HomeMy WebLinkAbout3123 COOLIDGE AVE - Building Permits(714) 754-5273 • Fax (714) 754-4056 • www.ci.costa-mesa.��SCTRICAL PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
ApplicanC
Address:
Owner:
Address
Contractor.
Address:
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 unils)
New Res (3+units)
Pool / Spa
Lighting Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to t000a
Service over 1000a
Motors to 1 hp
Motors to 10hp
Motors to SOhp
Molors to 100hp
Motors over 100hp
Communication tlrops
Sub panel to 200a
Pole Light Pkg
3123 COOLIDGE AV
14169334
JOHNSTON, THOMAS S
3123 COOLIDGE AVE
COSTA MESA, CA
JOHNSTON, THOMAS S
3123 COOLIDGE AVE
COSTA MESA, CA
OWNER BUILDER
Phone: 714-556-0373
Zip: 92626-2817
Phone:
Zip: 92626-2811
Phone:
Zip:
License: 000000
SCOP.E OF PERMIT
SERVICE UPGRADE TO 200 AMP. .
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$30.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
�uantity
FEESUMMARY
Temp Dist System / Lighting
Busway /100 k
Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
� .:.:............up to �0 kva/kw
.................up to 50 kva/kw
.................up to:100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misc. Conduit
Misc. Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Chnstmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Status: ISSUED
Applied: 03/08/2004
Issued: 03/08/2004
ISSUED BY:
Quantify
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 , 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 � 0
$0.00 0
$0.00
$0.00
$0.00
50.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis 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 ot 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicabla codes, and all
required Inspeetiona 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
zaas-as (sioo)
WORKERS'COMPENSATON DECLARAnON: � �
I hereby affirtn under penalry of perjury one oi Ihe tollowing declarations: -
❑ I heve and will meintain a certifiwte of consent to sel4lnsure for workers' compensation, es provided tor by section 3700 of the Labor Code, for the pedormance of the
work for which ihis pertnit is issuetl. �
❑ I have and will maimain workers' compensation insurence, es required by section 370CwI.he L,eCQr Code, for the perfortnance of the work tor whic� Nis pertnit is issuetl.
My workers' compensa�'pn �naOrRnce carngr aAd Policy number are:
Carner.
(This;�
et one
orless.)
Policy Numher:
yj}' I cehity thet in ihe performence of the work for which this permit is issued, I shall not employ any person in any manner so as to bacome subject to ihe workers'
'\\ compensetion laws of Californi and agrae that I ap uld become subject to the workers' compensetion provisions of Secti n 3700 f Ihe Labor Code, I shell forihwith
V comply with ihese � �� � � (� �
Applicant Signawre: �r« � Date: U
WARNING FAILURE TO SECURE WORKERS' CA SATIIXJ COVERAGE IS UNLAWFUL AND SHALL SOBIECT AN EMPLOYER TO CRIMINAL PENA�TIES AND CIVIL FINES UP TO ONE HUNDRED
TFIOUSAND DOLLARE (5100,OW), IN AODITIIXJ TO THE COST OF COMPENSATION, DMMGES AS PROVIDED f-0R IN SECiIIXJ 3]O60F THE LABOR COOE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aMirm ihat I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 ot the Business and Professions Code, and my license is in full
force antl ettecL Lic, a Class q
Contractors Signawre: Date:
CONSTRUCTION LEN�ING AGENCY:
❑ I hereby aRirm that there is a consimction lending agency for the pertormance of �he work br which this permit is issuetl. (Sec. 3097, Civil Cotle).
, Lender's Name: Lender's Address:
� Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirm that under panalry of per�ury that I am EXEMPT FROM TME CON7RACTOFS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business antl Professlons
Code: Any city or county which requires e permit to cons�ruct, alter, improva, demolish, or repair eny stmcture, prior to its issuance, also requires ihe ep0licant for such permit
to file a signed slatement ihat he or she Is licensetl pursuent to the pmvisions oi the Contractors License Law (Ghapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Cotle) or ihet he or she is ezempt theretrom and the hesis for ihe alleged exemption. Any violetion of Section 7031.5 by any applicent br e pertnit
subjects the applicant to a civil penalry of not more ihan five hundred dollars ($500).):
�I, as owner ot t�e property, or my employees with wages es their sole compensation, WILL DO THE WORK, antl the swcture is not intended or oflered tor sale (Sec.
7044, Business and Protessions Code: The Coniractors License Law tloes not apply to en owner of property who builtls or improves ihereon, and who does such work
himself or hersel� or ihrough his o� her own employeas, provitled �ha� such improvements are not intendetl or offeretl for sale. If, however, the builtling or improvement is
soltl within one year oi completioq the owner-builder will have the burtlen of proving ihat he or she did not build or improva for purpose oi saie.). �
❑ I, as owner of the pmperty, em E%CWSIVELV CONTRACTING WITH LICENSED CONTRACTORS m constmct the project (Sec. 7046, Business and Professions
Code: 7�e coniractors License Law tloes not apply to an owner oi propeny who �uilds or Impmves iheraon, and who contrects for such project with a contrector(s)
iicense pursuant to t Contractors License Laws.).
❑ I am ex pt ec. Business antl Pmfessions Cotle for this reason:
Signature: 'l —� Date:
Owner ID veritied by dnver's licen� Ves ❑ No Driver's License No. Expires:
Veri(icetion ot Ownership by (type of tlocument, i.e. - property tex bill or deetlj:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATON:
❑ I hereby cenify that no excavetlon tive (5) or more feet in depth into which a person is requlred to descend, will be made in connection with work euthonzetl by this
permit, and that no 6uilding slrucNre, scattoltling, falsework, or demolition or dismantling ihereoi, will be more �hen ihirry-six (36) tee� high. (Chap. 32, Gry 2, Art 2, Sec.
341, Tlle B, Celifomia Atlministrative Cotle).
❑ As owner-builder, I will not employ enyone to do work which would raquire e permit from the Division of Industriel Safety, as noted ebove, unless such person hes a
permit to tlo such work from the division.
Signature: Date:
Division ot Indus�rial Safery Permit Number.
CERTIFICATE OF COMPLIANCE AND AU7HOHIZAl70N OF ENiTiY: I certify under penalry of perjury Ihat I have read ihis application and sta�e �hat Ihe informalion given is
correct I agree to comply wi�h all s�ate laws antl city ordinances relating to building consWction, end aNhonze represen�a'ves of t e Ci�y ot Costa Mesa to enter upon ihe
above-descnbed property for inspection puryoses. I agree not to occupy or allow occupancy of any building authonzed by thi pe ntirljli I i pection.
� � V�
Signawre Ot Legal Owner(s) � Date
And/Or Amhorized Applicam
CODE�, INSPELTIONTYVE
7616 Pixed System Final Fire Preventlon
1266 Poal Spa Finel
200 Finel Re-Root
201 Final Block/Retaining Wail
202
203
204
Final Factory Pire Place
Final Sign
Final Demolition
J�g� INi1TI�L5
yO�E 1 INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing
210 Final Eleciricel
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 FinalBuilding/Occupancy
3 �9
OATE
It�EL$
AOOPESSOFBVILpNO: 317� CUCJT,ID�E A��
OYMEXSNM1EIFqqWN: KRINV, MARVIAI C
r,00pEu: 3123 COOLIDGE AVE
f�F��'TA Mfi6ia, CA
lnr�. ruiuwo �oo�ss:
�AIICHREtt OP ENC�NEEN:
UICH ON ENG.'S /iWNESS:
caxm�cTarswu�: LEE ROOFING
cam�crorrswuuua 1653 SUPERIOR
aoo�ss: COSTA MESA
926''6
ca
92627
OHfF�CTONS DECLAXATION: 1 Mreby eflim uMx perely d pmjury tlal
wnh Secwn )000) W Dir'vun a al iM1e Buvma eM Prclaavms Cada. vd n
069337 uc.cuss: C-35 uc�o.:^49�
UNT:
rLOOD: X 97
lIC N0.:
UNT:
(714)642-7223
ucaa: 349686
uxr:
m licenaed wds pra�eune d Chepr B
w in hA iace vN e%se.
6 EXP: 02/98
N BUI ^Efl ��CUINATION: I Mmby elfirm urMer perely d pe�thet I em avmq Imm �he COMretlae Licanea law fa tM
'^q (`�ion ]0.tt.5 Buanesa eM PMeubro COEe: A�ry c Y a counry xfiitli repuirea e permil to conelrucY. ellm. impwe.
d olivh, or repeir eny evucture, qia io ne eaueMe, ebo raQuiren iM appliceM fm wch permil lo fib e eqned eietameM thai M a ehe
ia nsad Wnuen� lo ihe povieione d tha ConlreGoro Licenae Lew [Cheqer 9(mmmmdiq wilh Sedion ]000) d 0'vuion 9 d IFr
Businms end PrWeeeons COEe� a thel M or eha ie uamq iherehom eM the basie la the ellepeE examqion. My violetion of Sedion
IW 1.5 by eny epplirant Iw e permX eubjaee the epplicanl lo e dvil penelry oi nd more ihen INe huMretl dolbn �S:AO�).
❑ I, ea owner M Ihe popany «my empbyeae xiih weges es Ihar eole oompemetion, will Eo ihe woM, eM ihe eVucNro is rwl in�ended
or MereE la sele (Seclion laa, Buainesa enE Proleasiona Cade: The Conlredae Limme law dma �wt eppN �a ��erd propa�ly
wM1a builde or'unprovee �hereon, enE wiw doea auch woM MmseM or Mrselt or Mraph h6 a her own employeee, poWded thm such
impravemeMs ue mi imended aWerad lar sele. II, however.lhe buikiip or impmvement ia eoltl wi�hin wro yeu d mmpbtbn, the
owner-Wildar xill heve iM buNen M provirp he w ehe did mi WiW « improva Iw tM pwpme d eeb).
� I. es mmer d Iha v�PoM. � eRduarvely mniretl'rp wilh licenaed cont�ectas W conehua �M pqetl (Sedion lM�. BwiMee eM
PMessiona Coda: TM ConVepoeelicanse Lew Eoes ml xpply W an owim d propeny wha buiMe «impovwiMnon end wlw
convecn i« auch projeea wnh e mnVeqor(s) Icensed vursueM lo iM COMreG«a licenve Lew).
� I em uemp urder SMion: B. 8 P.C., br Nis �eemn:
oa�a: ow�«:
� ao nerabvi cenM uw � em .wme a eM waeiamnd �n. naulremenn d cal'fanu NmM end sefelr coee seaiom 2ssos, usa9, am
?5511. eM thet I a eiry tuNre buiMirq rcapeM will / WI �(d�ck an) ��o camply wih seid nna mdr enA tM nqu'vamaMs br
e pe�mn Inovutrutlion«madifiralion hamtMA'r�emqmenl Di9iid. FuiEaMiel cm9rupian eppira�ioruan uanq Imn tlme
wwision+.
Dete: AVd��
WOFKEH'S CONPEN51Tlpi DECUX�TION: I Mreby alfirm ueqs paiul�y d pa�jwy an d tlr ldbwi�q datlarmiom:
� I heve eM xil meinien e cMRkeb W mroenl to aellimure br waken' mnpe'setion, n provided la by Sacaon 3J00 d �M lebor
Code. la tln peelameiwe d Ihe xwk lor which I�e permil o oauad.
Q � nev. ene w meimen waxeie� comw�� �,renoe. m na��e M seaion a�ao a mme �enor coee. m. m. v.��� a m.
•� ��������mm�m�.�Wa��'S1ATE� FUND �°��m��� EXPIRES
ca,�..:
PdiryNumber: 1.�VV740-7/ 06/30/98
an meC irot be romWereC / IheGa^^t is la om hunEmd Ldlars (;1001 a bss.)
� I�m ty Uel in tha pMormercn d �M wak tor whch ihia permn ia inuad, I ehefl iwl empby erry pamn in vry memx n u lo
e auEl� lo �he waekere' campen+e�ion �ewe d Celilomu, eMe�e Mel il1 Mouk become abptl to iM xabn'
%/` emion orovisime W Seeion a'!oo d iha lebor Code. L-56oM14�h�+�hrN��GN'�+� v�N�
p: F�ll6n �cun woM'xi rompxuetlon covenp li uNa uul aMll �i.d/ect en smp/oyw ro MMixl p�nWu en0
W� ,
fl� up lo • �un��W flrouu/W Oo1Nr� (SIOO,Q001, In MCI ro I�s cosf o1 ro�vsivatlort a�p� �� Pro��� blln
SroHon 3]OS o/ tlro LMor COM. Inhn�t, mE attomsY'a Nss.
NSTHUCTION LENDINO AOENCY: I hereby elfirm uMer penelry oi perjury ihet Ihem is e cone��udion bMi�q epancy br IM
peAwmence W IM1B waM bf which IM10 pem�� le ivBUeA (Sadwn 309]. Cx. C).
LENDEP'S NAME:
LENUER'S 1DDAE54:
I cerliy ihel I heva read Nie epplicelion eM tleb IM1et ihe ebove intormetian e conM. I epree to wmpN �h ell ary W ooumy orEineMes
ark aime lexs rele�vp b Euildvp conslrudan ad hereW aW�aae represemetivea d �hm My to eMer upon ihe ebvae-mentioned propeny
�or ios�aioo w�o�s M I K F. B URK E
I/
Whno-BuiWip d Se1bL:^OreamFb: Cenery��AppS�ant; Rnk-Revenue: Gddenod-Avx�aa
CITY t?F CUSTti MESA - BUILDING FERh9lT
PERM NO: B 0�367`_
PEkMIT NCti; H 083675 PL[�N CHE�_Y. A70_ N GOVT; N SUFU; N
CONSTRUCTIUN TYPE: V-N PERMIT TYPE: S'tR PURPOSE: OTH
JOB DESCRIPTION : T/OFF RESHEATH 6 REROOF W/COMP. SQ FT: 4,669
CLAIM VALUE: 4,669.00 CALC-VALUE: 4,669.00 GROUP OCC: R-3 /U-i
COMMENTS: RESZPENTIAL REROOF
if �1t 9E iE �JE iE jE dE iF 3F iF iF 3f 3E 3' 9F iE �Yt *�lf iE �?f �3!-jF dF * iF �lh * iE dF i!� 3E if iE i(�-N� �X.- if jt?(� iE 9f df 9E jF # jt if i! �FiE 3E iE-]F-1(�-k �M� 9E iF � dE �1(� if 9f �k� iF �%-)E iE?i� if �x-�iE 9(- K-dE :+.-#
Z O N I N G R E Q U I R E M E �J T S _
S E T B A C K S
------------ MAIN BUTLDING ---------- -------- ACCESSORY BUILDING --------
FRNT: FT IN REe�R: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: F'f IN LEFT: FT IN RGHT; FT IN
PARItING REQ: PROV: PARCEL: 14169339 ZNE: REF N0:
PLANNSNG D7UTES�>� ;
f(� if iE �7f'lf 3E jE 3k iE dF i(�',E if iE ik;iE iF 3f� 3E if iE �1P iE i4 iF if� iE i(' iE 9i� iE iE �7E')f'k'1f if"If 1E iE iE if iE iE 1E a`E ik iE iE # if i(� if i(� ik iF 1t'1E i4 �E iE iE iE aE' aE �f iE # i� iF')f j(-jE 3E 3f �1E jE-1t iE
D E V E JL O P M E N T S E R V I C E S R E p U I R E M E N;"I' S
ZONING APF+ROVED BY DATE:
BUILDING APPROF£D HY : DATE: ` _
APPLICATION ISS�IED BY: - DATE: �
*�*��**x�r**��*�'*�*�*** � ,�-_ . .� *��c+�*�r****�� � . �*1
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL S�GMENT:Y
bLDG PMT PLUMBING ELECTRIC MECHANIC • FZRE SMIP/RES GRADING
PERMIT 99.75 SU
SMIP/NON-RES
PLAN
ISSUE FEE
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECR TOTAL PAID DUE
TOTALS----> 100.25 0.00 0.00 100.25 100.25 .00
REVENUE DIVZSION TOTALS--> COLLECTED: 100.25 OVER/SHOkT: ,00
BLDG PMT PLUMBING ELECTRIC MECHATIIC FIRE SMIP/TOT GRADING PLAN-CHECK
99.75 .SU
'1E'1E'1E �f jE jf dklE 3f iF iE i(� iE iE iF if �f �]E iE if� iE 3f jE �1E ih �1F'N' iF dE iE iE if iF if if ik �1f * iE iE iE� iE iE?EY,� iF jF iE %'3E iE ?E if 3E �]E 3E �' 3E' iF �f 1E'K- iE � iF 7k 1f #'IE i4 if 1E ik?E 3F jE'H' jE 3f'
I N D I V I D U A L F E E b R E A K D O W N
TYF�E QTY D E 5 C R I P T I O N UNIT COST TOTAL COST
SFR 4669 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 9,669.00
END OF FEES
W-B9-1997/88:53 pM/f188.25
RCPiq:81-B888B66
PERMIT:B83675
e
CONSTNuCTION AND PLANNING ' POOL 8 �
APPROVALS Permit # � Date I�nspector qppROVALS Perniit # Date Inspector
� t. Temporary Electrical Service or Pole.. 52. Pool & Equipment Location _
2. $pii Pipe-Undrgrnd. � 53. Steel Reinforcement '
3. Electrical Conduit Utility-Undrgrnd. - 54. Porms
4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding � �
5. Steel Reinforcement 56. Rough P�umbing & Pressure Test �
6. Electrical UFER Gmd. � 57. APPROVAL TO COVER�GUNITE �
7. Footings 58. Electricai Conduit-Undrgrnd. �
8. Foundation _ 59. Gas Pipe, O Undrgrnd., Test �
9. VUater Pipe-Undrgrnd. � , . 60. Backwash Lines, P�Trap, O Undr9rnd.
10. Structural Floor Svstem -. 61. APPROVAL TO DECK �
7 t, prnperty Sewer Line & House Connection . 62. Backwash & Receptor-Final " '
12. Sewer Cap , - 63. Heater & Vent-Final �.�
13. Roof Drains ' 64. Plum6ing SYstem - Final
14. Rough Plumbing 65. Electricai�Final , �
15. Rough Electrical-Conduit - . • 66. Solar System�Final -
16. Rough Electric Wiring � 67. Fencing & Access ApProval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Fough Electrical�T Bar Ceiling '�69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT
20. Rough Factory Firepiace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilatin9 71. Product Piping C7 Gas' ❑ Oil '
23. Gas Pipe�Rough & Test 72, Undergro�nd Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing '%/Q,t`? �___/ 74. Overhead Hvdro
! (
26. T�6ar Ceiling ($tructurall & Monocwt 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulatio� � 78. FIRE PREV. FINAL
30. Drywall Naiting NEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat 79. FINAL INSPEC710N � ( �
32. Elactrica� Power Meter�Final 80. FpOD CERTIFICATE ISSUED �l '
33. Pinal Electric Notes: f
34. Final Heating & Air Conditioning
i
35. Final Gas Pipe�Test
36. Hood or Canopy
37. Final Factory Fireplace " "
38. Final Plumbing -
39. Water Service�Final
40. Gas Service-Final
47. Solar pomestic�Final
42. Backflow Preventer
-43. BaGkflow Irrigation �
44, Landscape Irriqation System
:�
45. Sound Attenuation ?? t;
�
46; Handicap Regulations ' ' _.
47. FINAL STRUCTURE & BUILDING �_�� 47 �!/ �:"
G N� ` '� =
48. FINAL PLANNING '� i'�'
49. Electric Release to Edison '
- ns
SOl Gas Release to Southem Caiifomia Gas Co :<-.
51,. CERTIFICATE OF OCCUPANCY
No. Oate
r • �
CITY OF COSTA MESA
BUILDING DIVISION
ROOF COVERING CERTIFICATION
Permit No. � � � b� �
Property Address / g' nvG
Owner V/ K�Q�1(/��
. . •��^ � •' • u' .
State Contractor License Number 349686 Classification C—
I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the
above address in conformance with Chapter 32, and Section 1704 of the latest adopted edition of the Uniform Building
Code, as amended in Se�tion 5-17 Title 5 Costa Mesa Municipal Code, and the installation instructions of the
manufacturer.
.\
❑ I further certiTy that I am the owner of the property. (Owner-Builder permittee only).
�C I further certifyj that I am:
�
❑ Owner of sole proprietorship company
❑ Full partner of the company
❑ Limited partner of the company
Q Officer of the corporation
I certify that as an authorized officer or agent of the company or corporation, 1 am empowered to make
this certification, which shall be binding on all successors or assigns of the company or corporation.
I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the Building
Division for acceptance.
Received by Building Division
By:
�� �l �� l��
Initial Date
0990-46 White�Building Div.; Canary-Conhaclar, Pink�Owner
LEE ROOFING OF COSTA MESA, INC.
Company or Corporaie Name
1653 Supecior Avenue
naaress
Costa Mesa, CA 92627
i % � 4 9i
SignaWre Da e
/y%/c�iA� l �U,�'JC�
Printetl or �yped name
v n a�uas
AP
or
LH1G U 17 V�
BUILDING PERMIT
VAL
SUBCONTRACTOR
ZONE
s�
: �
> .. � ,—
• :. �' :.
�OSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BO%9f] GOSTAMEBA,CALIFORNIA
For Appllcanf to Fill In Complefaly
TYPE OR PRINT
BUILDIN6 � "��i � •
A�DRE53 .J
COSTA MESA, CALIFORNIA
MAIL �'
AODRE59
c�n � c
ARCHITECT /' � L
ORENGINEER L �
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ADORE58 /
CONTRACTOR • — V
ADDREiB I��%
a�n�c � / �
LIG. NO.
SIZE
OF LOT
USE OF
EXISTING BLDO.
BHTBACK LIl1[ II10M
NO. OPlLD08.
DESCRIPTION OF WORK
J6% p �K � � � ROOMfi
0
7R WALL I ROOI
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BU ILDIflG ARD WORK TO E
I1 HEREBY ACKNOWLeDae THAT` XAVB HBAD TH19 APPL�GTION
ANO STATB THAT TX8 ABOVH �8 COHqBCT ANO AOq6[ TO COM.
PLY WITH ALL CITY OPDINANCU AND 9TAT6 LAW6 R[ODUTING
BU�LOINO CONBTRUCTION.
61GNATUREOP� , � �C �j
� AUTHORIZHDA68NT � CJ � I. ��i� ._ _ �
/� '? /'�
C9
� CITY OF CO5 f� MESA
PPLICAt}6'IW FOR VE�f�
BUILDING
for i6/iCa�(15� dfNl
' ZONING
NO.OI U680P N6W �ry ��
PLAN6 �, BUILD�Ha
.GO� 7 � 7 'S'O Z-
/�!/ — 6 9� .y �y
1VE OVERMANG SHALL BE LE9S THAN
YARDSAPPROVEO
MAIN BUILOINO
2 �'
VAR. iC
YARD9APPROVE�
ACCE"ySORYBUILDING
BHT. MAII�1 Q
ACCESS.BLI
GATE
APPROVHD
oare / �
w
6Q. FT. �
THE AMOUNT BNOWN UNOER VALUATION IB POR TN8 F
PlIRP08i 01 HBTABLIBHINO A pHqM�T PEH ONLY. �
VALUATION A � m
��� PERMITFEE S 7 j
m
s3o� y
0
� `
TOTALFEE $
/��_���--� .
. �;� 2i33� FEE RECEIVtO
�COSTA MESA BUILDING-SAFETY DEPARTMENT JAN 1 7 1964
P. o. aox „� C091p MHB11, CALIFORNIA FINANCE DEP�
Fo► App�lcanf �o Fill In Completaly APPLICa110K1'��2 �R
TYPE OR PRINT BUILDING
eui�oiNa
For Office Use Only
ADDRE55
R[C[IIf NO.
COSTA MESA, CALIFORNIA
N6C61V DOT O�T_[qRCrVlp OATHIBBUBD
/ 6 JHlJ 1 F
OWNE H
BUILDINO
ADDRESS 1 39 Las Flores A�DRES9
CITY NO. 16 92 =ON8 TYPE GROUP �
�-�+ APPROVED
ORENGINEER C Hiller NO.iti ZOO BY DATE
ZONIN(3
ADDRESS Anaheim
ry NO. O� 11YQ O� N
V �LANG �) OU�LDINO� � 1 /
CONTRACTOR Bonser Const. Inc. � `•�. �
L80AL
woofiea I.2.S Flores oeccRirt�on � D �^
Fountain Valley A. P. NO.
GITY
1, NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
L?C.TNO. 21 Q W NE`.� 5316792 90' TO 8ID8 B REAR P. L, '
[C EAVEB
OFLOT O�JRl�l NO.OPe�oGa. O qLLOWED (U.B.C.REOUIREM6NT)
NOW ON T
YARDBAPPROVED VARDSAPPROVED
USEOP oo , MAINBUILDINO ACCE590RYBUILDINO
EXI6TINO BLOO,
( FROM GL 9TREET
seiewcK �ine PnOM FRONT FI'. FT.
CENTER OP 9TREfi} REAR YARD
61DHYARDI L p7' I RIOHT ZO R.SIDE O Ff. Ff.
/
DESCRIPTION OF WORK L. HIDB Fr. Rr.
NEW X ALTERATION ADDITION REAR� 'L FT•
OIBTANCQ BHT. BHi. MAIN R
REPAIR MOVIN DEMOLISH MAIN BLDGS. ACCESS.BLDGB.
BUILDIN6 NO.OP VAR.ii DATE
SIZE ROOMB 6f p H81 C. U. P. APPP VED
EXTERIOR WAL ROOp APPROV , tu -- �
COVERING COVERIN6 YSLIl ZB BY ��'1 DATE /
USfi OF BUILDINO A(iD WORK TO BE PERFORMED j
ar
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- so. �. "
1 NBNEBY ACKNOy/�gO08 TNAT pBAD THIB APPLIC�T�OH THe AMOUNT eHOW NUBR V�LU�TION 18 ROR THE
•NO BTATE THA OV 8 CORqE i ANO AORHE TO COM- PlIRP068 OP 68TABL�BHINO A PERMIT RE8 ONLY. p
pLY WITX AL ITy ON ANO 8 �Te LAW6 REOULATINO ypLUATION 0
BOILDINOCO 9Tqyp}� , d H
pERM1T FEE S • •'V
SIGNATUR O s������ p
PERMITTE EC .. �i o
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AUTMORIZED ApENT 70TAL FEE �� �' v