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HomeMy WebLinkAbout1055 CHEYENNE ST - Building Permits(714) 754-5273 • Fax (714) 764-4856 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT Job Address: 1055 CHEYENNEST Suite No Vicinity: Parcel Nunmber: 14159517 Applicant: RON NOCK Address: 11612 KNOTT ST GARDEN GROVE, CA i Owner " HANSEN, NORMAN B JR Address"/ 1055 CHEYENNE ST COSTA MESA, CA Contractor: NOCK PLUMBING Address: 11612 KNOTT ST GARDEN GROVE, CA + I r ,Arch/Eng: Address: WATER HEATER. AMT ISSUE FEE $22.00 Backflow irrigation.- $0.00 Backflow Preventer $0.00, Bathtub - $0.00' Clarifier System $0.00 Connect (Ice,Soda,etc) $0.00 Dental Units -� $0.00 Dishwasher $0.00 Drain, Floor '$0.00 Drain, Rainwater - $0.00 Drain, Roof $0.00 Drinking Fountain x$0:00 Expansion Tank $0.00 Gas Earthquake Valve $0.00 Gas (1-4 outlets) $0.00 Gas (Over 4 outlets) $0.00 Gas Repipe $0.00 Gas Service $0.00 Interceptors (Grease, Oil) $0.00 Interceptors (Sand Auto ) $0.00 QTY PLUMBING PERMIT Phone: 714 895-1246 Zip: 92841 Phone: Zip: 92626 --Phone: 714 895-1246 Zip: 92841 License: 707775 Phone: Zip: License: SCOPE OF PERMIT FEESUMMARY_ AMT Laundry Tub / Washer $0.00 Landscape, Irrigation - $0.00 P -Trap - $0.00 Pressure Regulator $0.00 v.:Progess Piping (per 10 ft) - $0.00 . ` Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Connect $0.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) - $0.00. Spa (public) $0.00 QTY 0 0 0 0 0 0 0 0 •0 0 0 0 0 0 0 0 0 0 COMMENTS / SPECIAL CONDITIONS PERMIT NUMBER V/P99-00205 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 04/01/1999 Issued: 04/01/1999 ISSUED BY: EXOT Ds'�"a �O r� s Sump Pump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re -pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: $33.00 QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 9 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12.21.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 DECLARATIONS r WORKERS' COMPENSATION DECLARATION: _ I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to saN-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ff'I have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this-pernil is issued. My workers' compensation Insurance carrier and poli number are: y, �� Carrier: �'/7 / /;k-_ I ) J Policy Number: 07 �/ 3 Lr Lrb2 (This section need not be completed i he permit Is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SI -ALL. SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($108000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OFTHE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: - I hereby affirm that I am licensed under provi g�f�pfef�(commencing with Section 7000) of Division 3 of the Business and Prgf-essio s Code, and my license is in full force and effect. Lic. x 7 }} Class 1i �- �� Contractors Signature: Data: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires: I'S Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five;(5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Celifomla'Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). __--_nt need to"..__ ..-._ _. .__--.,...__...-.__.. 3 Does or will the applicant or present or future building occupant neetl to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ NO (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Ves ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apermil for such Construction or modification from the South Coast Air Quality Management Distinct or from any other air pollution control district or agency? Yes a No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). —.—_.___ __— _--_.__.-_.__.. 8 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (It "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No _.._. 8 (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. 1 agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Ot Legal Owners) Date And/Or Authorized Applicant Date CODE I. INSPECTION TYPE PAIF IIOIRALS CODE INSPECTION TYPE D5g INTITALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ` 200 Final Re -Roof 210 Final Electrical 201 Final Stock/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire, Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition. 250 Final Building/Occupancy 244636 Applicant to fill in all spaces except those within heavy border lines and sign all appropri ate declarations. , O. ! 00.81 I 1/12/87 '� TL EPAIR ' _ A.P. # _ _ , ._ _ Zone - S Main Building: • Accessory Building: f ' TFront, ' O ARear 1 N ngle C Right N QO S Left G R Ping. Ref. # ' Parking Req./Provided I I E -. Planning Notes: M FEES 'ELECTRICAL _ FEES Automatic Washer Transformer ❑ 15-50 KW ' Construction Pole Sub. ❑ 50 + KW Cooking Unit - Meter ❑up to 100 amps - Dishwasher Meter, ❑over 100 amps- - I Dryers ❑Gas ❑Electric Sub Panel _ Fan - _ Motors ❑0-1 HP ❑1'/:-8 ' - I F.A.U. _ _ ' 1 I Inc. Solai 09-15 HP 016-15+ _ Fixtures I Microwave Device Boxes Pole Light - Outlets Range ' - Switches Sign - - Garbage Disposal Standing Sections Generator ❑0.5 KW 05-15 KW Trash Compactor $. 3 Reinspection Fee FEES $15 Issue Fee M $ 3 DEVELOPMENT SERVICES REQUIREMENTS: I - Zoning Approved By Date Building Approved By Date Application Issued By - Date___ • SUMMARY[XF FEES - BUILDING PERMIT $ ��'©,SMIP $. -• sT PLAN -CHECK $ 'PERMIT PLUMBING - '$ ISSUANCE -. '$ PLAN CHECK 25% 1$_ ENERGY P.C: ,$ ELECTRICAL $ •GRADING $ _ PLAN CHECK 50% $ - MICROFILM $ MECHANICAL $ . TOTAL FEE $-L_r " $ 3 PLAN CHECK 25% $ CITY OF COSTA MESA. CONSTRUCTION PERMIT PERMIT NO. j TRACT NO. LOT NO. :UNIT N ' Project Address X38XKX?§ X 1055 Cheyenne ' ' Applicant's Mailing Address ; 126 Commercial Way, !C,M, TYPE OF CONSTRUCTION NEW- ;ADD ALTERATION R NOrRIHaI15E'R '546-6341 El CONVERSION' ❑DEMOLISH OTHER Owner's Name Phone DESCRIPTION OF WORK/USE OF BLDG. Remo pNe i ria' i n.c Address 1055 Cheyenne, C. M, 300# "Class A" fiberglass la h' Arch/Eng. License No. TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ' ❑'ELECTRICAL. El PLUMBING ❑ MECHANICAL • Address 'Roofing ❑ OTHER ' Contractor's Nam, Crank Bros. Phone 548-5569 .;__ . 1 6Commercial, C_ M- 92627 PROJECT DESCRIPTION SR. FT. 3, 700 OCCUPANCY si 1 Address (mailing) CONSTRUCTION TYPE residneital VALUATION '$ 8-103. C{l0 City License No. sggi ZONE—GRADING CU. YDS. ACRES LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: with section 7000) of Division 3 of the Business and Professions Code, and j ly license is in full force and effect. . • ' \ Icen Class — Lic s677 Date _ Signature PLUMBING I1 l.. WORKERS' COMPENSATION CLA A I 'N ;Bar Sink, Showers, I hereby affirm that 1 have a certificate of consent to self-insur Ora certificate of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 3800, Lao: C.) 1 Policy No. - - 9R5 -994 -RF, pang ,` t11 ' Backflow Irrigation - Sewer'Ca ❑� Certified copy is hereby Turn lsM1etl �.rs�` , 1 _ _ Certified copy is fil wit h,t he cit I g rv' la- Bathtubs - n Sewer Connection �!' rYtate�1 '•-' (-4 — Applicant ra17 OS. O inCf CO. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - Clarifiers _ a Solar Collectors_ (This section need not be completed if the permit is for one hundred ($100 or less). ) Dishwasher Solar Piping ' 1 certlfy.that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Drirl king, Fouritains Solar Tank Workers' Compensation Laws of California. .. Date Signature Floor Drains Swimming Pool w/Spa NOTICE: If, after making this declaration, you should become subject t0 the --' Workers' Compensation provisions Of the Labor Code, you must forthwith Floor Sinks Urinal comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service ' DUBet$ Wdtef Closet Thereby affirm that there is a construction lending agency for the performance of the work ., for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater ' Lender's Name Lender's Address - Kitchen Sink - a Water Service - OWNER BUILDER DECLARATION I hereby affirm that;l'am exempt from the Contractor's License Law for the Lavatories Auto -Wash ollowing reason (Section 7031.5 Business and Professional Code: Any city or Canty which requires a permit to construct, alter, improve,. demolish or repair P -Trap Laundry Trays i structure, prior to its issuance, also requires the applicant for such permit --f thy o file a signed statement that he/she is licensed pursuant to the provisions of ROOF Drains the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division '3 of the Business and Professions Code) or that he/she is exempt - therefrom and the basis:for the alleged exemption. Any violation Of Section 7031.5 by any applicant for a permit subjects the applicant to a civil realty Of not more than five hundred dollars ($500). - 1, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee compensation, will do the work, and the structure is not intended or offered ' for sale (Section. 7044, Business and -Professional Code: The iContractor's - MECHANICAL License Law does not apply to an owner of a.property who builds or improves thereon, and who does such .work himself/herself or through his or her own Intended for Boiler Hood or - Type I ❑ employees, provided that such improvements are not or offered sale. -If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ - pletion; the owner will have the burden of proving he/she did not build or Ina- Duct - Under Ground - ' prove for the purposemf sale). I - ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct -Structural Refrigeration System tractors to construct the project (Section 7044, Business and ' Professions Cotle: The Contractor's License Law does not apply to an owner of property who Duct - Ventilating ' - - 130-100,000BTU ❑100,000 BTU builds or improves thereon, and who contracts for such projects with a con- tractor(zl'license pursuant to the Contractor's License Law): I am aware that Exhaust System -0 Multiple ❑ System'Repair/Alteration - proof off 'their Worker's Compensation Insurance Should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Firepl/Fact. BIL ICBO # Fire Dampers _ Date' Owner ` - Heating System & Ducting - Registers certify' that 1, r y y' have rt this application and state that the above information ❑0.100,000 BTU ❑100,000 BT . Informatiom is correct. I agree to c ply with all city and county ordinances and State laws relating to building c ion, nd hereby auor lie repre- sentatives;of 1 I city to ant r on ab e -mentioned prra inspection purp ' - - Signature Date - - '- Drivers' Lice a or 55 - - Reinspection Fee $15 Issue Fee CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor ' ate declarations. , O. ! 00.81 I 1/12/87 '� TL EPAIR ' _ A.P. # _ _ , ._ _ Zone - S Main Building: • Accessory Building: f ' TFront, ' O ARear 1 N ngle C Right N QO S Left G R Ping. Ref. # ' Parking Req./Provided I I E -. Planning Notes: M FEES 'ELECTRICAL _ FEES Automatic Washer Transformer ❑ 15-50 KW ' Construction Pole Sub. ❑ 50 + KW Cooking Unit - Meter ❑up to 100 amps - Dishwasher Meter, ❑over 100 amps- - I Dryers ❑Gas ❑Electric Sub Panel _ Fan - _ Motors ❑0-1 HP ❑1'/:-8 ' - I F.A.U. _ _ ' 1 I Inc. Solai 09-15 HP 016-15+ _ Fixtures I Microwave Device Boxes Pole Light - Outlets Range ' - Switches Sign - - Garbage Disposal Standing Sections Generator ❑0.5 KW 05-15 KW Trash Compactor $. 3 Reinspection Fee FEES $15 Issue Fee M $ 3 DEVELOPMENT SERVICES REQUIREMENTS: I - Zoning Approved By Date Building Approved By Date Application Issued By - Date___ • SUMMARY[XF FEES - BUILDING PERMIT $ ��'©,SMIP $. -• sT PLAN -CHECK $ 'PERMIT PLUMBING - '$ ISSUANCE -. '$ PLAN CHECK 25% 1$_ ENERGY P.C: ,$ ELECTRICAL $ •GRADING $ _ PLAN CHECK 50% $ - MICROFILM $ MECHANICAL $ . TOTAL FEE $-L_r " $ 3 PLAN CHECK 25% $ $. 3 Reinspection Fee FEES $15 Issue Fee M $ 3 DEVELOPMENT SERVICES REQUIREMENTS: I - Zoning Approved By Date Building Approved By Date Application Issued By - Date___ • SUMMARY[XF FEES - BUILDING PERMIT $ ��'©,SMIP $. -• sT PLAN -CHECK $ 'PERMIT PLUMBING - '$ ISSUANCE -. '$ PLAN CHECK 25% 1$_ ENERGY P.C: ,$ ELECTRICAL $ •GRADING $ _ PLAN CHECK 50% $ - MICROFILM $ MECHANICAL $ . TOTAL FEE $-L_r " $ 3 PLAN CHECK 25% $ CONSTRUCTION AND PLANNING, APPROVALS Permit,# Date Inspector , t POOL & SPA pppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location , 2. 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings - X58. Electrical Conduit-Undrgrnd. .� 8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 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 Elecfrical-T -Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL ' 19. Rough Heating &Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # ' - 20: Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 00il 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing _ 73. Undergrnd. Storage Tank 0Gas 00il 25. Roof Sheathing 74. Overhead Hydro - - 26: T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. F�ame,and Flashing 76. Dry Standpipe - 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29: Insulation 78. FIRE P.REV. 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: 34. Final Heating & Air Conditioning !• 35. Final Gas Pipe -Test 36. --Hood or Canopy 37. -Final Factory Fireplace . 38. Final Plumbing- ' 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Pre venter - - -43. Backflow Irrigation 44. Landscape Irrigation System' .. 45. Sound Attenuation t 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING ' F7 48%Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No.- ' ' Date i COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 917 COSTA MESA. CALIFORNIA For Appliconf fo Fill In Completely TYPE OR PRINT .BUILDING _ _ _ _ 1. FEE RECEIVED tEB 1 9' 1063 FAANCE DEPT. OF COSTA MESA APPLICATION FOR PERMIT BUILDING COSTA MESA. CALIFORNIA For Office Use Only RECEIPT NO. PE Mlj NO/� .„OWNER L(� IMAIL RECEIV EY I D�TP.1R jE1VElyrI1 DCr�SSUED ADDRESS- lVV Mils y TEL. CITY NO BUILDING ADDRESS Io<� ARCHITECT TEL. COSTA MESA. C IFORNIA ENGINEER NO. OR ENGINE O ADDRESS FIRE FIR E - TYPE GROUPJ CONTRACTORjEdpjdoh APPROVED BY DATE ZONING ADDRESS 2907 j3pnediri COY1 ZONE NO. OF USE OF NEW %/n9 llbRPy CI')'Y&1,1j,�' PLANS I BUILDINGSTA LEGAL LOY '1_S LIC.TNO. 147 � DESCRIPTION g TR 6 -NO. SIZE NO. OF SLOGS. OF LOT - NOW ON LOT A P NO USE OF YARDS EVES EXISTING BLDG APPROVED ALLOWED SETBACK LINE FROM (CENTER LINE SL) _ CENTER OF STREET - REAR YARD 0 FRONT '� FT. IN. SIDE YARD ILEFT (RIGHT _ R.SIDE �r FT. IN. DESCRIPTION OF WORK L. SIDE t FT. IN. NEW I X ALTERATION I ADDITION REAR 3 0 FT. '� (REPAIR I I MOVING I I DEMOLISH BYPROVE q/IN'. 4 DATE (^ V/V__”/ ' B ILDING,,II NO. OF 2 6 SIZE X M. ROOMS ' STORIES ERIOR WALL ROOF ICOVERIN !C VERING /I ;Us OF BUILING AN ( ORK TO BE PERFORMED 70 4/R % / Q 11 Iroj HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION THB AMOUNT SHOWN UNDER VALUATI IS FOR THE D STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. V WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION SIGNATURE OF PERMIT FEE S 7 �' PLAN CHECK S PERMITTE S;2/ ?�7 '/ �� z7—, AUTHORIZED AGE TOTAL FEE