HomeMy WebLinkAbout3214 DAKOTA AVE - Building Permits.�
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ApPlicant to fill in all spaces ezcept those within heavY �ortler Ilnes ana sign al1 aoo�ooriale tleclarations.
.. PERMIT NO� ,, TRACT NO. LOT NO. UNIT NU.
�CI t'r-OF�OSTA MESA CONSTRU. CTION P RMIT
PrOject Address i akafa-
AppliCant's Mailin ddre55
Owner's Nam� Phone ��
Address
Arch/Eng. License No.
Address �
Contractor's Nam �
Adtlress (mailing)
Ciry Licenu No.
LICENSED CONTRACTOR DECLARATION
I h¢reby affi�m Ihat I am Ilcensetl untler provi5ions ot Charte� 9(commenclnq
witn section ]000) o1 D' 'sion 3 of tne Business antl Professi s Cotle, antl
my license is in /ull for a�itl 'Lrc .
LJC2IISC CId55 lIS� NO.
Date�} n/ Si9nature
WORK RSE CO�ENSATION DECLA 16
I hereby aHirm tnat I hav¢ a certiticate o! consent to ulLln e or a cert ' e
of Worker ' Compensalion InSurance, o� a certif'etl co herEo ( octio
3800, La
Policy N . Company
eCertifietl copY �S hereby furnished.
Cert#fi�q,p ti h the city tli g D'
Date � �� ��ipplicant
EXEMPTION FROM WORKE0.5' COMPENSATION DECLARA
(Thissection neetl nol be completetl it the p¢rmit i5 for ona huntl ($]00) or
less).
I certify lhal in Ne per�o�mance of lhe wo�k tor whith th15 p¢r i IssueQ I
shall no[ employ any pe�zon in any mann¢r 50 as [O De[Ome SUb�ect to the
Worken' Compensation Laws of Califomia.
Date Si9nature
NOTICE: It, afte� making this decla�ation, you shoultl becomn subject to the
Wo�kers' Comp¢nsatlon provisions bf th¢ Ldbor Cotle, y0u must forthwltlt
comply wi[h such proNsions or this pe�mit snall be tleemetl r¢vok¢tl.
. CONSTRUCTION LENDING AGENCV
I 1 hereby atflrm that there Is a construction lentling agenty for the pertormance
� of fno work tor which this permit is Issuetl (Section 3097 Civ. CJ
LenGer's Name
Lentler's Atltltess
OWNER BUILDEN �ECLARATION
I hereby affirm that I,am exempt from the Contractor's Litense Law tor the
tollawin9 reason (Section 7031.5 Business antl Professional CoCe: Any city or
county which requires�a p¢rmit to cOnst�uct, altCr, iTptove, tlemOlish o� �epai�
my structure, prior Co its issuance, also requires the applicant tor such permit
o tile a signetl S[at¢ment that he/she is Ilcens¢tl pur5uant to the provisiOns of
Ne Contractor's Clcense Law (Cnapter 9.(commencing with Section 7000) ot
Division 3 of the Busine55 antl Profe55ion5 CotlO) of [ha[ be/Sh¢ is exempt
therefrom antl the basis for [he allegetl exemptlon. Any violalion of.5actlon
�031.5 by any applicant for a permit subjects lhe appliGant to a Civil
penalty of not more Ihan five huntlretl tlollars (E500).
❑ I, as owner of [he property o� my employaes wltM1 wage5 as thair sole
compensation, will tlo the work, antl the structure iz not IntentleG or oiferetl
for zal¢ (Seclion ]044, Bu5ine55 antl Protessional Cotla: The Contracto�'S
License Law tlOes not apply to an owner ot u proporty who builtls or Improves
thereon, antl who does such work hlmself/herseli or tnrough his or her own
empioyees, Provitletl that such improvements aro nol intentlatl or offeretl for
Sal¢. If, M1oweve�, the bulltling or imprOVBment is Soltl withln One yea� of com-
pletion, the owner will have the burtlen of provin9 he/she tlitl nol builtl or Im-
prova for tM1e purpose ot Sale).
❑ I, a5 owner of the property, am exclusively Contra<ting with Ilcense0 con-
tractorsto const�uct the pwject (Section ]044, Business antl Professions Cotle:
The ContractoYs Li[ense Law does mt apply [o an owner of proper[y who
builds or improves thereon, antl wM10 ton[rac[s tor such projects wlth a con-
tractor(s) license pursuant to the Cont�actor'S License Law). I am awar¢ that
proot of tbeir Worker'S Compenwlion insutanco zhoultl be provltletl to me.
❑ I am ezempt untler Section � B. & P. C. for thi5 reason
Date Oa'ner
I hereby cerSify IhaS eatl thi5 applicallc
information correcL I gi o com ly w th all
antl state la relatin t i in9 r ❑on,
sentatives of n on abo
inspectlon purposes.
Signature
Driver5' LicenSe or 55 �%
CMF OB65-46, rev. 10/84 White - Bulltlin ry
state Nat the above
�
ON
QF
ADD LJ ALTERATION LJ REPAIR
TYPE OF PERMIT LJ/GRndNG LJ FOUNDATION LJ $TRUC7U
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIP710N Sq. FT. OCCUanrv�
CON STRUCTION TVPE VALUATION S_
ZONE GRADINGCU.V�S. ACRES_
SinK
P�eventer
Irrigation
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains �
Reinspection Fea � $15
Boiler
Duct-UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑a� oo.000 eru O � ,000 aT
Reinspenion Fee � $75
Ilcant; Plnk - Accouniing; GolOenrotl - Assessor
ll
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecrors
Solar Piping
Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Trays
Issue Fee
Hootl or Type I ❑ '
Canopy Type I I ❑
Refrigeration System
❑0.100,00 U ❑100,OOOBTU
� m Repair/Alteration
FireDampers � '
Registero � �
Issue Fee
$ 3
$ 3
A.P. #�
S Main Buildi
�E
T Front
B Fear
A
C Ai9ht
K Left
S
Ping. Ref. 51E
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elecv
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches '
Garbage Disposal
Generator 00�5 KW ❑
Fee
_��: ; � : , —
Zone
Accessory Building:
Z
O
N
I
N
G
R
Parkiny Req./Provided E
Q
M
T
S
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps'
Merer ❑over100a
$ub Panel
Momrs -1HP�1Y�-S
I . olar 09-15 HP �76-15+
Microwave
Pole Light
Range
Sign
Standing Sections
5�15 KW Trash Compactor
$15 � � luue Fee
DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approvad By
Building Approved By A���
BUIL�ING PERMIY�
PLAN CHECK $
PLUMBING 5
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL $
PLAN CHECK 25% $
FEES
$ 3
SMIP $ �
PERMIT
ISSUANCE $
ENERGV P.C. $
GRADING $
MICROFILM $
TOTAL FEE $ 3/, �
CONSTRUCTION ANDPLANNING POOL&SPA
APPROVALS Permit# Date Inspector qpPROVALS 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. ElectricalUFER�Grnd. 57. APPROVALTOCOVER-GUNITE
7. Footings � 58. Electrical Conduit-Undrgrnd.
8. Foundation , ' 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe�Undrgrnd. - 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System � 61. APPROVAL TO DECK
17. 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 Electrica6T Bar Ceiling� 69. POOUSPA 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, Ventilating ' 71. Product Plping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush �
24. Roof Framing , ' 73. Undergrnd.StorageTank OGas ❑Oil �
25: Roof Shcathing 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 � r" �,�
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 CERTIFICAT ISSUED .
33. Final Electric Notes: j�6 8 ��_
34. Final Heating & Air Conditioning f� •
�v
35. Final Gas Pipe-Test , - � �
36:;Hood or Canopy -
37.�Finil Factory Fireplace • • '
38� Final Plumbing ' , " . ,
39!Water Service-Final .. �
40. Gas Service-Final _ � , , �•�t � • •
' 41. Solarpomestic-Final � r �.� �
�
' �42. Backflow Preventer • ' ' �,' ' . . �,'
r ' .
43,yBackflow Irrigation ' � 1 - ' � .
�
44...Landscape Irrigation System ' � - ' '
45!Sound Attenuation , � " , ; " "
46. �Handicap Regulations � i ,-
47..FINALSTRUCTURE&BUILDING 3 Lfld. ' _ , �
�•QJ
48'Special Requirements Completed ' � �- � �
49. Electric Release to Edison � • .
� - R
50. Gas Release to Southem California Gas Co ' ��� ' '
51. CERTIFICATE OF OCCUPANCY u�
No. Date
�
ICBO Evaluation Service, Inc.
n s�bs�d�a�y co�Po�ar;o� ofrhe International Conference of Building Officials
EVALUATION REPORT
Filing Category: ROOF COVERING AND ROOf DECK CONSTRUCTION—Roof Covering
S[ERRA ROOF[NC TILE
SIERRA'PILE
96150A"1'ES DRIVE
SACRAMEN'1'O, CALIF'ORNIA 95827
I. SubjrcL• Sicrra Roo(ing Tilc.
I I. Uescription: A. General: The ruol inE liles arc pressuR (ormed from
No. ?6 gauge G90 gulvani[ed shec� stcel cumplying aith ASTM Designa-
�wn A 44G Gradc B. O�crull lile sizc is 16 inchcs by 50'/: inchcs with an
inti�alled exposure of 14'/z inches by 49 inche>. Each tile wcighs 8.5 pounds
�nd iti dcsigncJ lo lap I'/z inchc� ovcr thc udjacnt li Ic iu provide a wcathcr-
�igh� construc(iun. 'fhc leading cdgc i� beN down I 4x inchcs whilc the
Irailing cdgc is slcppcd up I inch anJ back from I tu ? inchcs to providc
wca[hcr proteciion unJ tiuppon.
The tilc is Ircuicd wi�h a corroziun-inhiM1iting primer un the unJeniJe und
� urethane coaiing on exposeJ wrfaces. $Iune granu Ies ure embeddeJ in Ihe
ure�hanc coaiing uvcr which a cicur aliphatic urcthanc is applicd.
B. Ballens and Cuunlerbattens: Baucm musl be 2-inch by binch and
�ounlcrbattcns must bc I-inch by 3-inch numinal >izc No. ? Duu�lus firv
�arch or Mlter.
C. Installation---New Roofing—Fire Retardanl: The lilcs urc inslallcJ
�n spaced or solid shca�hing at roof picchcti of 3: I 2 mini mum. An undcrlay-
meni o(one IaycrTypc 30 (elt mu51 bc ins�alled as specificd in thc cafe (or
concrete ruo(ing tiles. Measuring From the (asciu boarJ, bancns placcd
14'/, inches on center are fas[ened w supporting members with nails u(
su(ficicnt Ieng[h lo pennmle the framing ut Icas� I inch, wilh 16-penny
nails as Ihe minimum. Rn�tens installed uver opcn raficn nn as the speced
sheathing. Hips and.ridges are frumeJ 2 inches abuce the insinlled banen
heighL ValieysercfremedtureceiveNu.28eaugecorrusion-resistantmetal
flashings exfending at Ieasl S inches Gnm ihe center line each way. A splash
Jivertcr rib not Iess than 'A inch high ai Ihe f low line musi be formed as par[
of �hc flashing. Val Icy f lashing end laps are 4 inches mi nimum. Full tiles are
placed anJ naileJ, star�ing at Ihc f irs[ full course down Gom Ihc ridge boarJ.
�Piles may be staggereJ. Tiles arc las�encd Io lhe wooJ bauens with a
minimum of (our 6-penny 2-inch-long No. 1 I gnugc @uWanimd rouling
n�ils. One nail is pluced near the bo[tom un �he dow�nwrn of the �ile I inch
�}om Ihe flutcs of �hc overlappcd cdgc. The rem�ining nuils' are placed un
cvery olher pun of Ihc tile at �he sume location as ihe first wil. Tiles arc
f��tcned In the side o( hip or ridge boards a(Icr miteri ng and bending Ihem to
match thc framing I incs. Tilcs urc cul and bcm down inm thc valleys Icaving
ei�her an open ur compietely covercJ vafleyt Tiln may be ew wi�h a
guillutinc, tin snips �nd sAill ur sabre �au�s wilh meial cWtin� blade5. A
portuble bmAc prcss is used tu bend Ihc tile ti>r hips. ridgea and .•nllcys.
Sierra Irim piaes arc uverlupped and nailed alung �he ridges, gable mkes.
�nd hip bo�rd, wi�h 6-penny 2-inch-long Nu. I I gaugc galvunizcd roofing
n�ils. Trim picecs are eilher preswre R�rmed or roll formeJ from No. 26
gauge gah�anizeJ ueel and thr surface is erealed ihe same as lhe lile.
Gpcnings in ihc rool arc to tk (lushed wilh standurd rcwfjacks and (lashings
�s rcyuired by coJe. Carc should be taken to udcquatcly wea�hcrprouf the
flashings and to suppon them wilh additional blocking or roof framing as
neccssary. Addilional details ;u�e shown in Figure No. 1. Sierra rwf liles
Report No. 4361
Mur, 1986
r�
inslalled in accurdance with Ihis repurt ure recognized as a fire-returduN
ra�f covering under Seclion 3203 (c) of Ihe caic.
D. Re•Roofing Applicalions: I. General: Wi�h Ihe old mu( covcring
removcd, all conditions m�ed in Scctiun II A through II C apply. Tilcs mav
alw bc installed over existing medium woal shake, wood shingle, usphali
shingle or gravcl-surfuced roofs, pmvidcd Ihe ruo(slope is minimum 3:12.
The existing rou(must be inspecicd as se[ Forth in Ihe appendix oFChupicr
3? in the Unif'arm Building Cudc.
2. Class C: RiJge and hip caps musl M removed und Ihe exisitng rcwl
covering cm back (lush wi�h Ihc fuscia or bargc covec On sh:ilcc roo(s. thc
firsl course may bc cut back sufficicnl to allow a build up of 2 by 2 baucn
and 1 by 4 couNerbanens in order m malch the roofline and providc
(oundation lor lhe roofing ry5icm. I by S counterbal[cns ure in>tnllcJ
parallcl to �he Iruming members at a maximum 20 inches on ceNet Coun-
terbauens are fu��ened at 12 inchcs un center with nails penctre�ing a� least I
inch inio ur IhrouEh the ma( shealhing or Guming membec Battens, spaced
14!L inches un center, are nailed w the munterbultens wilh 16-penny nails.
The �iles �re fastened [o the bauen syslem in the same mnnrter as in Sec�ion ll
C. New flashings is installcd uver and amund all existing flashings, vcnts
und chimneys in accordance with this repurl und Ihe ee�e The valley used in
re-roof applications mus[ be as shown in Figure No. 2.
3. Class B: Ins�allu�ion is the same �s Class C except an undcrlayment uf
lisled Manville I'h-inch-thick foil faced fiberglass bav insulation is in-
stalled with foil face up and 2-inch he;�d iups over the exisling roof surface.
prior to the inslallation of �he bauening systems.
J. Class A: Installation is thc same as Class C ezcepl, a layer of a
minimum'h-inch-thick wu�er-resistam gypsum sheathing complying with
U.B.C, $[andard Nu. 47-10 is ins[alled over[he counterbattens using 3-
penny drywall nnils. The wallboardjoinls are lighfly buued. Additionully,
one layer of Type 30 asphall-sawrated (elt is inslallcd over Ihe gypsum
sheathing wilh a 2-inch minimum head lap in accordance wilh the ca1e.
E. Identificalion: A tag containing the manufaclurer's nume, address.
product name and evaluation report number is uffixed to each pallet_
IIL Evidence Submit[ed: Repans of upliR, acceleru�ed weathering.
wind-driven rain, slruclural calculafions, and fire-retardam roo� tests anJ
installalion instruc�ions.
Flndings
IV. Findings: Thal tiles described in Ihis report are fire-re(ardam
roof coverings complying wflh lhe 1985 Uniform Building Code, sub-
jecl to the followinb cunditions:
1. The liles are manufac[urered, identificd und installed in uccurd-
ance with this repurt and the manufacturer's instructions.
2. Thelilerootlngsysteminstallatiunsarelimiledtoareashavingu
maximum basic wind spced of 80 mph, EXposure B as dc�cr-
mined in SecliUn 2311(b) uP lhe cude on buildings mt over 40 fcel
in heigh�.
This repor[ is subject lo re•examinalion in one year.
Evaluation reports af /CBO Evalua6on Service, lnr., are issued solely �o provide informafion �o Cbss A members of /CBO, ufilizing fhe code upon
which rhe reporr is based. Evaluation reports are no( to bt constru�d as representing aeslhetics or nny olherafbibutes not specificaUy addressed nor as
art endo(semert� or recommendabon for use oj�he subjeet report.
This repor� is based upon independertt [ests or othe� �echnical dam submuted by the applicanL The /CBO Evaluation Service, Inc., rechnica! smJf has
reviewed the test results and/or other dam, bu7 does naf possess tes� facilities m mnke an independen! verifrention. There is na wairan�y by ICBO
Eva(untion Service, lnc., express or implied, as m any "Finding" or o�her matter in the report or ns to nny product tovered by the report. This
disclaimer ineludes, bu! is no� iimired m, merchartmtiiii(y.
Page 1 ot 3
FASCIA DETAIL
ROOF TILE
�q91�• `
�p91i � .
CaUtTER RAFTER
�� FASCIABOARD
ROOF TILE DIM.
T
�
16Vi
r- 50+,Y
RIDGE HIP
GABLE RAKES aiDGE PiECE
TILE RAFfER RIDGEBOARD
BARGE PIECE
RAF7ER
BARGEBOAFD
VALLEVS CLOSED
VALLEYS OPEN
2 x 20ATTENS �BENDTILEDOVJN
BEND TILE DOWN
LL FEY/I.ASHIN
RAFTER
MRERING TILE
,! a '
'�I�'I�II�II
"�`..v.v �
�
MORTAR JOINT
FLASHING
BEND UP
TILE NAILING
%%i%%�%�%///�.,.d,
%%i%�I%�I!/�//
• • ••
CNIMNEY DETAIIS
METAL FASCIA
DETAIL
x4'COUNTERBATTEN
SOLIDOR 2" x 2"BA77ENS
SPACED �S NAILPOINT
SHEATNING `��, METALFASCIA
RAFTER
RIDGE
BARREL TRIM
NAIL POINT
RIDGEBOARD BARREL
ROOF TILE
� : ' �— RAFTER
� " �-_
FIGURE N0.1—NEW CONSTRUCTION
VENT/EXHAUST
DETAIL
5�����5��������
�
r
�/I� �1
L��I
ia
�, �;,�H�-/l
��////_L °
7. CUT HOLE IN TILE
2. POSITION VENT/E%HAUST
FLASHING OVER PIPE
3. MOLD VENT TO FIT ROOFING
TILE PROFILE
4. OPENING CAULKED AND
CHIPPED
5. SECTION TILES CUT AND
PLACED SO AS 70 COVER
THE FLASHING
b. VENT PIPE AND FLASHING
PAINTEDTO MATCH TILE
AFfER CAULKING
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O
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A
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m
J
. •
BARGE
BARREL TRIM
NAIL POINT
BARRELTRIM
2" x 2' BATTEN
1' * 4'COUNTEqBq7TEN
E%ISTlNG SOLIDOR 'NAILPOINT
SHAKE SPACED BARGEBOARD
SHEATHING
NOTE: SEE REPORT TEXT FOR ROOF �NSULATION, ETC.
BATTEN LAYOUT
SOII� OR �
SPACED
SHEA7NINCa �
rxa•
COUN7EABATTENS-
SHAKES/SHINGLES'
CUTSHAKESBACK
APPROX.4' —�
2' x Y BUILOUP �
NOTE: SEE REPORT TEXT FOR ROOF INSULATION, E7C.
x 2'BATfENS
VALLEVS
CLOSE� OPEN
CUT AND
���, BEND
�� TILE _ti�
VALLEY 7RIM
DETAIL
-annnc�sninti�t— / 1.DEPTH24i
ORSPACESHEATHINGJ 2.CENTEROUT3s�e
3.OVEqALLMEASUREMENT74i
RIDGE AND HIP
.. �
- '��_
�� ' � � � '• TW02' K 7BATTENSORONE
� � . 't _i � 7 x 4'BATTEN
MAX.
�
FIGURE NO. 2—RE-ROOF APPLICATION
�'SOLID OR SPACE SHEATHING
—7 x 2'BAITEN
x 4'COUMERBATTEN
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C I T Y O F C O S T A M E S A
IfVTER-OFFICE MEMORAiVDUM
Aup,ust 31 �g 70
TO Fred Sorsabal�City NtanaQer FROM Building Safety Departmant
SUBJECTs complaint regarding air-conditioning unit installed for Charles Peters� 3214
Dakota Avenue
As a result of a complaint 3n regards Lo aa air»conditioning unit instelled at the above
mentioned address� cve (the undersigned) found the folloe�ing conditions existing.
The neighbor at 3210 Dakota Avenue hus complained on sevezal occasions ubout the noisey
operation of the air-conditioning unit, lde found the noise level to be below average for
thls size unit. This appears to be in accord with the Gas Company personnel and also with
the Bowers Air-Conditioning Company who did the installation.
Qtt�er than some minor mechanical corrections which will be taken care oE by $owers� we find
the installation to be acceptable.
Howard Caffrey, Heating t, Plumbing Inspector
Ronald L. Rober[son� Electricul Inspector
HC/RLRtdh
�oT 74 - TRACT 3625
. �,�ca°o�
COSTA MESA BUILDING•SAFETY DEPARTMENT
P. O. BOX 917 GOHTA MEBA. CALIFORNIA
For Applieant to Fill In Completely
' TYPE OR PRINT �
BUILDING
ADDRE65 Z�lI DAKOTA AVENUE
COS7A MESA. CALIFORNIA
KENKOL CONSTRUCTION CO.
OWNER
MAII �555 PLACENT�A AVENUE
ADDRESS
ci.�, NEWPORT BEACH No4�lI 6-3zi
ARCHITECf' TEL.
K.W• Ko��
�555 PLALENTIA AVENUE
I��TNo. 6ii95 No: M� 6-3227
61ZE _ pQX � 00 I NO, OP BLOGe.O
BETBACK LIN2 RqOM �J� � 2 I
cer+raR oP BTneeT REAR YARD
t t
BIOE YARD I LEFT RIGHT 5
DESCRIPTION OF WORK
BUILDING / y NO. OF /
BIZE �O��.ISF ROOMS C7 STORIES �
EXTERIOR WALL STUCCO I ROOF WOOD SHAKES
ATTACHED
I GARAGE PLAN•�-A
BUILDING
FIRE
ZONE
LEGAL
'� , F EE RECEIV ED
._�`�� .5-�3��� .
FINANCrE DEPT•
APPLICATIO���RFPERA�fA M�
.. ;,,:r,..,,.-,.-�.
�; BUILDING Y -- • .
"�,
For Office Use Only
HECEIPT NO. I P.ERMlT1NO:C1
owre iesuen
COSTA MESA.
ZONING
NO.OF USE OF NEW
PLANB BUILDING �
LINe 6T.)
EVES
I
1 HEREBY ACKNOWLEDGC THAT 1 X�V6 R8A0 TH18 MPLIGTION TX8 AMOt1NT BHOWN UNOEH VALUAiION IS FOH TNE •
ANO BTAiE TMAT TX6 ABOVE IB GORIiECT AND AGREE TO COM� pURP086 OP EBTA9LIBHIN6 w PERMIT FEC ONLY.
PLY WITH ALL CIiY p�INANCEB ANU HTATE UWB REGULATINO
Bu1tnlNo CONBiqucY�oN. VALUATION � / �
BIGNATUR6 OF
PERMIT FEE $ ��
PERMITTE �A[ o
/'//�f��� �(.�,��•^ $ //�/� PLAN CHECK $ /�+ �
AUTNORIZEDAGENY LL�. 'l� L'� VV�'va�'y-' ry./ tt
TOTAL FEE J / ' 4
0
,�