The URL can be used to link to this page

Home My WebLink About3264 DAKOTA AVE - Building PermitsAGplinnt to /ill in all apaees e�eaD< <�ose wH�ln CITY OF COSTA MESA CONSTRUCTION PERMIT ApplicanY� Mailing Address I Project Address ��C' � � �%"k0 � U � Owner's Nema Phone - S b% Addrea �a �=� � A�OT l] U P • Arch/Enp. License No. � Address � �/, ,'/' Contrector's Nem hone �L�.�L� Address (m ut a1 .�. � . � n /)'1 f'+ /� /� � f'� License N� � � � LICENSED CONTRACTOR DECLARATION I�heraby affirm t�at 1 am Ilcensetl untler O�ovlslons of Charter 9(wmmencing wit� sectlon 7000) of Dlvlzion 3 01 t�a Buslneu ana Professlons Coae, an7 my IlCensa Is In full t c an H 4tt� Ucen 2� � �-t�-�-� _d/1$�_ fata�r LJcensa No. CJ—.�-S-ii 3 SI9 t _K-� Ld {�kC1n NORKERS' COMPENSATION DECLARATION 1 hera�y afflrm that I llave a certlflcale of consent ta selT�nsura ot a certitluta . ot Workars' Compensation Iniurance, or a cert A copy tha{eot Section 3800, Lab. ) G ,l / , , Policy No. �� ! � � ' Company OC Cert'(�eG��Y lc �80 wi�t00 I�naY Bulltll pIvly Or1� 'n,�,,- �U i� �(- L[:. Y'� El(EMPTION FROM WORKERS' COMPENSATION DECLARATION Isi)s soction neetl nol Oe comD�eteE if t�e Oermit Ii tar one �unOreC (5100) or I certity that In the performance ot t�e work /or whlch this perm�[ iz iisuatl 1 shall not emD�oy any person In any manner so as to becoma subject. to ti�e Warkars' CompensaUan Laws of GII}arnla. � - Date • Siqnature NOTICE: If, a}ter making t�is tleclarallon, you shoulC become sub�act to lhe Workerz' CampenSaUon O�a��slons of lhe Labon COCo, you must forthwith comply wit� such provlsions or thls permlt shall be tlaemea' revokatl. �CONSTRUCTION lENO1NG AOENCV ' I heraby aHirm that there Is a�constructlon lentling aqency br [he pertormance ot lhe work for which this pormil I5 IisuoO (Sectlon 3097 Civ. C.) LenAer's Name LenAer'S' AAarass � � � OWNER BUILOER OECIARATION ' � I hereby a/firm that 1 am ¢xBTpt irom the COntractorY Llcenia Lnw tOi tne � followlnq raason (Soction 7031.5 Buslnoss antl Profasslonal Cotlo: Any cilY or . countv which reauires a Dermit to construct, altor, improvo, tlemolish or repair the allegatl exomptlon. Any vioiat�on o� Se a. a oermit sublects tno aoollcant to a L'J I, as owner of the Droporry or my employeei witn wages as meir soie compensatlon wlll tlo the work, antl thn structure is not IMentletl or offerod for sate (Sac{lon 7044, Businozs antl Profeszional Cotlo: Tha Contrattor's Licensa Law tloes not apP�Y �o an owner of a prooerty who bulltls or Improves thereon,�antl who tlOes such wOrk ttlTzeH/hOrsul! Or througn �Is or her own ¢mploYees, OroviEetl that such Impravaments are not Intnntletl or offaratl 1or sale. If howavar, Ino �ulltlinp or improvement Is soltl wlthin ono yoar of com• plation, tha owner wlll �ave tho burtlen of provin9 ho/she tlltl not bulltl or Im- �rove for the purposa of sale). I, as owner of the property, am axclusively contractin9 wit� Ilcensetl con- tractors to construct tha project (Saction 7044, Buslness antl Rotessians Cotle: The Contrattor•s License Law doos not appry to an owner of Oroperly who builtls ar Improvas theraon, antl who contracts for such projacts with a con- tractor(s) Ilcense pursuant to l�e ContraGtor's Licensa Law). ❑ I am exempt under Sattion B. & P. C. tor this r¢ason Date Ownar I nerebv tartifv that I hare reai antl state laws relailn sentatives of.tnl cfl Inspection purp 5� SI t � 1 thiz appliwtlon antl state that the above- comply wit� all dty antl counry ortllnances g conztructlon, antl hereby aut�oriza reDre- . u0on tne aDova-mentlone0 DroDerty for ' Date�[(�� TVPE OF CONSTRUCTION LJ nE ❑ CONVERSION ❑ DEMOLISH DESCRIVTION OF WORK eo.aer J ADD OTHER inE fiqn all a00/oDrbb tlaClantiom. ALTE(3ATION LJ REPAIR TVPE OF PERMIT LJ GRADING LI FOUNDATIO�N� LJ STRUCTURAI ❑ TENANT ❑ ELEGTRICAL ❑ PLUMBING UGMECNANICAL ❑ �OTHER PRQIECT DESCRIPTION 5�. FT. OCCVPANCV CONSTRUCTION TVPF VAIUATION S ZONE GRADINGCU.VDS. ACRFe Hemarks: Bar Siak Backflow Preventer Beckflow irrigation Bathtubs rinking FounWins loor Dreins � ' loor Sinks - as Service' Outlets Kitclien Sink Lavatories P—Trap ' Roof Drains � Showers Service Sink Boiler Duct - Under Grt Duct - Structural ExhaustSystem ❑ Multiple � Firepl/Fact.Blt.ICBO�k Hea �System & Ducting ' I �00.000 BTU�O100.000 � Hood or Tvoe I ❑ � gna ure � I I Registers Drivers' Ucense ar 55 � CMF 0865-06 rev. 12/82 White - Builtlin9: ��ary - A�G��wnt: P�nk - Acwunting; GOltlenroU - Assessor Soler Collectws Soler PiPing - � � Sotar Tank . Swimming Pool w/Spa Urinal Water Clomt � Water Heater Water Service Reinspection Fee � Issue Fee MECHANICAL Refrigeretion $ystem 00-100,0008TU 0100,OOOBTU System RepairlAlteration • PLNG. RE LEfT SIDE VARD PKG.SPACE RE�. STREET WIDTH Automatic Washer • Construction Pole .' Cooking Unit „ DishNasher Dryers ❑Gas ❑Electric Fan • F.A.U. Fixtures Device Bozes ' Outleis Switches Garbege D isposal Generator DO-5 KW �5� Transformer 015�50 KW ❑5U+ KW $15 Meter ❑up to 100 amps $ 3 Zoning APProved BY . Applintion Approved By — APDliption Isued By _ Reinspection Fee 515 Issue Fee S 3 BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK ELECTRICAL t PLAN CHECK � MECHANICAL PLAN CHECK 91 �' {.��.,,.�. .. REAH VARD (TO P/U qIGHTSIDE VARD PROVIDED PARK FEE S 70' i . Sub Panel Sub Pole Motors OO-1 HP ❑7X-8 Inc.Solar �g-15 HP 016-75+ Microwave Pole Light . Range Sign ' StandingSections � Trash Compattor KW Reinspection Fee 575 . .Issue Fee � ' $ 3 Dete Date -� , !�i oa:. O �-7 SUMMARV OF FEES $ SMIP $ PERMIT $ ISSUANCE� $ GRADING $ • $ MICROFILM $ GO TOTAL FEE $ LESS ADVANCED PC FINAL FEE r� ��CONSTRUCTION AND'PLANNING ' � - _ ' � � _. - :�� & SPA �_ �� f � Date � �Inspector � - Date Inspector. ' APPROVALS ' Permit�#� �-"APPROVACS Permit #� :� . „ . _ . _ . . . . � . �'.� �1: Temp'orary Electrical SerJice o'r�Pole i ^ � ° ` 52i Pool & �Equipment Location " - - � : � 2? Soil Pipe-Undrgrnd � � _ s;? . ' ��' � ^ �� _ ' -' � ' 53 j Steel Reinforcement . ' ' � �- 3: Electrical Conduit Utilitv-Undrgrnd. - � � � . 54: Forms � ' �t - �-',; 4. Electrical'Conduit-Undrgrrid� �. . � � � � - . - - 55r Electrical Bonding . � . � . , 5i Steel Reinforcem�nt ` ;, , - - -� � � - � : 56. Rough Plumbing & Pressure Test � B. �Electrical UFER Grnd.1 � � � �, ' ��1 - . 57.. APPROVAL�TO COVER�GUNITE _ . - 7. Footings ' � ' � ; ' . ,� "� ' .58'. Electrical �pnduit•Undromd. - i 8. koundation � . . ;� - r� ��59. Gas Pipe, O Undrgrnd., Test � � 9. Water Pi�pe-UndrgrPd� � ' - - ' ".60. Backwash� Lines,�P-Trap, O Undrgrnd. 10. Struaural Floor System : S� '" �c � 61. APP,ROVAL TO DECK - ' 11. Property Sewer Line &�House,Connectiom : � ' 62. Backwash & Receptor-Final � _ _ 12. SewerCap �� i�• ��_„ � I . i� 63. Heater�&�Vent•Final � � � f 13. �Roof Drsins ", � � ' - - • , ; � ' 64. Plumbing System - Final . � 14. Rough Plumbing � � ' ' - - -65. Electrical-Final � � - � c , ; _ :c �pui5�. �Rough Ele�tricaFConduit--�-'; -� -"��-7 � -�- -� ` ""�66� Solar SYstem-Final � - --- - . -__ ._.. `u16. Rough-�Electric Wiring� ,� 1 � , � � ' .-�' ' 67.� Fencing & Access Approval - '- -. ,�� ' ' - . - , v � ,.17. hRough Wiring�Sign - - ' � ' � •� ( - � ' � 'gg, APPROVED FOR PLASTERING - c � .�n - � c _ � i t .�': � `% - J : . ' • : . . . . . ��18.;Rough.Elec[rical-T'rBan Ceiling �, i': - 4� 1- � 69: POOUSRA SYSTEMS EINAL � � �''� 19. Rough�Hea�ing&,,Air�Conditioning '� i � ._� ; �?� � j 'pIREDEPT.�REQUIREMENT � _ � � - � � � { 20.��Rough:Factory Fireplace �, � ; i, � � i , � � ; APPROVALS � Permit# � _ . . � .' - � . . . .. . . . . ` ` 21�Duc[s; in SVuctuie� ' ; � .� � ' � . ' '70.� Undergrountl Hydro , � � 1 ? ;;;22i Duc[s, Ven[ilating J � ' , � , ! � �71. Product Piping O Gas ❑ Oil � �' 23'. �Gas Pipe-Rough & Test _ � �� ,. � � I � �72 � Underground Flush • � � 24. ��Roof Framing� ,�i: i �, I � . � , � � _; 73i Undergmd. Storage Tank O Gas ❑ Oil y ., , - � 25�Roof Sheathimg � y � ., � z - � � 74. Overhead Hydro . .= i26.;T-Bar CeilingyStruetural) & MonocoaY � � � - � • � � � �75. D,ry Chemical . � � .27.{IFrameantl�Flashing� -; ' � I� i' , �I ' � � 76! DryStandpipe � � , , � J 28. �Latliing & Siding' �-� �� , �I I. � 1 ' � �' 1 � �77: F-IXED SYSTEM FINAL � � V • �_29.;�Irisulation• ' � . - � � ' � � � � � � � , ,78. FIREPREV.FINAL - . � ��'30.�Drywall Nailing � . i � � ' Notes: , R � � , �� 31.�PlasterBrown Coat ' ' � ` ! 1 � � . i � a � 32.,�Electrical�Power MeterFinal � � �1 � �^� � ' i i , ' � ' �33�Finai Electric _ � �� ; i � � �34. Final Heating�& Ai� Co�ditioning � _8/�� ` ,� ' ' 35. Final Gas Pipe�Test r : ; = � '- ;i � = . - - , . � ' . , - � . . C ' 36. Hood or�CanopY ` � �,, ' .: � �; ' � , � , � : � I � � � - . �: �' . S -, �� j� t • i� � � � i� � . � ' . 37. Fina� Factory F�ireplace� ; r; =1 I'� �'' i �' i '' ' � � ' r. � 38. Final Plumbingi • � � •� � � � � � � . ' - � � � ' r 39. Water'Seivice-Final i ' ' . '�� i , ' � ' ' �. . � i 40. Gas Service-Pinal � i i . � �' � ' � i � � i� 41. Solar pomestic�Final I ', ' � � � � ' � ' � ' � . ' � . . - . - _ r. . . . _ . 42. Backflow Preventer,� , � ' � ^ � � � � ' _� _ ' • �_ � � - i 1 � 1 43. Backflow Iriigation,�' ! � � - � �� - ' � � � . ' � ' :r � 44. Landsc�pelrrigaYioniSystem� ; ^� �' I�. I . i. � 45. Soun.�l.Atte'nuation,� ;.,- ' - � �.��. i .' � j �� . �. �� I � � + , � � - . 46. HandicapRegu�ationsi ��: � ` �_ � . ,� � • � � �. . .' . - , l� � I 47. FINAL STRUCTURE'& BUILDING' � - , � ' . ' - I i I i 48. Special Requirements Completeii �' i � i� ' ' � , . 49. Elect��c�Releaseto;Edison � � " _ ti_._ � _ __ _ _ ' _ . . . � p � . 50. Gas Release'to Southe�n California Gas Co � . i . � , ' 51. CERTIKICATEOFOCCUPANCY a ._ � T__ t_1 . _ _ _; ` No �' n � Date � ' i � ' ' , � ' cc _ .-.a :- 1 (714) 754-5273 • Fax (714) 754-4856 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT �ob nddress: 3264 DAKOTA AV Suite: Vicinity: Parcel Nunmber: 13906705 App�icant: LATIMER, JEFF Address: Owner: GRISCOM, DAVID L Address P O BOX 1506 NEWPORT BEACH,CA Contractor: J R CONSTRUCTION Address: 03218 OREGON AV Arch / Eng : Address: Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: COSTA MESA CA BUILDING PERMIT Zoning: Phone: Zip: Phone: Zip: 92659 Phone: 714-641-7448 Zip: 92626 License: 485367 rl" � � ' PE IT NUMBER 898-02077 � 77 hAIH UHIVt, I:UJ IA MtJH. l:H BLbLb Phone: Zip: ' License: SCOPE OF PERMIT TEAR OFF OCK ROOF INSTALL 2 LAYERS OF 301BS. FELT 8 REROOF WITH 30 YEA COMP. SHINGLES. $0.00 $87.25 $0.50 $0.00 $0.00 $0.00 $87.75 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existina: 0 NOTES: Rear 0- 0 Rear 0- 0 Reauired: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 Status: ISSUED Applied: 11/18/1998 Issued: 11/18/1998 $a,000.00 sa,000.00 EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it 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 inapectiona end 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 WORKERS' COMPENSATON DECLARATION: I hereby aHirm under penelty ot perjuy one of ihe tollowing declarations: ❑ I heve entl will meintein e certliicete ot consent to self-Insure for workers' compensation, as provided for by section 3700 oi t�e Lebor Cotle, for the peAormence oi tha �work for which this pertnit is issuetl. I have anG will maintein workerS' compensation insurflnce, as required by seclion 3700 of the Lebor Code. br Ihe peAortnence ol the work for which this pertnit is issued. My workers' compensation Insurence certiar end policy number are: Carrier: (lhissection dnot ❑ certity that in compensetion la� com esi icant Signature: WARNING:FAILUR OS TtqUSAND E�StI LICENSED C TRAC y eHirm thet 1 a force and eHect. Lic. p. Contractafs Signeture: Policy Number: t is valued t one hundred dollars ($100) or less.) �rk for ch is permit is issued, I shall not employ eny pe n eny n ner so as to 6ewme subject to ihe workers' s th il d bewme subjed to t�e warkers' compenseti sians of ctlon 3700 af the Labor Cotle, I shall fonhwith Date: — - ^ t ISATION WVERAGE IS UNLFWFUL PND SHA�L SUBJECT EMPLOYER CFIMINAL PENALTIES AND GVIL FlNES UP TO ONE HUNDHED COSTOFCOMPENSAT70N,DMIAGESASPqOVIOEDWRI SECTI OBOFTHELABORCppE.INiEREST,ANDAiTORNEI"SFEES. with Sectlon 7000) at Class a � Date: / -/ i Code, antl my license is in full ❑ I hereby aflirm ihet there Is a cqnswction lending egency for the pedormance of the work for which this permit is issued. (Sec. 3097, qvil Coee). Lendar's Neme: Lendefs Atldress: Signature: OWHEH-BUILOER DECLAHATfONS: Data: I hereby etlirtn thet unOer penelry ot perjury thet I em EXEMP7 FROM TME CONTRACTORS LICENSE LAW tor the lollowing reeson (Sec. 7031.5, Business antl Professions Code: Any clry ar counry which raquires e permit to consiruct, alter, improve, damolish, or repair eny structure, pdor to Its Issuente, elso requires the applicant for such permil to ille e signetl stetement �het he or she Is Iicensed pursuent to Ihe provisions of t�e Contrectors License Law (Cheptar 9(commencing with Section 7000) of Division 3 of the Business and Professions Cotle) or ihet he or she is exempt ihereirom and ihe hasis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permil subjecls Ihe applicant to e civ,l penalty ot noi more than Ma huntlretl tlollars ($500).): ❑ I, es owner of the propeny, or my employees with weges as their sole wmpensatlon, WILL DO THE WORK, entl Ihe structure is not intentled or oHeratl tor sale (Sec. 7044, Business end Protessions Code: The Contrectors License Law does not apply to an owner of property who builds or Impmves thereon, end who tloes such work himselt ar hersell or ihrough hig or her own employees, providetl t�et such improvements ere not intended or offeretl for sale. II, however, �he bulitlinq or impmvement Is sold wi�hin one year ot complelion, the owner-bullder will have Ihe burden of proving Ihat he or she did not builA or impmve for puryose of sele.�. ❑ I, es owner of the property, am EXCLUSIVELY CONTRACTNG WITH LICENSEU CONTHAC70RS to wnstruct the project (Sec. 7044, Business end Pmfessions Code: The cnntrectors License Law does not apply to an owner of property who builds or improves �hereon, entl who contrects for such project with e contrectoqs) licensa pursuant ro the Goniractors Licensa Lews.). ❑ I am exempt under sec. Signature: Owner ID venfied by tlnvefs license. ❑ Yes ❑ No Business and Professions Code lor this reason: Verification ot Ownershlp by {rypa ot document, i.e. - property tax bill or deatl): Dnver's License No. Date: Eapires: DIVISION OF INOUS7RIAL SAFETY pERMR CERTIFICATION: ❑ I hereby certiy thet no eacavetion Ilva (5) or more feet in tlepth imo which a person is reqWred to tlescend, wlll be mede In connection with work authodzetl Dy this pertnii, end t�at no building slr4qure, scaHaltling, fel5ework, or demolition or dismantling Ihereot, wlll ba more then Ihirty-six (36) feei high. (Chep. 32, Grp 2. Art 2, SeC. 341, Title 8, Celitomla AdministreUve Cotle). ❑ As ownervbuilder, I will not employ enyone to do work which would require a permit irom �he Dlvlsion ot Indusirlal Sefery, es noted above, unless such person has a permit to tlo such work from tha division. Signature: Date: Division of Industrial Safely Parmit Number. ICERTIFlCATE OF COMPLIANCE AND AUTHORVA710N OF ENTAV: I certity undar penalry ot perjury thet I heva rea0 this applicetion antl state that the informetion given is I correct I egree to comply with all state lews and ciry ordinances relating to building construction, and euthonze representatives oi the Ciry ot Costa Mesa to eNer upon the ehove-descri�ed propeny for inspeclion purposes. I�gree not to occupy or allow occupency ot any 6uilding euthonzatl by this permi! until final inspection. CODE �. ixsrernoxnre � 1616 Fised System Final Fire Pr�vention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetalning Wall 202 Finel Fectory Fire Place 203 Final Sign 204 Finel Demolitian 2d46d6 1�� '' "/ LOOE I INSPECTION TYGE 206 Finel Mechenicel 20B Final Plumbing 210 Finel Elecidcel 212 Final Fire Preventlon 220 Flnel Planning Approval 222 250 Finel Site Final 8ulltling/Occupancy Date QAff U�61.S OWNER C.E. SV�SN JOB ADDRESS 3264 Dakota Ave GENERAL CONTRACTOR p�aner-b� APNo. 139-067-OSlOT 68 INSPECTIONS sou GNS W RTER ROUGM PLl1MBING PROP. SWR. LINE � HOUSE CON. � SPRINKLING SVSTEM MISGELUNE0l15 ROUGH MEATING ANO RIR CONqIT10NING TEMPORPRV SERVICE OP POL� UNOERGfiOUND CI POWEN � ROUGN W!RING TRENCHES FORMS STEEL REINF. FLOOR SVSTEM �ONO BERM I STEEL FEINFORCE I-I SHEATNING FRAME ANO FLRSHING LRTHING - IN OUT � PLASTER,BROWN COAT STRURURAL, FINAL MEATING, VENT., REFRIG. ANq �,�„ FINFL PLUMBING. FINAL ANO GAS i�ST n ELECTRiC, FINAL BUILOING, FINAL DATE FIRE ZONE SUBGONTRACTOR T N0. w an�i �in�ia� COSTA MESA BUILDINGSAFETY DEPARTMENT APPLI TION FOR-STRUCTURAL PERMIT -- P.O. BOX 1200 COS7A MESA, CALIFORNIA 92626 RECEIV DBV PERMIT J��O� For Applicant to Fill in Completely — Use Ink Only o+/�C� BUILDING �� A.P. NO. 3� ��J . ADORESS BUILDING / /� p� TENAN OR �C� �� ADDRE55 � Ztp !'7��/'� UNIT OR MAI LI NG SPACE NO. ADDRE55 TR.N�� LOT � BLK. TEL. dTV NO. NEW AOO LTER REPAIR MOVING DEMOLISH CONSiRUCTION /) LENDER /Z BRANCH C � ��'I � OWNER AD�RESS VALUE ARCHITECT TEL. USE �� } LL $ OR ENGINEER N . ADDRESS ZONE TVPE GROUP APPROVED CONTRACTOF BY DATE ADDFESS � S�7(/j� � TEL. CITV NO. STATE CITY APPROVEDSETBACKS LIC. NO. LIC. NO. SIZE NO.OF BLDGS. (FflOM C/l STREET) OF LOT NOW ON LOT ONT FT. USE OF EXISfING BLDG. Separate permits are required for L. SIDE electric, plumbing and heating work: U REAR F . USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTI N 1 \ LL/��w� APPROVED � ! (j�� APPROVE� /��% /� — ✓ I hereby acknowledge thet I have reatl this application antl nate that the abova information is correci and agree to comply with all laws regulaNng builtlinp cOnstructiOn, entl I shall not employ eny petwn in violation of t�e workman's compenution laws of iha State of California. I hereby certify that I am properly IicensaA as a contractor under SQ. FT. the State of Californta Business antl Professions Code, Division 3, THE AMOUNTSHOWN UNDER VALUATION IS FOR Chapter 9, antl thai suc� licenses are in full forca antl affect, or I THE PURPOSE OF ES7ABLISHING A PERMIT FEE ONLV: am ezampt trom the provisionz ot the State of California Business VALUATION antl Professions Cotla, Division 3, Chapter 9. PERMIT FEE S Q� Signatura ot � Y PLAN CHECK $ Permittae �.Ii��E��• �� $ ��,�U TAX $ 5� Aut�orizedAgant Date � �� TOTAIPAID E . �G h�zv • G�7T�xi�v 5� Lot.68 '� Tr r3722- �� COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 COBTA MEBA. CALIFORNIA For Applieani fo Fill In Complefely . TYPE OR PRINT C05TA MESA. CALIFORNIA & E Develo�ment C NEWPORT B TEL. NO; OF-BIDGB. Q 88TBACK LINB FROM C6NTeR oP eTRHeT SO � REAR YARI SIDE YARD I LEF7 5�� I RICaHT S� DESCRIPTION OF WORK IS ZEDING � SRKcF ROOMS Fl STORIES WALLSTUCCO IC ❑LDIN6 AND WORK FEE RECEIVED U�.�' i3—coa-�`C fINA�CE DEPT. �PLIC�TIO�tJ�jF�QR� EP�RM li BUILDING For Office Use Only BUILDING COSTA MESA. CALIFORNIA ZONING ZONE NO.OF U6E OF NEW R_l Purvs p em�oiHc yr LEGAL t [C6NTER LIN¢ 9TJ _ FRONi and Attacl1ed Garage azi - f-HEREBY ACKNOW�DOE TXAT I NAVE ReAO THIB APPLIWTION ANO eTATE THAT YHE ABOV¢ I8 CORRECT AND AGPEE TO COM- PlY W�TH ALL CIT' ORDINANC¢9 AND ATE LA e REGULATING BUILDINO CON9TR� ON. /^. � SIGNATURE OP �/// i d . _ � TXE AMOUNT BHOWN UNOER VALIIATION IB iOH THE PURPOBE OR ESTABLIBHING A PERMIT FEE ONLY. VALUATION �"J � (p/ �/G/y PERMIT FEE S . �J G/�J{� $ �" /� PLAN CHECK $ I�' � AUTHORIZED AGENT � I t..T.. �ce a.�'Y -�