HomeMy WebLinkAbout1454 DEAUVILLE PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 www.Ci.costa-masa.ca.uc 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 3168 CHEMIN DE FER WY
Suite:
Vicinity: -t S , 1452'1f. 4 1456 DEAUVILLE PL
Parcel Number: TPN98079 Zoning:
Applicant: PEARSON, VESS
Address: P O BOX 3908
SEAL BEACH, CA
Owner:
FRENCH QUARTERS HOA
Address
2020 E FIRST ST
Issued:
SUITE 500
$0.85
SANTA ANA, CA
Contractor:
G M ROOFING COMPANY
Address:
P 0 BOX 3908
SEAL BEACH, CA
Zip: 90740
Arch :
Address:
Phone: 562-429-7663
Zip: 90740
Phone: 714-285-2626X211
Zip: 92705
Phone: 562-429-7663
License: 472566
Eng
Address
Phone:
ISSUED BY:
Status:
ISSUED
Applied:
06/08/2004.
Issued:
06/08/2004
Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF CONDO BLDG WITH UNITS 1050, 1452, 1454, 1456 DEAUVILLE PL ONLY: T/O EXISTING ROOF, INSTALL 2 LAYERS 15# FELT
UNDERLAYMENT, APPLY "GAF 40 -YEAR COMP SHINGLES PER MFGR'S SPECS.- 37 SQUARES
Plan Check:
$0.00
MAIN STRUCTURE Front 0-0
Permit:
$167.25
SMIP Res:
$0.85
Required: 0
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total: $168.10
SETBACKS
MAIN STRUCTURE Front 0-0
Rear 0-0
ACCESSORY Front 0-0
Rear 0-0
PARKING Existing: 0
Required: 0
FEE SUMMARY
Calc Valuation: $8,450.00
Claim Valuation: $8,450.00
PLANNING & ZONING
Lek 0-0 Right 0-0
Left 0-0 Right 0-0
Proposed: 0
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) 754.5626
94646 (6/00)
DECLARATIi 77
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penally of perjury one of the following declarations.
❑ 1 have and will maintain a certificate of consent to sell -Insure for workerscompensation, as provided for by section 3700 01 the Labor Code, for the performance of the
work tot which This permit is issued.
-Q� I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Owe. for the performance of the work for which this permit is issued.
My workers' compensation Insurance carrier and policy number are:
Carrier: �5 Policy Number: L(•!'•�(
(This section need not be completed it the permit is valued alone hundred dollars (5100) or less.)
❑ I cenity 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 IO the workers' compensation provisions of Section 3700 of the Labor Cotle, I shall forthwith
Comply with these provisions 0
Applicant Signature: _V,. ._y .4, •, t.,,,_ Date: L � Y
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUWECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSAND OOLLARE (SIo0,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECT ON 3706OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect. Lic. a L"I ( L S i• G Class 4 y
Contractor's Signature: e L n. - t' Date: 9, G
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).
Lender's 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
Cope: 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 tire 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 penally of not more than live hundred dollars (5500).):
❑ 1, as owner of the properly. 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 chered 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 properly, 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 progeny who builds or improves thereon, and who contracts for such project with a contraclor(s)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires:
Verification of Ownership by Itype of document. i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cenity 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 demolitinn or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title B, California 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 ;oma 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 veer a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or200 cubic f ... .... ..... ............. _... _........ .... ........ .....
2 Dries or vnll the applicant or present or future building occupant need to file a registration term for acutely hazar0ow materials? ❑Ves ❑ 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 ouanlity of arutnly 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).
............ ...._.. .. ..... _ ... .. .......................................... ..........
3 Does or will the applicant or present or future building occupant need to o-epare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
(Section 25534 of the California Health and Safely 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.
........... ............... .. ...... .......... ................ .... ............ .. .......... ... .... I..... ... ......._.._ . ......... .. .............. ... ......,... ...... ... .........,
A 11 an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
........ ....... .. .............. ..... ............ ........ ..__....... ........... _..... ...... ..........
5 Dons nr will the applicant or present or future building occupant require for the work which is the subject of this 8ptcahon a�ermh for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency. Ll vas No
(Section 6.5050 2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
............ .. ....... ........ .... ..... _._...... ......_.. _..
6 Will an ort of the tacitly to be constructed under thi= o
permit be within 10001eet from the oule �
y p, y _ p _r boundaries of a school [J Yes ❑ No
(11 "ves". the facility roust meet line requirement of Sections 25534 and 42303 of the California Health and Safety Code).
......._.. .. ............... ...........,.._. _._ ............ ...... ...... ........ ......... .. ..._..... ..__......_... .. ............... ........ ..._...... ... ... _._. .... ...... __... ...........
7 If a permit fine, the South Coast Air Orality Management District o� 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 Safely Code Section 42303 been made? E] Yes El No
........... .......... ....,...... ... _ ..._P ......_.... ...... ....
8 (II yr Mach r„nrfrcate of compliance from the appropriate air pollution control officer)
CERTIPICA TIE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all stale laws and city ordinances
regard'mq Ilaznrdnus Materials and Ernitranns.
SignnWw: 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. I agree to comply with all slate laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described properly for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature OI Legal Ownegsj1) ate
4 iii -7
Antl/Or Authorized Applicant Date
[ODE L IN4PF.CT1271TYPE a<IE INTITId S C_00IEgil N TyPE f),Tj INTRIAIS
1616 Fixed System Final Fire Prevention 205 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final He -Roof ..'-- -Il4111, 210 Final Electrical
201 Final Block/Reaming 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 BuildinglOccuoancy
Applicant
to fill in all spaces except.those within heavy border lines and sign all appropriate declarations.
..
_ 0434
COSTA MESA CONSTRUCTION PERMIT
P T NO.
aa9s�
'TRACT NO.
3
LOT N
UNIT NO.
Project Address �y C,, S A �� .
-
'1381% I'^ f''h'n•Qd
TYPE OF CONSTRUCTION
NEW ADD ALTERATION REPAIR
Applicant's Mailing Address S h\nQ�f3�
❑ DEMOLISH
❑ OTHER
` L'�-rC\"
Owner's Name Go/ S �jF art- L �•-Phone �u�-n���
.CONVERSION
DESCRIPTION OF-WORK/USE.OF
BLDG. -
A.P.# ,•
_� -- Zone
Address \yCL1 �• v~\'lN ,�-y).1A MISS (�_
- -. „
S
Main Building: _
Accessory Building:
License No' y31s�i+-
TYPE OF PERMI GRADIN ❑ FOUNDATION ❑ STRUCTURAL
❑
T
Front
r
Z,
Address
_ ❑.TENANT ELECTRICAL�PLUMBING MECHANICAL
B
Rear -
'_
N
_
Contractor's Name O Phone -22Q - tidD
❑'OTHER -
A
I
N'
C
Right
-
Address (mailing)�i&���5,• /Vn �-k LL: 2 /q'
PROJECT DESCRIPTION SO. FT, idC�STt OCCUPANCY
/
K
G,
CONSTRUCTION l"YPE
VALUATION $
SR-7
�I�
City License No.- � �-_/ � I
ZONE
GRADING CU.YDS. ACRES
Ping. Re # -
_
: Parking Req:/Provided
•� -
R.
E
LICENSED CONTRACTOR•DECLARATION
.1
r
[-hereby affirm that I amunder provisions of Charter 9'(commencing
Remarks: . II
Planning Notes:
-
M
with section 7000) of ,Division 3 of the Business and Professions Code, and
my license is in full force and effect.
-
S't
License Class Li n
'Signature
'FEES
Date •� —
PLUMBING
I `IORKERS' COMPENSATION DECLARATION
Hereby affirm that I have a certificatelof consent to self-insure or a certificate
Bar Sink
Showers
I
ELECTRICAL `'
FEES
Workers' Compensation-'Insurance: or a- certified copy thereof%(Section-
a e
- - - -
Backflow Preventer
-
-
Service Sink ;
.:..
--
i Automatic Washer
,
Transformer ❑ 15750 KW
I
o" y Np. W 1Y $! 13 W Ig Company ;=RF_mrsh j7 l
' Backflow Irrigation
p
Sewer Ca ••�,
�`
w�
Construction POI¢ Sub.
❑ 50 +',KW
V�
1
certifietl Copy is hereby furnished. ; •:.'
ertjjjt;,tl-opy iletl wi h the cit skiing 01&.
Bathtubs
Sewer Connection
OL
I ".
❑up
,,L
u�p
.�.
Cooking Unit
Meter to 100 amps
r
Date �S p licant
_
,'S
.EXEMPTION FROM WORKERS' COMP SATION OECLA ATION - -
_ C arif lets
Solar COII¢CtorS. - _
.Dishwasher
_ _ Meter Dover 1002mps -
- -
(This section need not be completed if the permit is for one hundred ($100) or
less)-.
I Dishwasher
Solar Piping
'
Dryers ❑Gas ❑Electric
y_ I
1 certify, that in the performance of the work for, which this permit is issued.fl
_
:'s
Sub Panel
-
shall noC employ any person in any manner so as to become subject to the
Workers' Compensation California.
Drinking Fountains
Solar Tank' 1
.�'
Fan s•
Motors 00-1 HP ❑1'/:'- 8-
Laws of
. Date �'' • Signature
'NOTICE:
Floor Drains
I
SwimmingPool w/S a
P I
F.A.U.
I -
Inc. Solar ❑9-15 HP El16-15+
If; after making this declaration, you should become subject to the
-provisions 'Labor
'Sinks
- -
i
Workers' •Compensation of. the Code, you must forthwith-'
Floor
Urinal
-
Fixtures..
- Y•
Microwave l
comply with such provisions. or this permit shall be deemed revoketl.
CONSTRUCTION LENDING AGENCY '
I hereby,affirm that there is a construction lending agency for the performance
Gas Service; Outl¢ts
1
YI
Water Closet ''7]��
-V
' Device Boxes_
Pole Light '
of the work for which this permit is issued-(Section _3097 Civ. C.) -
Lentler's Name
`Interceptors
-
Water Heater
-
- _
- Outlets'[
_
Range
T
�V
Lender's Address ' - -Kitchen
"" ;
� Sink
i
- _
'Water Service,
) SwitChesT I
Sign
OWNER BUILDER DECLARATION -
°
_
_
r'• -
'I
•'
I hereby affirm that I am exempt from the Contractor's License Law for the
Lavatories' - C
. Auto-Wash :
Garbage Disposal,,.
Standing Sections 'j
-
following reason (Section 7031-.5 Business and Professional Cotle:. Any city or
'`,I
,
county which requires a permit to construct, alter, improve, demolish or repair'
for'such
P-Trap _
Laundry Trays
-y y
'v
V
Generator ❑O-5 KW ❑5.15
KW Trash Compactor
- '
any structure, prior to its issuance, also requires the applicant permit
to file a signed statement.thathe/She is licensed pursuant to the provisions of
ROOF Drains
-'
.f
- -
Contractor's License Law (Chapter 9 (commencing with Section 7000) of-,
i
ision 3 of the Business 'and Professions Code) or that he/she is exempt :
t'A^,refrom'
- - -
rr,•x"
and .the basis for the alleged exemption. Any violation ofSection
by for the to
_ -
_ i
r 1't �^
to
,L;S31-.5 any applicant a permit Subjects - applicant-a civil
- penalty of not more than five hundred dollars:($500). -
LJ th wages as their sole :
I, as owner of the property. or my employees wi
. Reinspection. Fee.
$15
-
T Issue Fee '
$ 3
'" 'y •, a
.•t r--
+
,
compensation, will do the work, and the structure is not intended or offered
��y'
Reeinspectioli
$15 Issue Fee )ft;
$ 3
for sale (Section 7044, Business and Professional Code: The Contractor's'
MECHANICAL
FEES
_Fee'-
License Law-does not apply to an owner'of a property who builds or Thproves
thereon, and who does such work himself/herself or, through his or. her own
-
-
Hood Type ❑
I DEVELOPMENT SERVICES REQUIREMENTS:
s -
employees, provided that such improvements are not intended or offered for
Boiler
or I
Uw
, �i�
sale. If,. however, the building or improvement is sold within one year of com-
Canopy. Type II ❑
{ZOoing Approved8y
- 'Date
pleb on, the owner will have the burden of proving he/she tlitl not build or Im-
Duct - Under Ground
Builds Ag Approved By
DatO
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con- :
Duct - Structural
13efrigerati0 stem
ApplicationAssued By
Date
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License-Law doesnot apply to_an.owner of property who
builds improves thereon, for a con-
Duct -Ventilating
- -
❑0-10 0 BTU D100,000BTU
-
I•*y-:'� _
$SIN ARrVj OF FEES
or such projects aware
and who,conContractor's
tr license pursuant to the Contractor's License Law). I aware that
Exhaust System ❑ Multiple ❑
tem Repair/Alteration
BUILDINGPERMIT$
_
(pp O SMIP $
50
oIof f
proof o their Worker's Compensation insurance should be provided me..
ov
^
h'
b
❑ I,am'exem pt under Section B. & P. C. for this reason
ea
Firepl/Fact.Bit. ICBG #
Fire Dampers f
•"^ PLAN CHECK - -
$ r PERMIT
PLUMBING" "
$ ISSUANCES $
�0
Date - Owner
Heating System &Dueling
Registers
'
PLAN:CHECK'. 25%
$ ENERGY C. $
f,,.�.-...; _ _
ez
Aeby certify that have rto this application antl state that the
state that '
lotion is
❑0-100,000 BTU ❑100,
BT
-
_�
�,E LECTRICAL
,..
',e
$ GRADING $
correct. agree comply with all city abces
ord ina nces
ite laws tela o uiltling construction, and hereby authorize repro.
yes
-
✓ PLAN CHECK 50%
$ MICROFILMS' $ :
"'—
of this city to ter upon th above-mentioned property for
city
'on
roses. ..., �_GI
Date �SZ
•7 ,MECHANICAL
$ ;TOTAL FEE r; $
leen r SS w _
Reinspection Fee
$15
Issue Fee
$ 3
.�% PLAN CHECK 25%
$ • ;,�'
�, rev. 10/84 White - Building; Canary -Applicant; Pink - Accounting;
Goldenrod -Assessor
ACV r G
I
CONSTRUCTON AND PLANNING
APPROVALS/ Permit # Date
Inspector
PO( SPA
- APPROVALS Permit #
Date
1. Temporary lectrical Service or Pole
12.
52. Pool & Equipment Location
Soil Pipe-(ndrgrnd.
-
53. Steel Reinforcement
3. Electrical conduit Utility-Undrgrnd.
54. Forms -
4: ElectricalConduit-Undrgrnd.
r
55. Electrical Bonding
5. Steel Renforcement •
56. Rough Plumbing & Pressure Test
6. Electrial UFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footinjs
58. Electrical Conduit-Undrgrnd.
8. Founration
59. Gas Pipe, O Undrgrnd., Test
9. WateiPipe-Undrgrnd. /
r
60. Backwash Lines, P -Trap, O Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Proferty Sewer Line & House Connection
+
62. Backwash &Receptor -Final
12. Sever Cap
63. Heater & Vent -Final
-
13. Roof Drains
{
64. Plumbing System - Final
14. Rough Plumbing
-%Q -}i(+
(/rt�
65. Electrical -Final
15. Rough Electrical -Conduit
'66. Solar System -Final
16. Rough Electric Wiring
3/fZ
67. Fencing & Access Approval
17:'Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -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 ❑Oil
'
23. Gas Pipe -Rough & Test
72. Underground Flush
24.; Roof Framing
73. Undergrnd. Storage Tank O Gas O Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27: Frame and Flashing
3
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL '
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing I
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
,3S3%
' C�
Notes:
34. Final Heating & Air Conditioning
a
-/3 G o
35. Final Gas Pipe -Test.
a {
H-7-a�G 1'W orrf �vin E , r -•u7 _
36. Hood or Canopy-
a
'37. Final Factory Fireplace
W • In'L(
38. Final Plumbing p
y--�o
(100
7 '6c6
39. Water Service -Final
`1
40. Gas Service -Final
- �=
41. Solar Domestic -Final
42. Backflow Preventer
b
43. Backflow Irrigation
p
44. Landscape Irrigation System
`
45. Sound Attenuation
46. Handicap Regulations
,
47. FINAL STRUCTURE & BUILDING
6
48. Special Requirements Completed
49. Electric Release to Edison
- -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Inspector
21683
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 917 COSTA MESA, CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
BUILDING —WDeauville Place
ADDRESS
COSTA MESA. CALIFORNIA
I
ITY Santa Ana, California No' KL 922,
RCuITENER RAY LEVANA$ `• No•6737010
3432 Via Oporto N.P.. Beach
ONTRACTOR Lifoetime Res. Build Corp.DDRESS 2131,5. Artesia
TY Santa Ana, -California
-STATEE.. No. 208676 No. Ki 92204
F LOT 1883 I NOW ONUSEOF
OFSSO
XIST NG BLDG. NOSE
SETBACK LINE FROM .. �. ��{
CENTER OF STREET REAR YARDZ817"
SIDEYARDI LEFT 0 - I -RIGHT ' 0
DESCRIPTION OF WORK
N' x' ALTERATION ADDITIQN
SIZE DING 1265 ROOMS
® EXTERIOR WALL rn A nm I ROOF
1 HEREBY ACKNOWLEDOE TH HAVE READ THIS
AND STATE THAT THE ABOVE 1 CORRECT A
PLY WITH ALL CITY OR AN AND S WE
BUILDING CONSTRUCTI
SIGNATURE OR /
PERMITTE
AUTHORIZED AGENT
FEE CEIVED
192
p�8 2 �
FINANCE DEPT.
CITY OF COSTA MESA 5d,
APPLICATION APPLICATION FOR PERMIT
BUILDING
For Office Use Only
RECHIPT NO. Q�
RECEIV BY D HREC VE DATE ISSUED
BUILDING
ADDRESS
FIRE
ZONE TYPE GROUP
APPROVED
BY DATE
ZONING CN.
/ 011
A. P. NO. — 6
NOTE: NO SAVE OVERHANG SHALL BE LESS THAN
(n
90" TO SIDE 3 REAR P. L. �rj r� 1-p
,E•••
Y\ yy % O`
Z
EAVES
R
ALLOWED (U. B. C. REQUIREMENT)
YARDS APPROVED
YARDS APPROVED
MAIN BUILDING
ACCESSORY BUILDING
C:
(FROM REET)
FRONT FT.
_
_ FT.
Cy
LLAQ
�
R. SIDE FT.
FT."
Q
L. SIDE FT.Ar.M
T.�
REAR FT. -
0.
O . '
DISTANCE, BET.
MAIN BLDGS.
ACCESS. BLDGS.
C4
U.
VAR.*
DATE
U.
C. U. P.:C
_
APPRO"VED
–�
Q
B PROVE
..%
�� ^ V L
DATE
0
FT.
Q.
THE AMOUNT SHOWN UNDER VALUATION 1E FOR THE �•,
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
VALUATION m
PERMITFEE $
U/ L efJ yMAN CtiECK B
v
/ TOTAL FEE $ 7z