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Home My WebLink About2791 CIBOLA AVE - Building Permits2� • AVG�icant to fill in all spaces exeeot tnose within heavY oortler Iines ana sign all apurooriate aeclarations. PEFMIT NO TRACT NO LOT NO. UNIT NO CirYOF COSTA nnESA CONSTRUCTION PERMIT ' ProjecQ Address � 7 9/ G� RO �-/� Applicant's Mailin9 Address ��"� � �A.P0.�1'Cr� $7 GiC/L(/6Lr Owner's Name M1AG1-��D Phone �6�0-3�rC-.5~ Address d�/�� C�pOC� �%�si� /y6si% Arch/Eng. License No. Address Contracmr'sName �o77/CR/46� ,QGG• Phone�-�� Address (mailing) �� Yi O+�i1A%i 9 6,6 City License No. 33 � LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensetl untler provisions of CM1arter 9(commencin9 witM1 secNon ]000) o� Division 3 o! the eusiness and Professlons Cotle, antl �ny iicense is in t� �� a�a etfea. �Ke%�i� ,_ License N l ' �ate J/ Signature �' y �'. WORKERS' COMPENSATION DECLqRATION I hereby aifirm Mat 1 nave a certificate of consent to self-insure ora certificate of Workers' Compensation Insurance, or a certifietl copY thereot (Section 380Q Lab. C.) Policy No. � 17p/�-� f Company S� TG FU'V.1% �Cert!f iCtl �oOY(�15 t letlbwi[hrthehciUy B iltling Di isi�=�y��, � Date � ��o Applicanf � �I^-��iy/�"'��' `� - EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thi55ection neetl noLbe completetl i{ the permit is Tor One huntlretl ($]00) or less). 1 certify that in the perfo�mance of tM1e work for which this permk is issuetl, I shall not employ any person in any manner so as to become subject [o the Worke�s' Compensation Laws of Cal{fomia. Da[e Si9nature NOTICE: If, after makin9 tnis tleclaration, you shoultl become subject to Me Workers' Compensation provisions o( the Labor Cotle, you must forthwith comply with such provisions or �his permit shall be tleemetl revoketl. CONSTRUC710N LENDING AGENCY 1 hereby affi�m tha[ there is a ronstr4ction lentling agency tor the pe�fo�mance of the work for which this permit is issuetl (Section 309] Civ. C.) Lentler's Name ' Lentler's Aatlress OWNER BUILDEH OECLHRATION � I bereby affirm that I am ezempt irom [he Contractor's License Law for tne following reason (Section 7031.5 Business and Professional Cotle: Any city or ounty which requires a permit to construct, alteq improve, Cemolish or repair ny st�ucture, prior to it5 issuance, also requi�es the applicant for such permit .o file a signetl statement tbat he/she is licensetl pursuant to tbe provi5ions of the Contractor'S License Law (Chapter 9(commencing witM1 Section ]000) of Division 3 of the Bu5ine55 antl Prpfessions Cotle) or that he/she is exempt theretrom and the basis for the all@getl exemption. Any violation of Section 7031.5 by any applicant fo� a permit subjects the applicanS to a civil �enalty of not more than five huntlretl tlollars (5500). I, as owne� of the properTy ot my employee5 witn wages a5 their sole <ompensation, will do the work, antl the structure is not intentletl or otteretl fo� sale (Section 7044, Business dntl Professional Cotle: The Contractor'S License Ldw does not apply to an oWner ot a property who builtls or improve5 the�eon, antl who tloes such work himself/heroelt or IhrougM1 his o� ner own employees, provitletl that such imp�ovements are not Intentletl or oft¢retl for sale. If, however, tbe builtling or imp�ovement is soltl within one year of com- pletion, the owner will have the burtlen of proving h¢/she tlitl not builtl or im- prove torthe purpose oisale). ❑ I, as owne� of lhe properiy, am exclusively cont�acting wilh licensetl con- vactors td consvuct tne project (Seetion 7044, Bus�ness antl Protessions Cotle: Tne Contractor's License Law doeS not apply [o an owne� ot property who builtls or improves [hereon, antl who contracts for such projects witn a con- tractor(s1 license pu�suant to the CbnVat[or'S License Law). I am aware that proof of their Worker'S Compen5ation insutance shoultl be prOvitletl to me. ❑ 1 am exempt untler Sec[ion B. & P. C. for this reason Date Owner I hereby certify that I have reatl Information is <orrect. I agree to < antl state laws relating to builtlinc sentatives of this city fo en.�," inspection pu se /J��jx Siqnatu}e ./�/v' �33 �07 8 TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ESCRIPTION OF ORK/ SE OF BLDG. P�f � P'��IDEivGB ��_—��-�" �.YSo� T PEOFPERMIT GRADIN ❑ FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER � d�F R � PROJEC7 DESCRIPTION 5a. FT. occVcarvCv �S, CONSTRUCTION TVPE �/V VALUATION $ 3��•�� ZONE GRADING GU. VDS. ACRES Remarks: l� `_' Lu ��;� Preventer Irrigation Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service IfIS2(CBpiOfS Ki[chen Sink Lavatories P-Trap Roof Drains Reinspection Fee �ycnSs rFfr�ScjS.[ w PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collecmrs Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Ouilets Water Cioset_ � Water Heater Water Service Auto-Wash Laundrv Travs $15 I I Issue Fee $ 3 Boiler Duct-UnderGround Duct - Sttuctural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. BIL ICBO # Heating System & Ducting ❑0-100,000 BTU 0100,000 Reinspection Fee � $75 CMF 0865-46, rev. 30/B4 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor A.P. # . S Main Buildii E T Front B Rear A C Right K Left S Ping. Ref. # Planning Notes:� Automatic Washer Construction Pole Sub. Cooking Unit D ishwasher Dryers OGas ❑Electric Zone Accessory Building: Z O N I N G R Parking Req./Provided � E Q M T 5 E�ECTRICAL Transformer ❑ iS50 KW ❑ 50+KW Fan F.A.U. Fixtures Device Boxes � OULI225 Switches � � Garbage Disposal Generator �0.5 KW 05-15 KW Meter lJup to 100 amps Meter ❑over 100 amps Sub Panel � � Motors �0-1 HP 01'h - 8 �a Solar �9-15 HP �i6-15+ Microwave Pole Light � Range Sign Standing Sections Trash Compacmr IANICAL FEES Reinspection Fee I$75 Issue Fee Hood or Type I ❑ DEVELOPMENT SERVICES REQUIREMENTS: Canopy TYPe I I ❑ Zoning Approved By Buildin9 APProved BY � �--T ;--�—.�r-/'�A/ Refrigeration System ❑0-100,OOOBTU ❑100,OOOBT System Repair/P.!±=ratior fi e Dampers Registers Issue Fee � $ 3 SUMMARV OF F BUILDING PERMIT $ .�.OB PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAI $ PLAN CHECK 25% $ FEES $ 3 SMIP ? • s� PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTALFEE $ �-'�r� TCsT b3.5G CONSTRUCTION AND PLANNING POOL & SPA APPROVALS . Permit # Date Inspector AppROVALS Permit # . Date Inspector 1 �ITemporary ElectricaljService or Pole 52. Pool & Equipment Location � �. . 2. Soil Pipe-Undrgrnd. .�� 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Uridrgrnd. 55. Electrical Bonding 5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test r:•t 6. Electrical UFER Grnci. , 57. APPROVAL TO COVER-GUNITE 7. Footings i f` 58. Electrical Conduit-Undrgrnd. 8. Foundation _ j` 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Un�rgmd. �• j 60. Backwash Lines, P-Trap, O Undrgmd. 10. Structural Floor System � 61. APPROVAL TO DECK 7 7. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap � 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FIN'AL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT � � �' i 20. Rough Factory Fireplace APPROVALS Permit # ' 21. Ducts, in Structure � ' � 70. Underground Hydro . 22. Ducts, Ventilating 71. Product Piping 0 Gas ❑ Oil 23. Gas Pipe-Rough & Test 72, Underground Flush �� `� 24. Roof Framing 73. Undergrnd.StorageTank QGas ❑Oil 25. Roof Sheathing � 74. Overhead HYdro �. i,� ;�.� ' � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical - P-� i 27. Frame and Flashing � 76. Dry Standpipe �• i � f� � 28. Lathirig & Siding j 77. FIXED SYSTEM FINAL�' %� � ,, 29. Insulation 78. FIRE PREV. FINAL ' �"� t 30. Drywall Nailing HEALTH DEPT: REQUIREMENT � 31. Plaster Brown Coat 79. FINAL INSPECTION `� i • 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE��ISSUED ' � 33, Final Electric Notes: �� vi 34. Final Heating & Air Conditioning � � '� ' � � 35. Final Gas Pipe-Test ' c� " i' ` 36. Hood or Canopy _ 37-. Final Factory Fireplace , , . 38� Final Plumbing ' ' i 39: Water Service-Final ` � � 40. Gas Service-Final . 41. Solar pomestic-Final ' � , 42. Backflow Preventer ' �^�� „�:,,4-: �'� � � � � ' ,, 43. Backflow Irrigation � - , , � 44. ;Landscape Irrigation System � . , . � i 45 Sound Attenuation . ' �, . ' 46. Handicap Regulations 47. FINAL$TRUCTURE&BUILDING g S�0 e . 48. Special Requirements Completed � � � �� 49.� Electric Release to Edison ' . , '. 50. Gas Release to Southern California Gas Co J �' ,. � 57. CERTIFICATE OF OCCUPANCY No. Date ,i � \..� . _. y 1 \� ' • '. Aoo�icant to fi11 in all spaces ezceot those within heavy bortler Iines an0 sign all aporoo��ate tleclarations. CITY OF COSTA MESAn, CON�TRUCTION PERMIT PERMIyY�lO._ . _ _. TRACT NO. LOT NO. UNIT NO. Projerl Address � —/ � �R C�' Applicant's Mailing Address �{j S�% �• �i �yX Owner's Name �R �AC-� �nurl Phone`�� 3�'I�S� Address 27y1 G�i1o`Y-i `•H'� Arch/Eng. _ License No. Address Contractor'sNam E �� - v�b� PnOne �'� 0� Address (mailing) � � �J�L�� P City License No. - , -S� � LICENSEO CONT(3ACTOR.OECLARATION 1 hereby affi�m that I am licensetl untlet provisions of Charte� 9(commencing with section 7000) af Oivision 3 a! the Business antl Protessions Cotle, dntl my license is in tu fo �e�dntl efie�L ' License class �� mense No.� '� ybS�O�- DatP1' (S',"A!„ Siqnaturet�:�..�c�a zS WORKERS' COMPENSATION DE LARATION I hereby affirm that I nave a certiFicate of mnsent to selt-insure or a certifiGyte of Workers' Compensation Insurance, or a certifietl cOpy thereot (Section ' 3800, Lab. C.) Poli<y No. Company BCertified copy is hereby furnixhetl. � Certitie� copy is filetl wi[h ME city Builtling Division. Date Apolicant EXEMPTION FROM WORKERS• COMPENSATION DECLARATION (This sectian neetl mt be complet¢tl if the permit is fo� one huntlreC ($300) or Iess). I certify [hat in the per(ormance of the work fo� whic this pe�m�t is issuetl, I shall not employ any pe�son in anne(, so as ecome subject to the Worke�s_Co�pGpsatlDn Laws of alitor ia. Oate�� tS,EF(�Si9nature �NOTICE: If, at[er making tnis tlecla� ion, you 5hOu1C become ubject to the Wo�kers' Compen5ation provisions of the Labor Cotle, you mu5t forthwith comply wiih such provi5ion5_ vr this Oe�mit shall be tleemetl remketl. CONSTRUCTION LENDING AGENCV ' I hereby affirm IM1at there is a mnst�uction lentling agency for the perfo�mance of tne work tor which tnis permit is issuetl ($ection 309] Civ. CJ Lender's Name Lentler's Adtlress � OWNER BUIIOER �ECLARATION � 1 hereby atiirm that 1 am exemp( }rom the Contractor's License Law tor the following reason (Section 7031.$ gusiness antl Professional Cotle: Any city or :ounTy whicM1 requires a pe�mit ko consbuct, alter, improve. tlemolish or repair my structure, prior lo it5 issuance, also requi�es th¢ applicant tor such peYmit [o file a slgnetl slaiement [hat he/she is IicenSetl pursuant to the provisions of tne Contractor's License Law (ChaDter 9(commencing with Section ]000) of Division 3 ot the Business antl Professions Cotle) o� tha[ he/sne is exempt the�efrom antl the basis for tM1e alle9etl exemption. Any violation of Section ]031.5 by any applican[ to� a permit subjects the applicant to a civil �enalty of not mo�e Ihan five huntl�etl tlollars ($500). I, as owner ot the property pr my employee5 with wages as their sole compensation, will ao the wotk� antl the st�ucture is not intentletl o� offeretl for sale (Section ]044, Busine55 anG Prot¢ssional Cotle: The Conttacto�'s License Law tloes nol apply to a� owner ot a proper[y who builtls or improves tbereon, antl who tloes such wOrk himself/herzelt o� through his or h¢r own empioy¢es, provi0etl that such iMprovements a�e not intentletl or offe�ed for Sale. If, however, the builtling oY improvement is soltl within one yea� of com- pletion, the owner will have the burtlen of proving ne/she tlitl not builtl or im- p�ove for the purpo5e of sale). ❑ i, a5 owne� ot lhe pro0erty, am exclusively tont�acting wifh licensetl con- [raciorsto consVuct lhe pro�e<t (Section J044, BuSinessantl Professions Cotle: The Con[ractor's License Law ryoes mt apply to an owner of property who . builtls or improves [hereon, antl who'wnfrac[5 tor such project5 witM1 a con- tractor(sl license purouant�[o the Contractor's Licenze Law). I am aware that proof o� their Worker's Gompepsation insu�anre sM1oultl be provitletl [o me. ❑ I am exempt untler Section B. & P. C. for this reason Date Owner I hereby certify -that I have reatl �this apPlication antl Stale Ihat the above information is correct. I agree tU �comply witn all city antl coun[y ortlinances antl state laws relating to bu Itlin9 construction, and hereby autnorize repre- Sertativoc—nl�thi5 City t9��t�r upon the above-menti➢ned property fo� ure TYP�qE OF CONSTRUC710N LJ NEW IJ AOD LJ ALTERATION LJ REPAIR — �p CONVERSION ❑ DEMOLISH ❑ OTHER � q,p, # DESCRIPTIONQ`��RK/USE OF BLDG. �-'��'/ �� '—h�*-� T S��./e. •.7•Z� L - - 5 Main Buildin9: TVPE OF PERMIT ❑ GRADING FOUNDATION ❑ STRVGTVRAL T Front ❑ TENANT ❑ ELECTRICAL �I PLUMBING ❑ MECHANICAL A qear ❑ OTHER PROJECT DESCRIPTION 5c�. FT. oCCUPANCv C Right CON STRUCTION TYPE VALUATION $' S Left ZONE GRADING CU. YDS. ACRES p�ng. Ref. # Remarks: � clR (1 G� ....c ' Planning Notes: Sink Preventer I rrigation Clarifiers Dishwasher Drinking Fountains Floor Orains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink � Lavarories � P—Trap • --- ' Roof Drains ' Reinspection Fee $15 Boiler Duct - Under Ground Duct - Sttuctural . Duct - Ventilating Ezhaust Syseem ❑ Multiple Firepl/Fact. Blt. IC60 # Heating System & Ducting ❑0-100,000 BTU-� 100,000 R' F � I emspeMion ee I -ffriverY �cense or 55 � _ CMF 0865-46, �ev. 10/84 WM1i[e - guiltlin9; Canary - Applicdnt: Pink - ACCOunting; GOltlen�Otl - ASSe550� $15 Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet - Water Heater Water Service ' Laundry Trays Issue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑0�100,000 B7U ❑100,000 BT System Repair/Alteration PireDampers � Registers Issue Fee FEES 947F 2/ I 3/I'6 f_ o. '- 2one Accessory Building: Z O N I N G R Parking ReqJProvided E Q M S ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construction PoleSub. � SO+KW Cooking Unit : Meter ❑up to 100 amps Dishwasher � . Mecer ❑over 100 amps, - Dryers ❑Gas ❑Electric SubPanel Fan Momrs DO-i HP �1'/:-8 F.A.U. Inc.Solar 09-15 HP 016-15+ Fixtures Microwave Device Boxes Pole Light Outlets Switches Gar6age Disposal Generator �0-5 KW 05-15 KW Sign ; Standing Sections Trash Compactor FEES $ 3 I � Reinspection Fee $15 luue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Appliwtion Issuad By ��-- Dat � SUMMARV OP FEES BUILDING PERMIT $ SMIP 5 P,LAN CHECK $ PERMIT PLUMBING $ � ISSUANCE $ � PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL S GRADING S PLANCHECK 50% $ - MICROFILM $ !� MECHANICAL 5 ' TOTALFEE $ J'� $ 3 PLAN CHECK 25% $ / CONSTRUCTION AND PLANNIIv� �OL & SPA Date Inspector Date Inspector APPROVALS -Permit # APPROVALS Permit # 1. �Temporary Electrical Service or Pole 52. Pool & Equipment Location � �. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings � 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK � 11 . Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing SYstem - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval - 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough FactorY Fireplace � APPROVALS Permit # � 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventileting 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and FlBshing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation ' 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: L44�VG NO Mii�i2 62ra6. �Zq, [,�p. 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test (j/4-li�o f.i� 36. Hood or CanopY 37. Final Factory Fireplace 38. Final Plumbing Z''��:'if� GG1 39. Water Service-Final 40. Gas Service-Final 47. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound AttenUation 46. Handicap Regulations , ' 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed 49. Elearic ReleaSe to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date e5$ OWNER n�JOB ADDRESS �GENERAL CO] AY No. 11F1—�7 '�:�• Ave. FIHE 'LONE DATE BUILDING PER: VALUE $ DESCRCPTION OF SUBCONTSiACTOR OCT - 7 1961 , " r No.. 23061 - 1 000.00 Add Pe.�iO �x[cW BQ to Res. ZONE R1 , ;. 23061 ; YJSTA MESA BUILDING.SAFEfY DEPARTMEM P.O. BOX 21] C09ip MH9A. CALIFORNIA For Appllcanf to Fill In Completely TYPE OR PRINT BUILDIN6 y, C,,�e�A A�� AD RE53 • COSTA MESA. CALI�ORNIA OWNER oecar AcLEo� MAIL �'7 gI / J 0 LA ADDRH88 �_ TEL. �_ NO. u STATE �_ LIC. NO. OF LOT � USEOF � � EXISTING BLD6. B6TpACK L�N[ FROM S' M�N r' HPT RIONT V DESCRIPTION OP WORK I BUILOING � SIZE EXTERIOR WALL SN/A/sLE. 1 HBHEBY �CKNOWL8D08 TN�T I XAVe qBAD TX�B �PPLICAT�OH •N� 9T�TE THAT TXe �BOVe IB COFHEtt �ND /�OqHf TO COM� P�Y WITH ALL <�TY ORDINANCy.Aµp t AT[ LAWY H[OULATINO OUILDINOCONBTP I ��/ 61GNATURE OP PERMITTH V �'L AUTHORIZHD A6HNT tea�� FEE RECEIVED APPLICATION fOR PERMR ��,I�t��Ij��. OCT 81964: Fi�'WfA'icaVO.%� Only R . IEqMIT NO. NO. OP 119[ O� N8W PUND �li EUILOINO '� �il V��r—c � V �.� O BHALL BE LE39 THAN YARDSMPROVED YARDSAPPROVED MAIN BUILDIN6 ACCESSORY BUILOINO tOM C/L STREET) � Q VAR. SF BET. MAIN @ ACCE85. BLL DATE TM8 AMOUNT BXOWN UNOBR V�LU�TION IB POH THe y PURP08H OP BBTABLI6HINO A PERMIT PEH ONLY. p VALUATION � � m PERMIT FEE $ � 0 m s 1 pC`� C� " o . > �.�Q _g<<-9!?�osrr, »y� �o-�tral'i'2.50 �.� ; � I 892� COSTA MESA BUILDING•SAFETY DEPARTMENT. P. O. BOX 9f7 COBTA MEBA. CALIRORNIA For Applicanf fo Ffll In Complefely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING ADDRESS �91 CSbola Avenue COSiA MESA. GALIFORNIA For Offite Use Only R¢LEIPT NO. PEHMIT NO. OWNER Mesa Del Mar Develo ment Co. '�C�� MAIL RECEI O Y UATE ¢LEI E DATE IB9UED ADDRESS 3800 East Coast Highway -%p -/p � hjQR 8 1963 cirv Corona del Mar No.bR 34220 qDDRess ARCHITECT Macco Rea1C Co. TE� � OR ENGINEER Y NoOR 34220 COSTA MESA. CALIFORNfA ADDRESS `S21�e dS BbOVE: FIRE ZONE TYPE GROUP CONTRACTOR acco Real O A�'�'ROVED BY DATH AODRE65 `S�e aS above ZONING �� O ZONB- NO. OF U8E OF N � CITY J�e 8$ above I PLANB I BU�LDIN � LIC.TNO. GO �� NO. DH6CPIPTION LOt 6�t TraCt 480$ ` $'ZE 6231 S.F. I�°w oH oabne OF LOT A, P, NO. ' USE OF �one YARDS EVES EXIBTING BLo APPROVEO ALLOW D B6TBACK LINB FROM � � «MTEA L�NC 6TJ C¢NTER OF 8iA¢eT 5� REAR YARD 29 FRONT ' FT. IN. � SIDE YARD I LEFT S� I RIGHT 6� R. SIDE " FT. IN. DESCRIPTION OF WORK L. SIOE ^ FT._ IN. NEW I x IIALTERATION I IIADDITION I REAR !7I� ) FT. IN. � REPAIR I II MOVING I II DEMOLISH I p'PPROVE � (/' .�' BY DATE i �J 61ZIELDINGS4�X41�bn ROOMS 7 5T041E5 2 �/ / Sin le Famil Res. W/att. Gara e Plan �500-BR Living Area: 2266 S.F. Garage Area: 460 S.F. I HEREBY ACKNOWLEDGE TXAT 1 NAVQ READ THIe MPLICATION THE AMOUNT 6HOWN UNOER VALUATION �B POR THE ANO 9TATE TXAT TXE ABOVE 18 GQ�ECT AND AGRE6 TO COM- pUitP08¢ OP EBTABLIBHING A PERMIT FEE ONLV. PLY WIiH AlL CITY OP�INANCE9 hND BTATE LAWB REGULATINO OUILDINO CONBTRUGTION. VALUATION r SIGNATURE OF PERMIT FEE $ PERMITTEE Mesa Del Mar Develo ment Co. 2� L � By • r $ 23, 925.0� p�pN CHECK� $ J�/ `� � F AUTHORIZE� AGENT ��, p � TOTAL FEE S D LL