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Home My WebLink About477 BROADWAY - Building PermitsIIII in aIl soaces witnin CITY OF COSTA MESA PERMIT CONSTRUCTION PERMIT i%i- Addres Address Address Eoraer linas anC sign all approp�Iate tleclaralions. TRACT NO. LOT NO. � BLDG.NO. U TVPE OF C,�O.,/NSTRUCTION PhOn — ❑ NEW 18 A00 ❑ ALTERATION � � ❑RE7AIR ❑CONVERSION ❑DEMOLISH LiCenSC NO. ❑ OTHER DESCRIPTION OF WORK 1 here�y at(Irm that I am Iitensetl untler provisions of C�arter 9(com- mancing wltn sectlon 7000) of Division 3 0( the Businass tl Rofesslons Co , antl my Ilcensa Is in tull larca antl e1 ct. Llcens��,—Cla�ss U an Oat t�,�� —519 t r � _ "ORKERS'COMPENSATION�LARATION iereby aftirm that I have a cerUfiwte ol conient to self-Insure or a «ififate of Workers' Compensation Insuranca, or a tertltie0 topy .nereof l5ect r b�C�/ C//'/G/)�� Policy No. ��mpany ❑ Gertitietl copy Is �ereby furnlshe0. er[IfieU copy Is tileE w(th Ihe Uty BWltling Divislon. %EMGTION FROM WORKERS' COMPENSATION DECLARATION (This settion neetl not be completetl if Iha permit is for one huntlreG SS10o) or ieu). cert�fy t�at in [he pertormance oi the work br whith lhii permil i5 iszuatl, I shall not emPloy any perzon In any manner so as to �ecome zuGject to the workers Compensatlon Laws o( Cdll(ornia. Data Signature NOTICE: It after making this tleUaration, you i�oultl bacomo suD7ect to tne Workers' Compensation provisions oi the Labor Coae, you must torthwlth <omply with suth provislonz or this permil ihall be tleemetl �evoketl. CONSTRUCTION �ENDING AGENCV 1 hereby atfirm that thera IS a mnstruttion Ientling agancy for the per- formant¢ Ot [h8'wOrk fOr wtlith•thls pOfTit Is ISSUCtl (SOCtIo0�309] CIV. CJ. Lentler's Name Lentler'S Atltlreis m .5 a -" � Icensetl puRuant to the provlsions ot the Contractor's Ucanso Law x�?�arapter 9(commencinq wlth Soction 7000) of Divislon 3 of ttte Rs�vsln¢ss antl Pro/esslons Cotle) ar Ihat ho IS exompl thereirOm antl the basls for the allegetl axemp[Ion. Any violallon oi Setlion 7031.5 by any appliwM iOr a perTit sub�ects the applicant t0 a civil penalty of not more t�an Iive nuntlretl tlollars (5500). ❑ I, as owner ot lne p�oper[y, o� my om010y¢e5 wiln wage5 a5 lhalr SOIC compensatlon, will tlo th¢ work, antl the stluCturG Is n0[ IntCntlOtl Or otferetl for Sale. (SeCtiOn 7044, Bu51nG55 anG R0lezslOns COGO: Tha Contrattor's IJcense Law tloes not appry to an owner of a property who builtls o� Improves [M1e�eon, and who tlOeS Sucn work himSolf Or througn nls own employees, provitletl that SUGh ImprovOmOnts arC nOt Intentletl or oHeretl for Sale. If, howev¢r, Ih0 bUIlCing or Improvamant is soltl within OnC yGar OI COmpletion, the owner will hava Iho burtlOn of proving M1c tlltl not bulltl or improve tor the purpose ol sala). ❑ I, as owner of the propnrty, am exclusively contracting wit� IICCf15Ctl <Ol1tldCtOlS t0 COnSVIICI Ibc plqeCl ($BCLIOp �)044, BUSI0055 dntl Professions COtle: The Contracto!'s LlconSa Ldw tl005 nOt apply lo an Own¢r 01 plopelty wh0 bUlltlS or ImprOvlS thCrOOn, antl who cOm lrac[s from such pro�ects with a Contraclor(s) ❑cesnotl pursuant l0 LJ I am eaemp[ untler SeCtion B. 6 P. C. for th15 reason Date Owner tha[ I have reatl thii applicatlon and stata Ihal lhe dbOve CorrlCt. I a9r¢e IO comply witb all tlry antl cOunty state laws relating to constru<tion, antl hereby authorize of th15 _clty t0 BnIGf_ upon the above mCntlOnetl TVPE OF PERMIT ❑ GRADING ❑ FOVNDATION ❑ STRVCTURAL ❑ TENANT ❑ ELECTRICAL OPLUMBING �p-0ECFIAI ❑ OTHER PROJECT DESC� � 81�ION 50. FT. y OCCUPANCV_CONSTRUCTION TVPE VALUATION ZONE GRADING GU. VDS. ACRES PLUMBING PLAN CHECK TOILETS LAVATORIES KIT. SINKS �SERVICE SIiJKS FLOOR SINKS DRINKING FOUNTAINS Bu90 10/UO/JG� A.P. q ZONE REAR VARO (T PKG. SPACE RE� STREET WIDTH NG APPROVED BV IAL CONDITIONS: PLNG. REF. � PARK ELECTRICAL aLAN Cr�Eac VRINALS TRANSFORMER 0-1KW_1-lOKW DOUBLELAV$ APPLIANCE 10-50KW_SO+KW DISHWASHERS MOTORS 0-1 HP_1-30 HP SUMPS �(�NC. SOLAR) ]0-50 HP 50 + HP FLOOR DRAINS INTERCEPTORS CLARIFIERS WATERSERVICE GASSERVICE WATER HEATERS SEWER CONNECTIONS SOLARTANK SOLAR PIPING SYS. ISSUE FEE MECHANICAL ALTERATION OUTLETS BTU OVTPUT COLLECTORS PLAN CHECK HEATING SVSTEM 0-100.000 9TU, ANDDUCTING 100,000+8TV, REFRIGERHTION 0-100,0008TU. SVSTEM 100,000+8TU, BOILERS BTV SVSTEM REPAIR, EXHAUSTSVSTE Si9nature Dale � I Orivers' Lit sp or 55 � � � �SSUE FEE CMF 0865-46 White-Builtling; Canary-ApP�iwnt; Wnk-Accoun[Ing; Goltlenrotl-Asussor AITERATION M MULTIPLE FIXTVRES OUTLETS SWITCHES GAS TUBE SIGNS POLE LIGHTS POLES METERED SUB PANELS MAIN SUB SEHVICE AMP ISSUE FEE HPPLICATION P.PPROVED BV SUMMARV OF FEES BUILDING �/ �U PERMIT E Y� PIAN CHECK E PLVMBING § PLANCHECK S ELECTRICAL b PLAN CHEGK 5 MEGHANICAL 5� � PLAN CHECK S 9v0(1 TI. SMIP E PERMIT ISSUANCE E GRADING E E MICROFILN E TOTAL FEE E LESS AO- VANCE PC E FINALFEE Ey.4_ . , CONSTRUCTIpN AND PLANNING POOL & SPA APPROVALS permit # ��s��j Date Inspector qppROVALS Permit # Date Inspector 7. 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 ein orce 47. Rou h Plumbin & Pressure Test 6. Electricai UFEA Grn 48. APPROVAL TO COVER-GUN17E 7. ootings 49. Electrical Conduit-Undr rn 8. Foundation 50. Gas Pipe, ❑ Undr rn, Test 9. Water Pipe-Undr rn 51. Backwash Lines P-Tra ❑ ndr rn 10. Structural Floor System 52. APPROVALTO DECK 11. Property Sewer �ine & 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. Rou h Electric-Wiring 57. Solar System-Final � 76. Rough Heating & Air Conditioning • encing & Access Approval 17. Ducts in Structure APPROVED FOR PLASTERING 18. Ducts, Ventilating 19. Gas Pipe-Rough & Test � • 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing 21. Roof Sheathin ' � � 22. Frameand Flashin NOTES: _yZ 23. Insulation 24. Lathing & Siding 25. Drywall Nailing 26. Plaster Brown Cpat 27. Electrical Power Meter-Final 28. Final Electric � ' 29. Final Heating & Air Conditioning - y 30. Final Gas Pipe-Test 31. Final Plumbing � ' 32. Water Service-Final ' 33. Gas Service-Final 34. Solar pomesticFinal � 35. Landsca e S rinklin S stem 36. Sound Attenuation 37. Handicap Regulations 38. FINALSTRUC7URE&BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 47. Gas Release to Southern Catifornia Gas Co. 42. CERTIFICATEOFOCCUPANCY No Date AOP��anl to fill in all s0aces within LITY OF COSTA MESA I Peg�yr r+S.�O CONSr�RUCTION PERMIT E 3 Address �C L Arch/Eng. License No. Address �l ', Contracmr Phor Address - ' �.�l3//.� .�% R,5 /C /ti� /. I he�¢by atfl�m th:.t I d mancing witn sectlon RofeSsions Cotl� Llcense Clajs 1RKER5' C6MPENSATION DECLARFTI� ereby affirm that 1 have a certificate of G sent to self-insure or a .tiflcate of Worktrs' COTpensation Ins nce, or a certitieG copy cnereof (Section 3800, Lab. CJ. Policy No. Company '� Certifietl copY I5 hereby furnlshetl. ❑ Certifletl capy Is (iletl with tha city B tlin Divisi n. E%EMPTION FROM WORKERS' CO PENS T ECLARATI (This 5¢ctlon neetl not be com0lete if thE r it i5 lor one h C (5100) or less). I certlty that In ihe pertorman<e o tha wo tor whl i mit s Issu¢tl, I Shall not em loy any p¢r On n a y ann a b¢C ¢ subject to lhe rk mpensat n I� Date ature �NOT : It after making tnis tlec ❑on, you s eco e sub�eci [o [he Wofkers' Comoensat100 DrOviSiOns of the or COtle. vou must torthwifh comply with sucn p�ovlslon5 0� LbiS pKmit snall be tleemetl revoketl. .. ' . . .. CONSTRUCTION LENDING AGENCV I h¢r¢by affirT that Ihm¢ Iz a con5truclion lentling agency for ihe per- formance of tne work for whith this,permi[ iz iszuetl (Section 3097 Civ. C.I. ' ' ' ' . . _ . Lentler's Name ' -^ Lentlet's Atl0�e55 OWNER BVIIDER DECLARFTION ' —' 1 hereby aitirm (hat I am exempt from tM1e Contractor's License Law for tne following reason �Section ]031.5 Buslness antl Pro�essions Gotle: Any city or county which reqWres a pe�mil to construct, alter, '^�prov¢, tlemoli5h o� �epai� dny struttur¢, prio� to I[s IsSUance, also �e- •es the ap�licanl for SUGh permil to lile a signetl statement that h¢ censetl pursuant to tne provisions oY the Contrattor's License Law apter 9(<ommenGng with Secilon ]000) ot Division 3 of the eSlness antl Pfde551on5 Cotl¢) Or that he Is exempt t�erefrom and tne bazls for the allegetl exemp[ion. Any violation ot 5ec[ion ]031.5 by any appll�nt tor a permit subje<ts the applicant to a civil penalty of not more lhan live huntlretl tlollars ($500). ❑ I, a5 owner oi lhe properly, or my employees with wages as their sole campensstion, wlll tlo�the work, antl the s[ructure is not intentletl or offeretl for sale. (Section �044, Business antl Professlons Cotle: The Cont�actor'S LicenSe Law tloe5 not appry to an, owne� of a property wh0 builtls or imprOves the�eon, antl who tloes such work himseff o� Ihrough his own employees, provltletl Ihal Tuch improvements a�e nol Intentletl ot offetetl lor Sale. If, howeveq the builtling or improvemen[ is soltl within one year o/ compleUon, the owner will have the burtlen o/ p�oving ne tlitl not builtl or imprOve for tne purpoze o( Sale). � ;� 1, as owner o/ [he property, -am exUusively conlracting with ucensea convactors to construct the praject (Sectlon �oaa, Business antl �Professions Cotle: The Contractor's Llcense Law does not apply to an owne� of property who builtls o� Improve5 thereon, antl who con- tracts bom such projetts with� a conlraGtor(s) licesnetl Oursuant �lo the Contractor's licensc Law). - O❑ I am exempt untl¢r Section � 8. & P. C. tor this �� reazon - - - � Date O er_ \ I h¢�¢by tertif thal I hav �eatl t is apyi T antl state tba[ the above inlormation i rorr cL I aaree lo atda with 11 ti[v and coun[v 519nature � V rv Dat Orivers' Licen e or 55 �' CMF0865-46 White-Builtling;Canary- Ai Eo�Oer lines an0 sign all app�opriate tleclaration TRACT NO. LOT NO. BLDG. NO. TVPE OF CONSTRUCTION ❑ NEW ❑ A�D ❑ ALTERATION ❑ REPAIR ❑ CONVERSION ❑OEMOLISH ❑ OTHER DESCRIPTION OF WORK 5973 5/17/82 ' . A.P. g ZONE TYPE OF PERMIT ' ❑ Gf3ADING ❑ FOUNDATION ❑ STRUCTURAL ❑ TENANT � ELECTRICAL �PLUMBING �❑MECHAI ❑ OTHER PROJECT DESCRIPTION _ SQ. FT. OCCUPANCV_CONSTRVCTION TVPE VALUATION ZONE GRADING CV. VDS. ACRES REMARKS: PLUMBING BATHTUBS TOILETS LAVATORIES �KIT. SINKS SERVICE SINKS FLOOR SINKS DRINKING FOVNTAINS INTERCEPTORS SWIMMING POOL - WATER SERVICE GAS SERV ICE PLAN CHECK SHOWERS URINAL$ DOUBLE LAVS DISHWASHERS SUMPS FLOOR DRAIN$ CLARIFIERS P TRAP ALTERATION OVTLET$ BTU OUTPUT SEWERCONNECTIONS � SOLARTANK' ' COLLECTORS SOLAR PIPING SVS. � � �ISSUE FEE � � MECHANICAL PLAN CHECK HEATINGSVSTEM 0-100,000BTV_ AND DUCTING 300,000 + BTU _ REFRIGERATION 0-300,000 BTU_ SYSTEM 100,000 + BTU _ BOILERS BTU SVSTEM REPAIR, ALTERATION EXHAUSTSYSTEM MULTIPLE ISSUE FEE Goltlenrotl-ASsessor REAR YARD (TO PKG.SPACE REQ. ZONING APPROVED BV SPECIAL CONDITIONS: ELECTRICAL PLNTGp. RUEF. � PROPE�RTY LIN'� PROVIDED PARK FEE —'DATI PLAN CHECK GENERATOR 0-1 KW_ 1-10 KW _ TRANSFORMER APPCIANCE - 30-SOKW_50+KW_ MOTORS p-1' HP_Id0 HP _ (INC.SOLAR) ]0•SOHP SO+HP _ FIXTl1RE5 OVTLETS SWITCHES GAS'TUBE SIGNS - POLE'LIGHT$ ' ' ' PANEL$ 'MAIN SER V ICE '- I I•APPLICATION APPROV ED BV SV� AMP � 14.00 TL SUMMARV OF FEES . BUILDING - - - PERMIT $ SMIP �. $ PLAN CHECK $ PERMIT - -ISSUANCE $� - PLUMBING $ • � PLANCHECK E � GRADING S ELECTRICAL S + � E MICROFILM S ' � PLAN CHECK E - TOTAL FEE S �' MECHANICAL E - LES$ AD- PLAN CHECK § VANCE PC S_ FINAL FEE b / ' "— CONSTflUCTION AND PLANNIN�G �� ' � POOL & SPA � APPROVALS Permit #��'=-.." � Date Inspector pppROVALS Permit # - Date fnspelCtpr 1. Temporary Electrical Service or Pole 43. Pool & Equipment Cocation �• -� - • � �� Soil ipe-Undrgm 44. Steel Reinforcement � - �-� - - 3. Electrical Conduit Utility-Undrgm - 45. Forms - �� • 4. Electrical Conduit-Undrgrn 46. Electrical Bonding_ -- � . tee ein orce 47. Rough Plumbin & Pressure Test - ' 6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE- -•� ' - -� - 7. Footings 49. Electrical Conduit-Undr rn � B. Foundation 50. Gas Pipe,- � Undr rn�, Test 9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra �' nd rn' �� ' � 10. §tructural Floor SYstem 52. APPROVAL TO DECK " ""'"' ' it. Property Sewer Line & House Connection � 53. Backwash & Rece tor-Final 12. Street Sewer Connection ' - 54. Heater & Vent-Final 13. Rougfi Plumbing 14. Rough Electric-Conduit 56. Electrical-Final 15. Rough Electric-Wiring 57. Solar System-Final ' � 16. Rough Heating & Air Conditioning • encing & Access Approval+ 17. Ducts in Structure ' 59. APPROVED FOR PLASTERING � ' 18. Ducts, Ventilating . ' _ ____ - , „ 19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL ' - 20. Roof Framing . • ' 21. Roof Sheathin � ' 22. Frame and Flashin NOTES: '�13'. Insulation Q � � �� l� 24. lathing & Siding 25. Drywall Nailing . � 26. Plaster Brown Coat ' • 27. Electrical Power Meter-Final �/ -�2 G 28. Final Electric - � 7�1 - /.C� 29. Final Heating & Air Conditioning 30. Final Gas Pipe-Test 31. Final Plumbing 32. Water Service-Final � 33. Gas Service-Final 3Q. Solar pomestic-Final � 35. Landsra e S rinklin S stem " 36. Sound Attenuation � � � 37. Handicap Regulations � � � ' � � 36. FINALSTRUCTURE&BUILDING � 39. Special Requirements Completed 40. Electric Release to Edison � 41. Gas Release to Southern California Gas Co. � 42. CERTIFICATEOFOCCUPANCY No Date - ~ ANGE COUNTY BUILDING DEPARTMENT 636 North Broadway -,.; SANTA ANA, CALIFORNIA � FOR APPLICANT TO FILL IN BUILDING ,lrJy F �RO�/T/JDW�1 nooRess y-� ORHTOWN IST. ��OS�/r i { 6S/. . f ' NEAREST l. CROSS ST. `{ OWNER b`D � �/SGN6� MAIL �� O -D ��' ADDRE55 TEL. arv OSTA 6Jfr • No. ARCHITECT O TEL. ENGINEER F L � NO. ADDRE55 G TEL. CONTRACTOR /�I�� NO. ADDRE55 7 ^ ��OHOW� LEGAL I �/ � r(jAGT /�J ./ DESCRIPTION lOT NO. J �O �BLOCK `� (ATTACH METES & BOUNOSI TRACT �% SIZE OF LOT V �/� ��'�%7I NOW pN LOT F�+ USE OF }� NO, OF NO. OF E%ISTING BLDG..YWP•LL� NG� F�kiues I ROOMS S DESCRIPTION OF WORK SIZE V `V ��'�O /LfO�OROOMS � STORIES WALL ROOF COVERING COVERING USE OF NEw l.J�g� �J 4 �' � BUILOING J (�� GOti O I HEREBY ACKNOWLE�JGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIT COUNTY OROINANCES AND STATE LAWS REGULA DING CO STRUCTION. SIGNATURE OF �`/ PERMITTE� AUTHOfiIZED AGT. j P. G. 3 � d '✓ � FEE G �A T� y 5�J . � �� FEE APPLICATION FOR PERMIT � � � BUILDING FOR OFFICE USE ONLY RECEIPT NO. PERMIT NO. �f aoS. 117UG 7 � RECEIyED OY OATE OF APPL. DATE ISSI�ED �� S --� a--� � � —�a �� BUtLDING N � • r R ADORE55 SCHOOL �IST. OR TOWN ��, 1 NEAREST '� � CRO55 SL V�x f N� 20NE� I P ANS I TYP� i GROUP R j�Z SETBACK LINE FROM CENTER OF 5T. �C� REAR YARp t ( SIDE VPRD APPROVE� 7...�a 1� • BV OATE r� CORRECTIONS � APPROVALS : LOCATION INSPECTOR OAl MATERIALS. INNING � � `D� G �t "� SqOPS.c . I/-.� i%�� LATM.E%T. PLASTER.INT PLASTER. E%T MASONRY RE BOND 6EAM FINAL 0 A n z D r , �' � m�t[�'d "` asOG • QO�LO—n .. ,. � �. , �, _ , , • _�� , . . ,, .` � ,_ . � � �. . . , �' } ' - _.,.! _. .>= yowNeR �� j'10B AD �GENER� �AP No. �INSPEC SOIL GAS WPTER ROUGH Pl PROP. SM . .SPRINKLI il:� UNOERGROUND U POWER ROUGH WIRING TRENCHES FORMS � FLOOR SYSTEM BONO BEAM ❑ STE�L RE SHEATHING FRAME AN� FLASHING LATHING - IN n OUT � PLASTER.BROWN COAT HEATING, VENT., REFRI PLUMBING, FINAL AND ELECTRIC, FINAL BUIL�ING, FINAL CON. T F INPL DATE 1y1:7�41:17 SUBCONTRACTOR Z . W w a U HZ 2F O fn am J7 J N ff1 J -m J Q U Q z¢ w dw WZ J Q m Z J � W w O z� W � � 0 H Z Q U J a a a � F � z 0 � U � � H N Z 37� IO COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely BUILDING � �� tl�jO Ah1_..d� ADDflE55 O/1 17��r��7 OWNEfi �vl.?Re,9REr Fs'ci/Ele ADDRESS � 7 7 I3Rof1-oWAY TE L..s� CITV C . �� NO. � RQ CONSTRVCfION LENDER �— BRANCH � ADDFESS — l/ ARCHITECT �+ / TEL. !lR FNGWFCF � �� NO CC ADDRESS z3 / l'J BR�7�YGL /7 ��. TEL.64� � c�Tv �° ; .� . No. ��n STATE w CITY LIC. NO. / ��,• �i ��I LIC. NO. OF l0T L. � NO.OF BLDGS. �CJ x J�Z�.S% �NOWONLOT � USE OF (-/�'�I R��. EXISTING BLDG. v SIZE OF NO. OF NEW BLDG. ROOMS STOFIES EMERIOR WALL flOOF COVERING COVEFING USE OF BVILDING AND WORK TO BE PERFORMED R/ LI�V oF ,4''� G''oHc. REC BUILDING ` ADDRESS � TRACT r: ROVED lUL 3O'73PAIOOOZ%7S# ****:�5.50 CNS+ TION FOR BUILDING PERMIT _�� `�l � PEfi LOT +� �C I 8 LOC K DATE � � )N� NO.Of USE OF PL4N$ � BUILDIN VARDSAPPROVEO VAR MAIN BUILDING ACCE: ROMC/LSTREET) � VAR, af-` C.U.P, iW W �ll / /i FT. � !i FT. BET. MAIN & ACCE$$. BLDGS. DATE PPPROVED ,.�, � �7=��73 I heraby acknowledge that I hnve reatl this applicaxion entl na�e - thnt the above information is cOrrect nnd eB/ee to comply wiih ell laws regulating builtling construction, antl I shall not employ T� any person in violation ot the workman's compensation laws of the State ot Calitomia. m � I hereby certify that I am prop¢rly licansetl az a connector untler SQ. FT. o Me State of Celifornia Business antl Professions Code, Divisicn 3, THE AMOUNTSHOWN UNDER VALVATION IS FOR � Chapror 9, antl that such licenses ata in full force entl aHact, or I THE PURPpSE OF ESTABLISHING A PERMIT FEE ONIV: m am exempt trom tl e provisions ot t�e Stato of Calitornia Business � antl Professions Crrtie, Oivision 3, Chapter 9. VALUATION ' � PERMIT FEE $ j Slp^e[ura of 1 � � m Permittee C 1 �v6 G.vs"R CD i $� 0 PWN CHECK $ E , ��, a Authorizatl ABent �- LL TOTAL FEE 5 ER FISHERL M. DATE 3-1-71 55 '+I ( tsroaaway BUILDING PERMIT N0. ONTRACTOR Ge t DESCRIPTION of WORK -331-1 LOT TRACT FIRE ZONE VALUE$ 2.000.00 GAS SUBCONTRACTOR ROUGM PLUMBING PROP. $WR. LINE � HOUSE CON. � SPRINKLING SVSTEM MISCELLANEOUS ROUGM HEATING ANO AIR CONDITIONING BONO BEAM � STEEL REINFORCE SHEFTHING FRAME ANO F�qSHING 1 I P�qSTER, BROWN COAT C Z aU Z ZQ O� am J � J N Q W fl] J • 00 J Q U � Za W � aw W Z J Q m Z J � W w � Z� W � �O H z Q U J a a Q � H N Z O F U � � H N Z ,� b COSTq MESA BUILDING•SAFETY DEPARTMENT P.O. QOX 7200 COSTA MESA, CALIFORNIA 92626 Fo� Applicant ro Fill in Completely ADDRESS �^T+_L��P�� f OWNER� ��,U�l MAIL AD�RESS ��%,t�,.yL(� A T CITV /' - � NO. BqANCH ADDRESS ARCHITECT TEL. ADDRESS CONTRACTOR e`� ADDRESS `LfRL CITV � � � STATE LIC. NO. �� SI2E OF LOT VSE OF EXISfING BLDG. SIZE OF NEW BLOG, E%TERIOR WqLL COVERING USJy,OF BUIL�ING AND NO. OF FOOMS ROOF COVERING �{ TO BE PE TEL. NO. CITV p LI0.N0. ��O' INO. OF BL� NOW ON LOT MED Fb1R -1-71��a�� 025+� ***��30.0� cnsn APPLICATION FOR BUILDING PERMIT fiECEIV D� V D TE RECEIVED pqTE ISSUI �� -1 -7l -�i'�J -. A.P. NO. � / -..�,� � / BUILDING /� �J "J ADDRESS �T' � / TRACT �� 1 FIFE ZONE N NO.OF � PLqry$ VARDS APPROVE MAIN BUILDINC VAR # C.U.P. # APPROVED I hereby dcknowl�lfa that I have reatl this application antl state that the above information is correct antl agrae to comply with all laws regulating building construction, and I shall not employ any Derson in violation of the workman's compensation laws of Me State of Califomia. I hereby certify that I am properly licensetl as a contractor under Me Staxe ot Californla Business entl Professions Code, Dlvisicn 3, THE AMO Chapter 9, and that such licenses are in full force antl effect, or I THE PURP( am ezempt from ihe provisions of the State of California Business VALUATION antl Professions Cotle, D' ' on 3, Chapter 9. . Signature Of �� yyL � Permkte¢ � vGI� g Authorizetl ABant �, —! � VALUE 3— J— � USE OF NEW BUILDING � VARDSAPPROVED ACCESSOPV BUILDING FT. ' BET. MAIN & ACCESS.BLpGS, DATE APPROVED .. . r � . � � / _ �i � � FT. o f SHOWN UNOER VALUATION IS FOR � OF ESTABLISHING A PERMIT FEE ONIV: m ¢ � d �� W PEFMIT FEE $ � 7 � PLAN CHECK $ /U � e `o TOTAL FEE $ 3 0. — "