Fill In Complefely
TYPE OR PRINT
cosrA Mesa
� MAIL
s¢e _�(j }
OF LOT
U6E OF
EXISTING BLDG.
BETBACK LINE F0.0M
TEL.
NO. OP BLDG9.
DESCRIPTION OF WORK
BUILDING NO. OF
61ZE D ROOMS STOF
EXTERIOR WALL W�0 A ROOF ,t
COVERING �%O COVER�NGS/TIN.
USE OF BUILDING AND WORK TO �E PERFORMED
FEE RECEIVED
Q��FP 2 19�Yp�
APPLICAT�,��4.E�
BUILDING �
For Offiee Use Only
RECEIPT NO. � }�$N�j�jif]�
COSTA MESA.
FIRE
ZONE
APPROVED
ZONING
ZONE I puN9 I BUILOIN6eW
LeaAL
OE6CRIPTI D L�
A. P. NO. U� � d' �� �/ O
VAROS EVES
APPROVED ALLOWED
ICEMCF LINH BTJ � l
APPROVED /�// _jO �J
BY G�/ f l /
1691IHO
✓ �'J/ •
I HEREBY ACKNOWLED6E TXAT 1 HAVQ R2A� TXIB APPLIGTION THE RMOUNT BXOWN UNDeR VALIIATION IB FOR THE
AN� BTATE THAT THE ABOVE IB CORAeL`�' ANO AGREE TO COM-
PIIRP08E OF EBTABLI9HIN0 A PERMIT FEE ONLY.
PLY WITH ALL GITY OIiDINANCEB ANO �ATQ L�WB HSOUTATING
euiWlNc coNernuciioN , VALUATION �`_
r
SIGNATURE OF ' ' ' ' � PERMIT FEE $ /j �
PERMITTE ��
AUTHORI�GENT / �JAlwAF /7 �iJ �w , $ �/'�� PLAN CHECK $ A -
V/
GENERAL CONTRACTOR p�.mer-HLdx'. _ VALUE
AP. No.� � �-Ql3-lO LOT TRACT FIRE ZONE DESCRIPTI02
INSPECTIONS i,in_i.i I DATE I GROUP I TYPE
SU6CONTRACTOR
OCCUPANCY
L7-60
PERMIT NO.
Form 210—SM-7 L59 5-B P . 13'�(�g
. ' " a_3zg�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BO% 917 COBTA ME6A. CALIPORNIA
For Applleanf fo Ffll In Complefely
TYPE OR PRINT � '
BUILDING �- O e
ADDRES6
COSTA MESA CALIFORNIA
� MAIL
USE OF
EXIBTING BLDG.
BETBACK LINe PNOM
CENTBR OP 8TRl8T �
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SIDE VARO I LEFT �O
DESCRIPTIO�
NEW I ' (IALTERAT�
REPAIR I IIMOVING
S 2E DING I Z 9L L L Roc
TEL.
or e�oos.
I /
RIGHT `S
OF WORK
BE
FE RECEIUED
� NOU 1 r 1960
FINANCf DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
PECEIPT NO. P[�IMIT NO.
/ ✓—�-1�/
necfiivee er � o�re necerveo I o�re iesufo,,
GOSTA MESA. CALIFORNIA
FIRE
ZONE lYP GROUP
BYPROVED DATE// � 1
ONING �
IO NO.OF ^ ' UBE OP NEW
I �UNB ` I BUILDINO
180AL / � 0 — ��
OQBCRIPTIO •S /�
A. P. NO. � / �,.}� / � —/ D
YARDS EVES
APPROVED ALLOWED
ICBNTHR LIN6 OTJ
FRONT / '� � IN.
R. 6IDE C7 FT. p IN.
L.SIDE ,� FT. IN.
REAR L' FT. IN.
APPROVED �
BY DATE /
I HHHEBY �cnrvowteece rHwr I NAVE rse�e niis �vvuurioN rxe AMOUNT 9HOWN UNDBR VALUATION 19 FOR TXC
ANO BTATE THAT TXE ABOVE 19 CORRECT ANO A6RE8 TO COM- pUPPOBH OP EBT�BLI6HINp � PERMIT FEE ONLY.
PLY WITH ALL CITY OR�INANCEB AMU HTATE LAWB PEOULATNO
au1tLlNa coNernuciloN. � VALUATION `n
81GNATURE OF
� � PERMIT FEE S /7/ �
PERMITTE /// � n
,--' _-L � � ^ /� �� S��A �U PLAN CHECK $ S '
� �'�---d ��u..[ N � F
AUTHORIZED AGENT �- � p
TOTAL FEE � �
u
owNEx rffLLER, OLIVE B.
JOB ADDRESS 280 F�oadwav
AP No. 117-�
INSPECTIONS
coat
OCCUPANCY
DATE
R QWIi�r-tfldi�. VALUE 3 11U.UU
LOT TRACT FIRE ZONE DESCRIPTION OF WORK
� Signature DATE GROUP J TYPE �7 7,ON�
SUBCONTRACTOR -.P��=
l77
� � � 17375
COSTA MESA BUILDING•SAFETY DEPARTMENT
P. O. BOX 917 COBTA MEBA. CALIPORNIA
For Applieanf to Fill In Complefely
TYPE OR PRINT
COSTA MESA
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� ARCHITECT
ADDRESS
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STATE TEL. .__���
LIG NO. _.�---'"-- NO.
SIZE ' NO. OF BLOGA �
oF �oT _ro � ia o �ow o� �o,
U
■ BHT6ACK LINE FNOM
DESCRIPTION OF WORK
EXTERIOR WALL ROOF
COVERING COVERING SYi/N L' L�
USE OF BUILDING AND WORK TO BE PERFORMED
i HEREBY ACKHOWLEDGE TXAT � HAYE READ THiB MPLIGTION
M!D BTATE THAT THE ABOVE I6 CORPE4T ANO AGREE TO COM-
PLY WITX ALL CITY ORDINANCES AND 9TATE LAWB REOULATIN6
BUILDINO CONBTRilGT10N.
l'1 .-"1 �\ /J r
'AUTHORIZED AGENT
-
FEE RECEIVED
JUN 1 9��62
. FINANCE OEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDIMG
For Office Use Only
NECEIPT NO. I PC�IA�j���
/ �
RECfi1VEP BY I DA RECE)V(/j�O�� DATE 8=�
/L ' /
BUILDING y �O /�
ADORESS �� P
COSTA MESA. CALIFORNIA ,
ZONING '
20NE �� I NO. OF I USE OF NEW
PLAN9 � aUILO1NG
LEGAL J ,-. -f- / /� /) / / / i
^ � V
ecexTew urve sr.� I
APPROVED
THE AMOUNT SHOWN UNDER VALUATION 18 FOR THE
PUPP09E OF EBTABLIBHING F PERMIT FEE ONLY.
VALUATION ../� ^�
/ pv PERM17 FEE $ ✓ '�
$ // D � PLAN CHECK $
TOTAL FEE $ �
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