HomeMy WebLinkAbout867 CORTEZ ST - Building Permits(714) 754-5273 • Fe�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
.lab Address: 867 CORTEZ ST
Suite:
Vicinity:
Parcel Number: 14132404
Applicant: GALLA RINI, MILES
Address: 346 E MEADOWBROOK
ORANGE,CA
Owner: MCGEADY, MARCUS R
Address 867 CORTEZ ST
COSTA MESA, CA
Contractor. GALLA RINI, MILES
Address: 346 E MEADOWBROOK
ORANGE,CA
Zip: 92668
Zoning: R1 R1
ISSUED BY:
Phone: (714)974-6424
Zip: 92668
Phone: 714-974-6424
Zip: 92626-5822�
Phone: (714)974-6424
License: 663983
Status: ISSUED
Applied: 11/17/2004
Issued: 11/17/2004
Arch : Eng:
Address: Address: � � -
� Phone: - � Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF COMP. SHINGLES. INSTALL 30 YEAR COMP. 1-15 LB FELT. �
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total
$0.00
$18125
$0.91
$0.00
$0.00
$0.00
$182.16
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existinq: o
NOTES:
Rear 0, 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
RighY 0- 0
Right 0- 0
$9,053.00
$9,053.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expira 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 vrork 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 ihe expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626
2446d8I�00)
WORKERS'COMPENSAnON DECLARATON: �
I hereby aHirm unGer penalry ot Perjury one ot the followmg daclarations: - �' �
❑ I have antl wlll melntain a �enificate ol wnsent to setl-Insure lor workars' compensation, es provided tor by section 3700 ot the Labor Code, for the pertortnence of Ihe
wark tor whlch thi5 permit is issuea.
�1 have and wlll maintain wo�kers' compensetion insurance, as reQuired by section 3700 ot Ne labor Code, for tlie peAortnance of t�e work far which this pertnll Is Issued,
My workers' c,�omp1ensatian Insurence carriar end policy number ere:
Cetner. S�. Vlh N� Polity Number: OI�� �� ��
,�This section need no( be comp�efed i1 the permit is valued e( one hunCred dWlars (5100) or less.) �
❑ I cenity that in t eAormance ol tha work for which Ihis pertnit is Issued, I shall not employ any person in any menner so as to become subject to Ihe workers'
compensetlon I ws oi Calitomia, and agree that II I should bewme sublect to Ihe workers' compensation pmdsions o1 Section 3700 ot Ihe Lebor Code. � shall torihwith
comply with th e rovisions. 1
�PPIicaM.SigneNra - � .t+�.Date� I I — I ���
VY' I�TO SECURE W�pN�COMPEN5AT10N COVERAGE IS UNLAWFUL PND SHALL SUBJECT AN EMPLOYER T6CRI�MINA1 PENALTIES AND CNIL FlNES UP TO qJE HUNDRED
THOUSAND DOLURE (St00,OW), IN ADDITION TO THE COST OF COMPENSATIdJ, DMMGES AS PROVIDED FOR IN SECTION 3]Ofi OF TME LABOF CODE, IMEREST, AND ATTORNE'f5 FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirm ihat I am IicensBd under provislons of Chepter 9(commencing wilh Section 7000) ot Division 3 of ihe BusinesYs and rofessions Code, and my Ilcense is in full
force and.�tc. M �0 �/I c .�S' � —r �.� ( .( /� — .�
Conireitors� ura:� � `�� ��e: � — I i . O �/
CONS7RUC710N LENDING AGENCY:
❑ I hereby aflirm that there is e consimction lending agency for ihe pedormance of �he work for which ihis permit is issued. (Sec. 3097, Civil Code).
Lenders Name�. LefWei s Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby ettirm Ihat untler penalty ol parjury thet I am E%EMPT FROM 7ME CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Buslness entl Professions
Code: Any city or county which requires e permit �o consimct, elter, improve, demolish, or repair any simcture, prior to its issuance, elso requires Ihe epplicant tor such pertnit
to file a signed statement t�at ne or she Is Ilcensetl pursuant to ihe provisions ot Ihe Contrectors License Lew (C�apter 9(commencing wIN Sectlon 7000) ol Divislon 3 ot the
Business end Professions Code) or tAet he or she is azempt theratrom and the basis for the allegetl exemption. Any violation of Section 7031.5 by any epplicent tor e permlt
subjecis ihe applicant to e civil penelty of not more ihan live hundred tlollars ($500).):
❑ I, as owner ol the property, or my employees with wages es their sole wmpensation, WILL DO THE WORK, end the structure is not intentletl or oMered lor sele (Sec.
7044, Business entl Profpssions Code: The Coniractore License Law does not apply to an owner ot property who builds or improves thereon, and who does such work
himseN or herself or through his or her own employees, provitled Ihet such improvemenis are not intended or oNered tor sele. II, however, ihe building or Improvement is
soltl wit�in one yeer of completion, the owner-builder will have ihe burden ol proving that he or she did not bUiltl or improve for purpose of sale.). '
❑ I, as owner of the property, em E%CLUSIVELV CONTRACTING WITH LILENSED CONTRACTORS to conslruct ihe prolect (Sec. 7044, Business and Professions
Code: The contractocs UGense Law tloes nat apply [o an owner ot property who tuiltls or Improvas thereon, antl who contracts lor such projeci with a contrector(s)
licen58 pur5uent to the COntractors LJtenSe Laws.).
❑ I am exempt untler sec.
Signature:
Owner ID verilied by dnvar's license. ❑ Ves ❑ No
Business end Protessions Cotle tor this reason:
Verllicetian oi Ownership by (type ol documenl, i.e. - propeny tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICATION:
Dnver'S LiCense No.
Date:
Expires:
❑ I hereby cenity Ihat no axCavation tive (5) or more leet in tlepih into which e person is required to descend, will be made in connecilon with work euiho�zetl Dy ihis
permit, end that no building siructure, scaffolding, lalsework, or demolilion or tlismantling thereol, will be more than Ihirry-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Ttle 8, Califomia Administrative Cotle).
❑ As owner-builtler, I will nat employ enyone to do work w�ich would require a permit from Ihe Division of Intlustrial Sefety, as notetl ebove, unless such person has e
permit to tlo such work from ihe tlivision.
Signature: Date:
Division of Industnel Sefery Permit Numbar:
CERTIFlCATE OF COMPLIANCE AND AUTHORVJ1T10N OF ENTRY: I certify under penalty of perjury that I have read this application and state that the informetion given is
correct. I agree to wmply wi�h all state laws and city ordinances relating to building consiruction, end authonze representetives ot �he Ciry ot Casta Mese Io enter upon tha
ebove-descnbed properry tor inspection purposes. I egree not to occupy or allow occupancy of any building authorized by �his permit until tinal inspection.
cooe.. ixsvecnoNTrve
Legal Ov�ner(5�
inz_ed.Applitant
PAg It�ALS
t61fi Fixetl System Final Fire Preventlon
1266 Pool Spe Finel
200 Finel Re-Roof
201 Finel BIocWRetaining Well
202 Final Fectory Fire Place
203 Final Sign
204 Final Demolitlon
'L o G --
400E� INSVECiIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building�Occupency
Pdffi It�L$
_. AGO������ �O 1111 In all spaces except [�osa wlihin heavY Dortler Iinas anG si9n all approvriata Ceclantions.
CITv uF COSTA MESAO CONSTRUCTION PERMIT
. Project Kbdress � v �� ��iZTG'-2.1"
Applicani's Maili Address S!} m G
Owner'sName �� L.R'r'n[ phone�d,
Address �"m�z-
Arch/Eng. — License No.
Address
Contractor's Nam Phone �
Address (mailing)
City Licenm No. " � '
LICENSED CONTRACTOR EC ARATION ' •
I hereby atiirm t�at i am licensetl untle� Orovisioni ot Chart¢/ 9(commenting
with sectlon �000) of Divislon 3 of the Business antl Crofeiilons Cotle, antl
my license i5 in tull force and et(eCL �
LiCenS¢ Class LicenSG NO.
Datc Signature �
'�ORKERS'COMPENSATION DECLARATION '
nereDy attirm tnat I have a certiticale ot consent to selhinzure or a certltlfate
.1 Worker5' .Compensation -Insurance, or a cerlitietl copy tnereof (Settion
3800, Lab. CJ
Policy No. ' Company �
eCettifietl copY �5 h¢reby furnishe0. �
Certifletl copy Is tiletl with the tlty Builtling DWlsion.
Odt¢ APPlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION �
(This sactlan neetl not be completetl it the permit is for one hunared (5100) or
less).
1 certlly tnat in th¢ p¢r(ormance of the work fOr which this perm�l Is Issued, I
shall noc employ any person in any manne�$qb oe,� me 5pbject to the
workers' Compens io� Laws oi California. / �// «-
Date � "!J-��l Si9na[ure 1 lc�1CfL7.0
'NOTICE: II, alter making this tleclaration, you shou�0�become subject to the
Workers' Compensatlon provision5 0( [he Labor Cotle, y0u must fortnwilh
comply wilh sucn proviSiOns Or [his pe�ml[ inall be tleemetl �evoketl.
CONSTRUCTION LENDING AGENCV ' ''
I hor¢by alllrm tbat ther¢ IS a construction Ientling agency 1or the per}ormdnCO
of tho work fOr wbich this permit.i5 issuetl (Settion 3097 Civ. C.) �
l.entler's Namc � -
Lontler'S Atltlress � �
OWNER BUILUEH bECLARATION " � �
1 hereby at/irm that I am ¢xempt irom the Contractor's License Law tor the
followln9 reason (Section 7031.5 BuSiness antl Pro/¢silonal Cotla: Any city or
countY whlGh requires a p¢rmlt to const�uGt, al[er, improve, tlemolish or �e0alr
any sVuctwe, prior to its issuance, also requires the apvli<ant for such pormlt
to fiio a slgneC slatemen[ tha[ he/she is Iicensetl pursuant to the provisions ol
r:;jho Contracror'S Llcense Law (Chapter 9(commencin9 with Sottlon 7000) of
��-�dlvi510n 3 of tho Busine55 an0 PfOfessioni CotlC) o! thal ho/ShC is exom0�
�`�rthcretrom antl the ba5it for the allegetl exemption. Any violation of SacUon
7031.5 by any appliCant ior a permit sub�ect5 Ih0 applicant t0 a clvil
enalty O1 not mor¢ than five huntlr¢tl t1011ars (E500).
ds owner ol [he prooerty o� my employees wlln wage5 as Ihelr solo
omponzatlan, will do the work, antl the structure (5'not IntonOotl or ofleretl
ior sale (Seclion ]044, Business an0 Professional Cotle: The Contractor's
License Law tloes not app1Y to an owner of a property who builAs or Improvos
thoreon, ana wno tloes such work nlmselt/herself or tnrou9h his or hor own
emploYees, proviCea tnat sucn imp.ovements are not intentl¢tl or o/terotl for
sale. II howOv¢r, lne builtlin9 or impravement IS SOId witbin one year ol com-
pbtion, the ownar wlll nave the burtlen ot provin9 �e/she aitl not bulla or Im- ,
prove iorthe purpose of sale). -
❑ I, a5 own<r o1 the pro0erry, am exclu5ively mntraGting with IICOnS¢tl con- '
Va<tOrsto conSVuct [he p�oj¢ct (SCCIIOO %044� BUSI0055 d11(1 PfOfOT5I005 COdB:
The Contra<tor's License Law does not apply [o dn Owner of PropOrty who
� bulltls or Improves theraon, ana who contracts tor such pmjects witn a con-
[ractOr(Sl OCense puRuant t0 tlle'Con[fac[or'S Licanse Ldw). 1 dm awara lhat
proot o( Ittelr Wa�ke�'S Compensatlon insUrance shOultl ba provitlOtl lo,ma.
, L7 1 am exempt untler Section B. & P. C. for this reason
/l i. .1 ,7
Date � ..� � �� � ��� Owner'.
I nereby tertlty that'I have reatl
in(ormation iz correct. 1 a9ree to c
anC'state laws relating�to builtlin9
sentatives ot inls citv to enteri
TYPE OF CONSTRUCTION LJ NEW IJ ADD LJ ALTERATION
❑ CONVERSION ❑ DEMOLISH ❑ OT�b/�E R ----�--�
-DESCRIPTION OF,1(SQIiK/IJ�E OF BLDG.f� -%��—,U - — �
TVPE OF PERMIT LI GRADING LJ FOVNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL �❑ PLVMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ.FT. OCCUPANCV_
CON STRUCTION TVPE VALUATION S_g�
ZONE GRADING CU. VOS. ACRES_
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
FloorSinks '
Gas Service
Interceptors
utle?s
Lavatories � �
?-Trap
Root Drains
Reinspection Fee 515
Boiler �
Duct - Under Ground
Ducl-Structural �
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO # �
Heating System & Ducting
� ai oo,000 eru O i oo,000
:oy aucnorixe reoro- �
ionaU property fOr
Oate �-�O-SS
I Drivers' �Licenze or 55 � � Reinspection Fee
CMF 0065�46, rev. 30/B4 White - Bulltling; Canary - Applicant: Pink - Atcountin9: Goltlenrotl - Assessor
$15
Showers
Service Sink
Sewer Cap
Sewer Connection
Soler ColleCtors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
laue Fee
R
FEES
5 3
A.P. qW
S Main Building:
E'
T Front
B Rear
A
� Right
g Lett
Ping. Ref. #
Plnnning Notes:
Aummatic Washer �
Con'svuction Pole Su
Cooking Unit
Dishwasher
Dryers ❑Gas �Eli
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
.SWIIC�ICS
Garbage Disposal
Generetor �0-5 KW
4546 6/10/85
Zono
Parking Req./P�ovided
ELECTRICAL
Transformer ❑ 15-50 KN
❑ 50+KW
Meter ❑up l0 700 amps
Meter ❑over 100 amps
Sub Panel
Motors �0.1 HP �d `h � 8
Inc. Solar 09-15 HP �16�
Microwave
Pole Light
Range '
5KW
; Stending Sections
� Trash Compactor
- Reinspectian Fee $15 laue Fee
IANICAL FEES
Hoodor Typel ❑ • DEVELOPMEN7SERVICESREQUIREMENTS:
Canopy Type I I ❑ Zoning Appravad By
__. _ _ BuildinB AVProved BY _
Refrigeration System
❑0.100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registe�s �
Issue Fee �� $ 3
BUILDING PERMIT $
PLAN CHECK §
PLUMBWG � S
PLAN CHECK 25% 5
ELECTRICAL $
PLAN CHECK 50%�$
MECHANICAL . $
PLAN CHECK .25% $
5+
tOonG TL
FEES
S3
2
O
N
1
N
G
R
E
�
M
T
$
FEES . �^
SMIP S ��
PERMIT
ISSUANCE S
ENERGV P.C. S
GRADING $
MICROFILM 5 ��� � //
TOTAL FEE ' $ ��
, �•
.
j�; CONSTRUCTION ANP PLANNING _ - PO, s SPA
. Date Ins ector -f
AVPROVALS Permit # P APPROVALS Permit # Date Inspector
� 1.'�Temporary Electrical Service or Pole � 52. Pool & Equipment Location
: 2. Soil Pi,pe�Undrgrnd. � 53. Sfeel fteinforcement � �
3. Electrical:Conduit Utility-Undrgrnd. .� 54. Forms � �
. 4.,F�Iectrical�Gonduit-Undrgmd. 55. Electrical6onding '
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 �� j'
9. Watei Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, O Undrgrnd. � �
. � ,
10. Structural Floor System ,' 61. APPROVAL TO DECK �� �
�
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
72. Sewer.Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough'Plumbing 65. Electrical-Final
� 15. �iough Electrical-Conduit 66. Solar SVstem-Final
t
76. 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
- 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplece APPROVALS Permit #
r
21. Ducts, in Structure 70. Underground Hydro
22. Ducts,:Ventilating 71. Product Piping � Gas � O Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing � � 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing , 74. Overhead Hydro
�26. T-Bar Ceiling (Structural� & Monocoat 75. Dry Chemical
27. Frame and Flashing � 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulat�on � 78. FIRE PREV. FINAL
30. Dryvyall Nailing ' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat . 79. FINAL INSPECTION
32. Electrical Power Mete�-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 pomestic-Final .
42. Backflow Preventer �
43. Backflow Irrigation _ '
44. Landscape Irrigation SYstem .
45. Sound Attenuation •
46. Handicap Regulations �
47. FI�NAL STRUCTURE & BUILDING �
48. Special Requirements Completed ' �
49. Electric Release to Edison - - �
50. Gas Release to Southern California Gas Co
� 51. CERTIFICATE OF OCCUPANCY , � '
No. � pafe ' . _
ADDRESS
DESCRLPTION OF WORK
FIIiE
SUBCONTRACTOR
� � 2�943
� COSTA MESA BUILDINGSAFETY DEPARTMEM
P, p. 90X 120! COSTA MESA, CAIIFORNIA 92E20
For Appllcant ro Ftll In Completoly
TYPE OR PRINT
eu��.cina � p�' c Z e� %Yl,
ADDRHYO
COSTA MESA. CALIFORNIA
�� i�%i6'�+' � no. ov e�no�.
ena,�cR uxs vrtor
DESCRIPTION OF WORK
u�'_9
� � i
1 MpI6pY ACRMOWLiDO[ T11AT.1 H�VS IIfAO TNI� N�LIGTON
ANO eTAT6 TMAT iNl ApOV[,IB CORR[C} ANO AOR6[ M COY.
PLY WITX All ��TY OIIDINANCp A11O AAi[ L11W/ N[OYlATNO
OUILCItlOCONBT1UCilON. �)
AUTHORIZ[P AORNT
nn2F ootaozn3���**3.00
A►PLICATION FOR PERMR
BUILDINO'
for OHic� Us� Onfy
ZONIN(i
NO.OI YI[O�NM'
i� runs '�/ .uaoixa
nuc��mox L(/�'��,� •�� �/,i i
A.P.NO. � ��� � ` — 1
N0T8: NOEAVlOVHRHANOBHALLEeLlBHTHAN
80' TO 61D8 0 RBAN P. L
EAVEB
wuoweo N. B. C. RCQUIRHM6NT:
YAHDBMPROV[D YARDBAPPROVHD
MAIN BUILDINO ACCHBSOHY BUILOIN6
R6AR IT. � P
DISTANC6 B6T. BET. MAIN Q
MAIN BLDOD. ACCHHB. BLI
VM. S� DATH
U(/" • 0�
CJ
80. RT. �
TN[ AMOYNT �NOWN UHOtP VALU�TION l0 IOq TX[ �
�YPNOI O! iRACL16HIN0 A P[11YIT I[l OHLY. �
VALUATION � �
�PERMIT FE8 ' q
Da X �
s w
0
-
OWNEK FORII, '7A Dan
JOB ADDRESS 7 Cortez S t.
GENERAL CONTRACTOR A11clri F
AY No. 11F1-32�-0�i LOT
INSPECTIONS
nnTE 10-17-62
R[IT7.DING PERMIT
VALUE S 147�
TRACT rIRE ZONE DESCRIPTION OF WOI2KA
Signaturc DATr GROUPJ TYP� V 7,ONE
PGR 1]
SUBCONTRACI'OR .,�
O
..t'S.
� � l80Q9
i
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 9f7 CO6TA MEBA. CALIFORNIA
For Applicant fo Fill In.Compleiely
TYPE OR PRINT
COSTA MESA
_. TEL. ��
� y/s-F'
STATE /�' S"/ ��/ TEL. 1 3 y� y O
LIC. NO. NO.
SIZE �I�IOS/� IO7a" 97�OW ON LOTB•
OF LOT
USE OF
EXISTING BLDG. _ ➢ �1 {_/ � ^-� � e ,
SHTBACK LINB PROM C�/ /7 f
� I LEFf /O I RIGHT I 3
DESCRIPTION OF WORK
3 %'X I � ROOMS �
- U���, .
1 HHRCBY ACIINOWLHOO6 TH�T I NAVB RGD THIB APPLIGTION
•NO eTATH THAT�ABOVH IB CAPRP��/�yAGg TO COM-
PLY WITX ALL CITY IiDiNANCCB AND 8T Cve apauunxo
OUII.DINO CON6 ON.� r �
�AUTHORIZED AGENT
� ' r � �� �;; I�9 ��, �i
�OCT 171�2
FINANCE DEPT.
CITY OF COSiA MESA
APPLICATION FOR PERMIT
BUILDING
For Offiee Use Only
neceivr Ho. pepyry�
! Ul1
e owTa qece�ye� owra iseueo
/O �7-6
COSTA MESA.
APPROVED
ZON6�J• / NO.OF ,` U86 OF NeW //�/G �
I( � PLANB BUILDINO �6
1�
�a.� �7` e� 7ii 3��3
DEBCPIPTION
. o u., �`/[ — 3 zy —o%
IC6M6H YNH BT. n _ /
FRONT /7� �"<<
R.SIDE "' -C�
L. SIDE � � z
REAR ��O �
!
� FXI �7
�' E,ri�?
TH8 AMOUNT BXOWN UNDBR VALUAT�ON �8 POp TNe
PUpP098 OP H9i/�BLIBHINO A PERMIT Pe¢ ONLY.
V LUATION � `
PERMIT FEE $
5���� PLAN CHEGK $ /S6
_...., �e� � / � t0
�
, �u���
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. �OX 817 C06TA MEBA. CALIPORNIA
For Applieanf �o Fill In Complefely
TYPE OR PRINT
BUILDING
ADDRE58 C.OitHZ Street
COSTA MESA CALIFORNIA
dal Mar T obH 34220
LIG. NO. [! �/ NO.
SIZE �./�.� �� I NO. OP B1D09.
� BETB/�CK IJNe pROM
■ BUILDING
/
4EF'f S RIGHT S'
D�SCRIPTION OF WORK
AND WORK TO
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