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Home My WebLink About3188 COUNTRY CLUB DR - Building Permits(714)754-5273 • Fax(714)754-4856 Job Address: Suite No Vicinity: CITY OF COSTA MESA B!/ILDING DIV/SION DEVELOPMENT SERVICES DEPARTMENT PERMIT PLUMBING PERMIT 3188 COUNTRY CLUB DR Parcel Nunmber: 13912302 Applicant: NOCK, RON -- _r.� l a'::�' ' Address: 11612 KNOTT ST�,if/� %��- r' �,- ,, CA � ��'� / �i � �-~ ` ` � Phone: GARDEN"GROVE � � I �� Zip: 'lf/, � , , � -' �l � ��/�/A �'�� i i _ �iJ.�.r,. �r.�..��,.� ��.,� .. �� s � - � Phone: Zip: i �'/ '/' - � i'' !�� ; ;' �it' � : ; � /`i:-% �'�Contractoc. NOCKPLUMBING � �> , .y" Address /1,7672 KNOTT ST � � . '�� r � . , . . ` ,-�A� .. � � �'� . Phone: i�, � , � ; �iGARDEN GROVE ,„.. �� . { c � - � -` Zip: � 3, � � , �' �r�� J � � �Z - ; � License iY � �,-�� „ _ r �� Arch I Eng �� ='.� �� i `i l � �' ' �Address:�,- �� % C� � ' ; �.� � ti _ Phone:� o � � � ' � . . " `"� 'Zlp: A•� .. , ';J' . . - - - License: " \ �. NUMBER 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: OB/26/1999 Issued: 08/26/1999 ISSUED BY: _. . : _r-�-�_., , _:�?'-��\`.. I � �-.�' �c, ^�`.., (714) 895-124� % i-...`��.,Y� 92841 � � r� � �� ,=��\ � {1 � A �� , � ' \��'�.\ � \ +'>.� �� , � \ �'��\.\ _��c<.� ��A r i A�.� . � `�`��;: '� O�\�� 92626 \�� ' `� \\ . � �� _-, \j�\/ �� \':i\ .:��\\ /� ��' ��^ I 6 ; �" �\ � � ' \ ��\ . . . � � �v� i � �� `1 l (714)...895-1246 . . � r \ � ` \ � �..�\ 92647 `,-',,,..�' , - -- �.�L; v-- � ;�. 707775 � � - i V ', ��1 � , - - , ,��i �\ � ��`q. ..'-_....._. - ,. �- t . ` ` -_-- = -�.� �----- . -f• �-� . ��. / J 1 . . 1 . __ _ . '�� _ �1 � ' . ` ,'J ' .:\. � 1 �� y �. � s- �� r ��s, �t` ' �s �r,� � �,�'; � � i ; v i E: R � -,i_- � �SCOPE OF.PERMIT r �, � � � - . � I i-1f�WATERHEATERCHANGEOUT r _ , �'�� > - _'' /7�� f :. � i. � � ��,_.� i ' .%,'� � ;,�� i '�� , . " FEESUMMARY_;I � i ,' � �� ,� V- " - '- . . �Ij�� - - 1��, /� . �"� AMT QTY . .. AMT- �' QTY � � r' � �: . AMT. ! QTY � ��$23.50 = , Laundry Tub / Washer $0.00 0 Sump Pump�; �/ ,� $0.00� 0 in , �' $0.00 0 `^�- Landscape Irrigation , �',,.� _ $0.00 0 Swimming Bool ��,, �/ $0.00 0 rter �$0.00 0 PTrap �,F`.� - ��''�$0.00 0 TrapPrimeF' ,%$OAO 0 BathWb V�� ;A ^ $0 00 ; 0 Pressure Regulator � � � $0 00'r 0 "� Un al�'/,- �. �;$0.00 0 Clanfier System '� $0 00 \�. �0 Process Piping (per 10.ft) -- $0 00;.` 0� ' Vacuum Brkr Bkflow(7-4) .�$OAO 0 < Connect Qce,Soda etc) $0 00 ��0 � - , ar `�Receptors,� ` - $0 00''� 0 -� ��"' �4� Vacuum Brkr Bkflow(5+� . ;� $0.00 0 Dental Units �� $0.00 ��0 ' � Septic Tank � - � � ''r�� $0.00 ` �'0 � � �-!Wash Basm % = $0.00 0 Dishwasher � �� $0 00 � 0 ��,�,�Se�ver Cap,fOr Demo " � r $0:00 �' 0 � . ' �" Wasli-Basin-Set � ��, � $0.00 0 Drain, Floor � `.� $0.00 , , ;0 �. Sewer Connect ` � , �$O.QO , 0 _ � , Waete antl Vent Syetem $0.00 0 Drain, Rainwater �� \ $0.00' � 0� � , � -�Sewer PriJate Line., c , $0.00 . � 0 " - ` Watei Closet (Toiletj $0.00 0 Drein,Root � ��:$0.00V� 0: ��. � Shower � - $0.00-�� 0 .�WaterHeaterlvent $12.30 1 Drinking Fountain `;$0.00, 0, ', � �, Sink, bar $0.00- ��0 � ' Water Piping-(Inst or Rep.) $0.00 0 Expansion Tank $0.00. � 0 , �� Sink, commeicial $0.00, � 0 - Water Re-pipe $0.00 0 Gas Earthquake Valve $O.OP � -0 � ` � Sink, Floor $0.00 0. - -' , � Water Service $0.00 0 Gas (1-4 oUtlets) $0.00 � 0 " Sink, kitchen - , $0.00 - 0 ' � Wa[er Softener $0.00 0 Gas (Over 4 outlets) $0.00 0 , Sink, service/mop $0.00 -0��. ' - "- OTHER $0.00 Gas Repipe $0.00 0 ' Spa (private) �. . �$0:00' � 0 " VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceplors (Sand Auto ) $0.00 0 TOTAL CALCULATED FEES: $35.80 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by ihis 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 it work is not commenced within 180 days, or if work is suspended or abandoned for a period of 780 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 Inspectiona antl final approval must be obtained. Failure to obtain inspec�ions and final approval will result in tha expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 WORKERS'COMPENSArON DECLARAnON: I hereby aHirm untler penalry of perjury one ot ihe tollawing tleclerations: ❑ I heve and will maintain a certifcate of consent to self-Insure for workers' compensation, as provitled for by section 3700 of ihe Labor Code, for ihe peAortnance of the work For which this permit is issued. �I have antl will maintain workers' compensation insurence, as requiretl by section 3700 ot the labor Code, for Ne pedortnance of ihe work for which Ihis permit is issued. My /w��or.ka�rs' rc�om�pen�sa•tion Insuranca wrtier and policy number are: � h_ y�� Cerrier: w�t./1—iN ��9i� Policy Number. NYV V (This secfion need not be cromp/etetl il the permiNs velued et one hundred dollars ($100) or less.) ❑ I certify that in the performance of Ihe work for which ihis pertnit is issued, I shall not employ any person in any manner so es to become subject to Ihe workers' compensetion laws of California d egrae that ii I should become sublect to the workers' compensation provisions ot Section 37 0 ot lhe La or Code, I shall forthwith comply with these pravisions. Applicant Signeture: � ' Date: WARNING FAILURE TO SECURE WORKE ' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL Sll&IECT AN EMPLOYER TO CRIMINAL PE 1LTIE5 AND GVIL FIN UP TOONE HUNDflED iHOUSANDDOLLARE(S1W,OW),INA�DITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORINSECiiON31060FTHELABORCODE,INTEREST,AN ATTORNEY'SFEES. LICENSED CON7RACTORS DECLARATION: I hereby attirm ihat I am force antl eHect Lic. N_ Contractofs SignaWra: of Chapter 9(commencing with Sectlon 7000) of Division 3 of ihe Business antl� o.,f/e�sions Code, and my license is in full Class k �'�— JLO � Date: ii� ,2�� /' .+ CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirm that there is e conswction lending agency for the pertormance oi �he work for which ihis permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Atltlress: Signature: Date: OWNER•BUILDER DECLARATIONS: I hereby aflirm that untler penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Professions Code: Any city or counry which requires a pertnit to construct, alter, improve, demolish, or repair any siructure, prior to its issuance, also requires ihe applican� for such permii to tile e signad statemen� the� he or she is licensetl pursuent to ihe provisions of the Coniractors Licensa Lew (Chapter 9(commencing with Section 7000) ot Division 3 of the Business and Protessions Cotle) or that he or she is exempt iheretrom end the basis tor the allegetl exemption. Any violation ot Section 7031.5 by any epplicant tor a permit sub�ects the epplicent to e civil penalty ot not mora t�an five huntlred dollers ($500).): ❑ 1, es owner ot the property, or my employeas with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or oHeretl for sale (Sec. 7044, Business and Professions Code: The Contractors License Law tloes not appiy to an owner of property who builds or improves thereon, and who does such work himself or hersetl or through his or her own employees, provided ihat such improvements are not intendetl or oHered for sale. If, however, the builtling or improvemeni is sold within one year of completioq the owner-builtler will have Ihe burden ot proving Ihet he or she ditl not builtl or improve for puryose of sala.). ❑ I, as owner oF the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct Ihe project (Sec. 7044, Business and Professions Cotle: The comractors License Law tloes not apply to en owner of proparty who builtls or improves thereon, and who coniracis for such project with a coniractor(s) license pursuant to ihe ConUactors License Laws.). ❑ I am exempt under sec. Business and Professions Code for ihis reason: Signa�ure: Da�e: Owner ID verified byrdriver's license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of doc'ument,�i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFE7V PERMIT CER7IFICA710N: YHlr ❑ I hereby certify ihat no excavation tive•(5) or more faet in depth into which a person Is requiretl to descend, will ba made in connection with work authonzetl by this permit, antl that no builtling sWcture, scaffolding, falsework, or demolition or dismantling ihereof, will be more �han ihirry-six (36) feet high. (Chap. 32, Gry 2, Atl 2, Sec. 341, Ttle B, Calitornia Administrative Code). ❑ As owner�builtler, I will not employ anyone to tlo work which woultl require a permit from Ihe Division of Industrial Safery, as noied above, unless such person has a permit to do such work fmm �he division. Signature: Date: Division of Industrial Safery Pertnit Number: CERTFICATE OF COMPLIANCE AND AUTHORVA710N OF ENTRY: I certify under penalty of perjury that I have read this application and state �hat ihe information given is correct I agree to comply with all state laws end ciry ordinances relating m builtling construction, antl au�horize representatives of ihe Ciry of Costa Mesa to enter upon the above-descnbed property for inspection puryoses. I agree not to occupy or allow occupancy of any building amhorizetl by t�is pertnit until final inspection. GO�E t. INSPECTIONTYGE 1616 Fixetl System Finel Fire Pravention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition 2446-e8 � �a�� ' Date j1ATF, NT�R� �€ INSPECTIONTYVE 206 Final Mechanical 20B Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approvel 222 Final Site 250 Final Building/Occupancy RTE INTRIALS `.�i/✓ i� (714) 754-5273 • Fax (714) 754-4856 Job Address: Suite No Vicinity: CITY OF COSTA MESA B!/ILD/NG DIV/SION DEVELOPMENT SERVICES DEPARTMENT PERMIT PLUMBING PERMIT 3188 COUNTRY CLUB DR Parcel Nunmber: 13912302 Applicant: COLMAR,KEITH � Address: 01910 E EDINGER',- � �"� � �, r ,F -1 i�,. . SANTAANA'CA /� ��' � ' /'if/, � . � � " , �/ �A -: � /,i%�\ �V� � � � : �,U� � ,/� � i% /fC ntract r ti ISAACS PLUMBING � ,,,i� �,1, � Address � 01910 E EDINGER i.' � i ' � `_ � � � SANTA ANA CA �' - � i'. �." ` .� ' � ' �i ;J � '�� `�.4` � �d>' /�.. � �A�hlEng F ../ �, '� � � Addresst l�` � ' / -' :,� ' ..�.. . / .. . ' � , ..- . , . �.. � : . . .' .i ,- Phone: Zip: Phone: Zip: Pfione: - ` Zip: License: Phone: , � -.. �Zip: License: PERMyT NUMBER � �99-00447 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 08/06/1999 Issued: 08/O6/7999 ISSUED BY: � 714-258-0603 / � ' � �-�\ � , �� 92705 . j � f� �V'- A ., �,� ��% -��_ � /'- ,> > -�t�� , , ,� , � , � � �; �,� . A i ��A ��i:;\�' ` �f � � ��.;, �c;� i � .� 92626 � �� i �\; ;�; '�� . � < ✓ �:i�. ��•�\�. �- � ;�� /' •` �`,A ,, � � �� : �� i l _ `� � 714-258-0803 � -. � Ati . �,A .. 92705 '. . ��,f,�'. . , ' .�a 429549' . � ; . , �� r` , ' - . 't j\/ \ � �,\ �\ 1' � t� Y�', _ .�� I '• � ��• � - ' �`, i .� \ .. . ......�... .. ` .'+ r . �� _ , � r i � 't, � � � � '' � � i , _ � � - ' � itr.� , �, ��fi r�.�y.� ./ ��i!� . � � �� t � �. � ,, - -� -.SCOPE OFPERMIT �� j � _ ',� .� 'i,NEWGASLWE. - _ . � - � - , �� " _ , ;, _ �'r� �:'�� ' � � - � i �'� •��'! � f �� -"" �� - FEESUMMARY � _ yr,(. r %`vi �\�� „ � \�\�'_AMT QTY " _'_ AMT `QTY � /i �AMT°/ QTY C ISSUEFEE \ ��•, �,% �� $23.50 _ . Laundry Tub / Washer, $0.00 0 Sump Pump �� -� � , ;' $0.00% 0 Backflov+�irrigalion ;� �,$0.00 0 `^ . Landscapelrrlgation . $0.00 0 Swimming�Pool ,i $0.00 0 BackFlowi�P�eventer �$0.00 0 - P-Trap ^. `�,_�-. ` � $0:00 0 Trap Primer;- � ; $0.00 0 Bathtub��= ', $0.00,:, 0 PressureRegulator - '$0.00: 0 •�'Urinali;� � .:$0.00 0 ClariferSyster'ri '' - $0.00;��0 ,,;ProcessFiping.(per,10ft), $0.00'. 0 - .'VacuumBrkrBkflow(1-4),;.�;$0.00 0 Connect (Ice,SoAa,etc) $0,00 ` � 0 � ' :'�� ` � Receptors � . ;, ' $0;00 �� 0 � � �`�- Vacuum Brkr BkBow(5+�; ; � � $0 00 0 Dental Unite ' V�, /$0.00 �0 - �' : Septic Tank "' � !� -$0.00� �b .; � � slNash Basin� . ;,j; $0.00 0 Dishwasher �� - �$0.00' ' 0 � Sevigr Cap for Demo � ' $0.00 � 0 , =- Wasti Basin Set , � �'/ $0.00 0 Drein, Floor V`- ,�- $0.00 ; ", 0, - . �Sewer Connect - - .. $0.00 .; 0 � � Waste,and Vent System $0.00 0 Drain, Ralnwater � �� $0:00 � � 0 , Sewer Private Line . , � $0.00 0 . � Water Closet (Toiletj, $0.00 0 Drain, Roof ��'$0.00` 0 �� Shower � $0.00 0 � WaterHeaterJvent $0.00 0 Drinking Fountain ��$0;00_, 0' " Sink, bar $0.00 0- � Water Piping�(Inst or Rep.) $0.00 0 Expansion Tank $0.00� � 0 � Sink, commercial � -� $0.00� 0- Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 _ 0 ' Sink, Floor $0.00 0 � -�.Water Service $0.00 0 Gas (1-4 outlets) $0.00 0� Sink, kitchen � $0.00 0 , �` Water Softener $0.00 0 Gas (Over a outlets) $0.00 0 � Sink; service/mop $0.00 . 0 �, �" _ " � OTHER $0.00 Gas Repipe $9.80 1 Spa (private) . . , ,$0.00' �0 - VIOLATION $0.00 Gas Service $0.00 0 Spa (public) . $0.00- 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0.00 0 TOTAL CALCULATED FEES: $33.30 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia 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 1 BO 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 requlred Inapeetlons and flnal approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARA710N: - ' I hereby eNirm untler penalry of per�ury one of the following declarations: ❑ I have entl will meimain e cenificate of consent to self-Insure tor workers' compensation, es provided for by sectlon 3700 of the Lebor Code, for ihe pertormance of the work for which Ihis permit is issuetl. - � I have end will maintain workers' compensation insurance, as required by sec�ion 3700 of the Labor Cotle, tor the pertortnance of tha work for which this permit is issued. My workers' compensation Insurance carner antl policy number are: Cerner: Policy Number: (This section need not be comp/efeC il the permlt is veluetl ef one hundred dallers ($100) or less.) ❑ I cenily thet in the peAortnance of the work for which this permit is issued, I shall not employ any person in eny menner so as to become sub�ect to the workers' compansation laws ot CaliFornia, end agree that � should become subject m the workers' compensation provisions oi Section 3700 of ihe Labor Code, I shall forihwith comply with these prov�isi % r Applicant Signature: � i7o � i / Date: �� 7� WARNING: FAILURE TO SECURE WORNER5' GOMFENSATION COVERACaE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVII FINES UP TOONE HUNDRED THOUSAND DOLL4RE ($100,000), IN A�DITIO�'1 TO THE COST OF COMPENSATION, �AMAGES AS PROVIOED FOR IN SECTIIXJ 31060F THE LABOR WDE, IMEREST, AND ATTOFNEY'S FEES. LICENSED CONTRACTORS DECLARA710N: I hereby aHirm that I am licensed under provisions f Chapter 9(commencing with Section 7000) of Division 3 of ihe Business antl Profe sions Coda, antl my Iicense is in tull force end eHect Lic. # �� dr � � n Class k �`�� ComracmYs SignaWre: ,` Date: ��0' CONSTRUCTION LENDING AGENCV: ❑ I hereby affirm Ihet there is a cons�Nction lendinq aqency tor the pertortnance of ihe work tor which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signeture: Date: OWNER-BUILUER DECLARATIONS: I hereby attirtn ihat under penalty of perjury Ihat I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Professions Code: My city or county which requires a permit to constmct, alter, improve, demolish, or repair any stmcWre, prior to its issuartce, also requires Ihe applicaot tor such permit lo file e signetl statement ihat he or she is licensed pureuant to the provisions ot the Con�ractors License Lew (Chapter 9(commencing with Section 7000) of Division 3 of ihe Business antl Professions Code) or iha� he or she is exempt therefrom and Ihe basis for ihe alleged ezemption. Any violation of Section 7031.5 by eny applicem for a permit subjects the applicant to e civll penalry oi not more ihan five huntlred tlollars ($500).): ❑ I, as owner of ihe property. or my employees with wages es iheir sole compansation, WILL DO THE WORK, and the stmcture is not intended or oRered for sale (Sec. 7044, Business entl Professions Code: The Contractors License Law tloes not apply to an owner of property who builtls or Improves theraon, end who does such work himself or herself or ihrough his or her own employees, provided that such improvements are not intentled or otterad for sale. If, however, the building or improvement is soltl within one year of completion, ihe owner-builder will have ihe burden of proving that he or she did not buiid or impmve tor purpose ot sale.). ❑ I, as owner ot the property, am ExCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Coda: The contrectors License Law does not apply to en owner of property who builds or improves thereon, and who contracis for such project with a contractor(s) license pursuant to the Contrectors License Laws.). � ❑ I am exempt untler sac. Business antl Professions Code tor ihis reason: SignaWre: Date: Ownar ID verifiad by tlriver's license. ❑ Yes ❑ No Dnver's License No. Venfication ot Ownership by (type of tlooument, i.e. - proparty tax bill or tleetl): DIVISION OF INDUSTRIAL SAFE7V PERMIT CERTIFICATION: Expires: ❑ I here6y certify that no ezcavation five (5� or more feet in depih into which a person is required to tlescend, will he made in cannection with work authorizetl by this permit, and Ihat no builtling stmcture, scafFolding, falsework, or tlemolition or dismantling thereoi, will be more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, California Adminisiretive Code). ❑ As ownar-builder, I will not employ anyone to tlo work which would require a permit from ihe Division ot Industrial Safety, as notetl ebove, unless such person has a permit to tlo suc� work from the tli�ision. Signeture: Date: Division of Industnal Sefery Permit Number. CERTFICATE OF COMPLIANCE AND AU7HORIZATION OF ENTRY: I certity under penalty of perjury that I have read this application antl state that the intormation given is correcL I agree to comply with all state laws and ci�y ordinances relating to Duiltling consimction, and authorize representetives ot the Ciry of Costa Mesa to enter upon Iha above-described properry tor inspection purposes. I agree not to occupy or ellow occupancy oi any building authonzetl by ihis pertnit until tinal inspection. aS��ur t gal ner�/ _ p�� 6� And/Or Au�honzed Applicant Date' COOE I. INSPECTIONTYPE 1616 Fiaetl System Finel Fire Preveniion 1266 Pool Spa Final 200 Final Re-Roof 207 Final BIocWRetaining Well 202 Final Fadory Fire Place 203 Finel Sign 204 Final Demolition QAjF tJ��^ f�QD�e INSPECTIONTYPE _ 206 Final Mechanical 208 Finel Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning ApprovaV 222 Final Site 250 Final Building/Occupancy QRg � INTIfIpLS s�--� � n/ ��Il� COSTA MESA BUILDING DEPARTMENT ' P.O. 80X 31] COSTA MESA, CA•LIFORNIA FOR APPLICANT TO FILL IN BUILDING 3188 Countr Club Drive ' ADDRE55 Y .COSTA MESA: CALIFORNIA OWNER Newport Homes, Inc. MAIL ADDRE55 t ecc r.1'....�.,.+... ARCHITECT OR ENGINEER ADDRE55 • j'�. LEGnL LOT OESCRIPTION NO. A.P. NO. • ' � , , ' � :.. �A� >,. b �v �� AU6 b 1959 �i�!f�,�'CF DEPT. ,� rn.:lr, �l',:�!i APPLI�CATION FOR PERMIT BUILDING FOR OFFICE USE ONLY Beach No: MI 6-3227 pDDRE55 ��c. COSTA MESA. CALIFORNIA Ho. Beach �ISZ� LIG. 1q1.1 �\ I NO. N�. T.T /_�']�t�l�. BYPROVED ru V �c,c TRACT Z']�Z rvo.oF e�ocs. �IOW ON LOT USE OF EXISTING BLDG. sElancrc �iHe vaoM '�O REAR VARD ��Q CENTER OF STREET SIDE YAR� RIGHT C+ LEFT L DESCRIPTION OF WORK NEW X ALTERATION AODITION REPAiR � MOVING DEMOLISH 5 ZI�LOING 1gV0 v ROOMS 6 STORIES 1 EXTERIOR WALL ROOF COVERING COVERING (� USE OF NEW 6UILDING _'___'�.__ ��T CQ//./li1// OATE CORRECTIONS I HEREBY ACNNOWLEDGE TMp i HnVE READ THIS /�PPLICl�TION.AND STATE THAT iHE FBOVE I$ CORRECT AND l�GPEE TO COMPLY WITH RLl , CITV ORDINANCES PND $TFTE LF�N$ REGVLPTING BIIILUING CONSTRVC� iiON. VALIJATION S I G ..�E..o..-�.�r /l PER T n 3 J� A � $ > 0 �1 PERMiT FEE $ �y f PLAN CHECK $ f9 '— TOTAL FEE $ i � — v��