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Home My WebLink About930 DARRELL ST - Building Permitsa (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.cPaLUMBING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: ,'930x�DARRELLtST� Status: ISSUEo SuiteNo �=TT�,�T�T��T Applied: 12/28/2005 i a_ 1 a� "� 1� Issued: 12/28/2005 Vicinity: ��T&,� . � ^ Parcel Nunmber: 42235226 `F-� PER�- Applicant: FULTZ, ROBERT W ISSUED BY: Address: 930DARRELLST /'�,r•%�'" P RF�� -I "II�L�� Owner: �' COSTA �� AMT 1 $23.50 � `,..� $0.00 � � $0.00 $0.00 \ D �' $0.00 c)� $0.00 \\\� $0.00 \ �\ $0.00 unnang r,oun[ain Expansion�Tank Gas EartFiquake, Valv � Gas (1-4 outlets)� Gas (Over 4 outlets)� Gas Repipe �' Gas Service � Interceptors (Grease, Oil) Inlerceptors (Sand Auto�) � '� Phone:'949-642-0887'��-�.;�� Zip: 92627 ' �, �� , �� —`-�-� ��.1 l Phone: Zip: 92627 . �ae",ZiP � o peo 0 i ��%.' ��o ��-.^=`"J__._ . �'e'� M � r�� . �.�r'" �. .� �-""� SCOPE OF PERMIT FOR 1 GAS LINE FOR FIREPLACE 0 �t 0 0 �� 0� 0 0 0 0 0 0 0 0 . d�-��+s°,� �J� �` � o` 0 o�/", .`.•'/� � / Washer Process Piping'(per 10 fl)"-'- Receptors Septic Tank � Sewer Cap for Demo -+ Sewer Connect .., er-..=�.:, Sewer Pnvate Lme vn Shower�} ;."�`JO . °. �� $ink ba��,l" � o - Sink„corrimercial °�9 �.n` Sink; Floo� a'�� 'Ctn° - Sink�, kitcheni� ° G �� c Sink;'ser"vice/mop ��'o o y Spe (private) o � o SPa'(PUbIiG)_ P .'� c' "� �� $0.00 $0.00 0 0 0 0 0 0 �o �J�O, �J j Sump Pump _ i Swimming P� __�� TrapPrimer _��, Urinal I Vacuum Brkr � Vacuum Brkr - _Wash Basin Wash Basin4 Waste and�V� N/aterCloset .^t!,� i t �;� �� _"-'1 +. � � �_ { � '�1'�� 1�1 � � ��.'Z� (�....i 1� �J�/% �,,, `�$0.00 iel� �-�` $OAO ant System $0.00 (ToileQ �'� :80.00 / vent �. $0:00 Qnst or Rep.) �"'$0.00 ei �S j) � $0.00 �� $0.00 :r �� $0.00 } G $0.00 $0.00 C Q� $0.00 ON $0.00 ED FEES: $29.65 il%�� '� � �� j � �� PER �. � EXPIRES � � �I 1 `� Q � 0 L' �0 �� 0 , 0 � 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This pe�mit shall automatically expire and become void if work is not commenced within 180 days, or if work is su pended or abandoned for a period of 1 BO days. INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codas, and all requlred Inspectlona and tinal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. . FOR INSPECTIONS CALL: (714) 7545626 � 2446d61N00) WORKERS' COMPENSATION DEGLARATION: � ��' I hereby aHirm under penelty of periury one of the tollowing declaretions: . ❑ I have and will meintain a certificate of wnsent to sel4lnsure for workers' compensation, as pmvided for by section 3700 of ihe Labor Code, tor the pedormance of ihe wark for which Ihis permit is issuetl. ❑ I have and will maintain workere' �mpensation insurance, es required by section 3700 of the Labor Code, Por tha pertortnance of ihe work for which Ihis pertnit is issued. My workars' compensation Insurance carrier and policy number ere: Carrier: Policy Number: �(7h/isy ecfion need no! be completed il the permit is valuetl at one hundred dollers ($ f00) or less.J E7-1 ceAify thatin.ihe p� or nce oi Ihe work for whic ' ' is issueq I shell not employ eny person in any manner so as to become subject to the workers' �compensatbdiaw of C fornia, an ee t� shoultl beco e subjact to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with.th �pro ' ian Applica�ntSigndtur .' Date�°� �� C— �� _ � WARNING:FAILUPE OSEWREWOR 'CAMPEN ION RA ISUNLAWFOLANpSHALLSUBIEGTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDRED THOUSAND DOLLNRE ($100,000), IN ADDITI�N TO THE CAST Of CAMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31O60F THE lAB9R WOE, INTEREST, MID ATTORNEY'$ FEES. LICENSED CONTRACTORS DECLAPAnON: 1 hereby aHirm that I am licensed under provisions of Chapter' 9(commencing with Section 7000) of Division 3 of ihe Business and Protessions Coda, end my license is in full force and eMecL Lic. N . Class k Contractor's SignaWre: Oa�e: CONSTRUCTION LENDING AGENCV: ❑ I hereby aflirtn that there is a cons�ruc�ion lentling agency tor the peAormance ot Ihe work for which Ihis permit is issued. (Sec. 3097, Civil Cotle). Lentler'S Name: Lender's Aadress: Signawre: Date: OWNER-BUILDER DECL'ARATIONS: I hereby affirtn thai unde� penalry of pe�ury that I am E%EMPT FROM THE CONTRACTORS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a�permit tobonstmct, alter, improve, tlemolish, or repair any sWCNre, prior ro its issuance, also requires the applicant tor such pertnit to file a sgned statemeM thet �e or she Is licensetl pursoant to the pmvisions W the ConlreMors License Lew (Chapter 9(commencing with Sectlon 70DD) of D'rvision 3 ot Ihe Business and Professions Cotle) or Ihat he oi she is�ezempt therefrom and ihe besis for the alleged eaemption. Any violation of Section 7031.5 by any applicant for a permit sublects.theapplicant to a�civil penalry ot not more than five hundred tloliars ($500).): � 6�es owner ot the property, or my employees�`wit� waqes as iheir sole compensation, WILL DO THE WORK, and ihe stmcWre is not intentled or oHeretl for sale (Sec. 7044, Business and Protessions Code: The Coniractors License Law tloes not epply to an owner of propeny who builds or improvas ihereon, and who does such work himself or herself or Ihrough his o� her own employees, provided that such improvements are not intendetl or oHered tor sale. If, however, the Duilding or impmvemem is sold wit�in ona year oi completion, the owner-builtler will have the burden of proving that he or she ditl not build or improve for purpose ot sale.). ' ❑ I, es owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct iha project (Sec. 7044, Business and Professions Code: The contractors License Law does not appty to an owner of property who builds or Improves Ihereon, and who contrecis for such project with a comractor(s) license pursyafipto ihe Con(rectors License Laws.). � lam Business and Professions Cotle for �his reason: OWneFID 4eritied by dnvers license. p Ye OyYo Verification of Ownership Dy pype af daumem, i.e. - propeny taz bill or daetl�: DIVISION OF INDUSTRIAL SAFETY PERMI7 CER7IFICATION: ❑ I hereby cehity ihat no excavation five (5) or more feet in depih into which a person is required to descend, wiil be made in connec�ion with work euihonzed by ihis permii, and that no buiiding stmcture, scalloltling, talsework, or demolition or tlismaMling thereoY, wifl be mora ihan thlrty-six (36) feel hlgh. (Chap. 32, Gry 2, Art 2, Sec. 341, Title e, California Adminisire�ive Code). ❑ As owner-builder, I will not employ anyone to do work which would require e permit fmm the Division of Intlustnal Safery, as noted above, unleu such person has e pertnit to tlo such work irom the division. SignaWre: Date: Division of Industrial Satety Permit Number: CERTIFICATEQ C MPLIANCE AND A 0R7JR1C!� OF ENTRY: I certify under penalry of perjury �ha� I �ave read ihis application and state the� the informa�ion given is correct. I agr 4 to mpl h all stat aws end city orpinances relating to builtling construction, antl authonze representatives of the Ciry ot Cos�a Mesa to anter upon the above-descri r ope n ectiyai�p='s. I ag 6e notM1 csup�y or ellow o.ccupancy ot eny building authonzed by this permii until final inspection. \ l �� Signa�_re�� w �" Date � ' And/Or AUt�onzed Applicant cooe �, iNsrecnoNnve 1616 Fized System final Pire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Fina181ocWRetaining Wall 202 Fi�al Factory Fire Place 203 Final Sign 204 Final Demolition P�L COpE 1 INSPECTION TYPE � 206 Final Mec�anical 20B Final Plumbing 270 Pinal Electrical 2i2 Final Fire Prevention 220, Final Planninq Approval 222 Final Site 250 Final Building/Occupancy PA__E IMRIALS .X 6 3 il mo G•9•I�ro (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT �� 8�1`�� obnddress p,93�RELL�:STs•�•„ w., SuiteNo � ��g�- . Vicinily: � � - � � �.�' Parcel Nunmber: 42235226 . Appliwnt: FULTZ, ROBERT W Address: 930 DARRELL' ST ISSUED BY: COSTA MESA, CA' � J% � 2ip- —92627 �`'-� �-.:.;=�_,� ..� � � � � / �"�=. �.`� �. \-� ,� ��/ � \ <<� �,, ownec FULTZ; O ERT W� .� �� _ i �,�� r . � /�,, Address /930.DARRELL ST j �� `' ��i� \ \\ \ ��e�`c��a��---�_� /`�� f �� COSTA'MESA'CAi !G/-r"lrZip: 92627 "'��\�� ISSUE FEE Temp servic Res..a/c pai i Re`s (1-2 u i Res (3+uni Res �Service to,1000a Service over�1000a � Motors to �1 hp Z Motors to 10hp� Motors lo SOhp < Motors to 100h\ Motors over 100hp Communication drops� Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole 3UILDER Phc � Zip: � ^• Lice G` ' �, � �;'� o � •' �-c -n � a �ri �� SCOI L PERMIT FOR 4 LIGHT FIXTS. 50.00 so.00 $0.00 so.00 so.00 $4.40 $4.40 $4.40 $0.00 so.00 $0.00 0 4 4 4 0 0 0 0 2 v �'- r ,�� ,� U.J1tEEl111JMAtiYA�ll �7 Busway /100 N ,.up to'10 kva/kw ,.lup�fo 50 kva/kw .'up�to�100 kva/kw _``over-100 kva/kw age Equipment Wiring System / Ckt ',.wv��tJ�° � a -Misc: Co`nductoc,. -'N'b o 9 . � ° ° Ci�cus ( genb��ritle) „�� o�U a iCircus (mecti ride or ��a 0�� ChristmasTree,Stor °c on p� � o„o Fireworks�Stand,, ,,- �� .�_ � o� d�0 Other Electrical Fee' 4 p ..o � Uv ^i0 status: ISSUED Applied: 12/28/2005 Issued: 12/28/2005 . 'y'��i � i� � � �uantity' �,�f�' 1.� � �$0.00 0, 7�, � �`� $0.00 0��I�I� L--��I Iso.00 o� r $0.00 0 � � � ! so.00 o� t�_ =— � $0.00 0� 1 .�,;' � �`� 1 so.00 �oJ �`��'J �', 1 $0.00/j/�0 � �/ �,�� ' $0.00�� 0 �✓ �!�' l $�� $0.00�0� '�'$0.00 0 /^, " \�.��-.. -��`_"�/ ' � � 0� Inv_estigahonFee C�� 0 � PlarcCheck Feg�--'� � �0�� Reinspedion.Fee(`\ �� r, � llJ ��0 V� �� TOTAL CAL!CU ULA7ED FE 'J'� �00 u t� � �� % . � ^��J,--� � _ v�j.Y/'��,,.� � PER 3 �p1RES NO710E: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Calitornia regulations. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is sus{ tor 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 appl required inapeetlona and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expirat FOR INSPECTIONS CALL: (714) 7545626 ' eawaaa Iwuu7 related orabantloned codes, and all this permit. WORKERS' COMPENSATION DECLARAnON:� �'1 � I hereby aHirtn untler penelry of perjury one oi the following declaretions: . - - i ❑ I heve antl will mainlain a certificate of consent to selt-Insure for workers' compensation, es provitled tor by sect .;700 otihe Labor �otle, tor t�e pertormence of the work tor which this permit is issued. ---4:— ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the pedormance of the work for which Ihis permit is issued. My workars' compansation Insurance carrier and policy number are: Carrier: (rhls section permif is valued et one ar less.) Policy Number: �� I certify.t�ef iirthe partor ce of t�e work for w�ch�thlspe it is issued, I shall not employ eny person in any mannei so es to become subject to the workers' �ompensation laws of al mia, E�rae t i42ii pe b come subject to the workers' compansation provisions of Section 3700 of the Labor Code, I shall forthwith com�sep fons. - �� D � O �/- APP�iL c�,97�re: Date:��-.�.� Z WARNING FAILURE TO ECURE WORKERS' COMPEN CAVERAGE ISf�q WFUL ANp SHALL SUBIECT AN EM O�FA.TOCWMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDqED THOUSAND DOLLAFE ($100,000), IN ADDITION TO TME COST OF CpMPENSA'f�IXJ, DAMAGES AS PqpVIDED FOR IN SECTION 3]O60F THE LABOR CODE, IMEREST, ANO ATrORNEY'S FEES. LICENSED CONTRACTORS DECLARATIDN: ' I hereby attirm that I am licensetl under provisions ot Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business and Professions Code, and my license is in full force and eHecL Lia N Class N Comractor's SignaWre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirm ihat Ihere is a construG�ion tending agency for Ihe pertormance of tha work for whic� ihis permit is issued. (Sec. 3097, Civil Code). Lentler's Name: Lender's Adtlress: Signeture: Data: OWNER-BUILDER DECLARATIONS: I hereby aHirtn that under penalry ot perjury ihat I am EXEMPT FROM TME CONTRAC70RS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires a permit to construct alter, improve, demolish, or repair any stmcture, pnor to its issuance, also requires tha epplicant tor such permit to file a signetl stetement ihat he or she is licensed pursuant to ihe provisions ot the Contractors Licensa Law (Chapter 9(commencing with Section 7000) of Division 3 of t�e Business and Pmfessions Code) or that he or she is eaempt therefrom antl the basis br the elleqed exemption. Any violetion of Section 7031.5 by any epplicant for a permit s jectsdhe.epplicam m a civil penalry ot no� more ihan five hundred dollars ($500).): I�adowner of the property, or my employeas with wages as their sote compensation, W ILl DO THE WORK, and tha struciure is not imantletl or otSerad tor sale (Sec. 7044, 8usiness end Professions Code: The Contractors License Law tloes not apply lo an owner ot property who builtls or improves thereon, and who does such work himself or herself or ihrough his or her own employees, provided ihat such impmvemenis are not imended or ottered for sale. If, however, the building or impmvement is sold within one year of complation, thB owner-builder will have the burden of proving ihat he or she did not builtl or improve for purpose of sale.). � ❑ I, as owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business and Professions Code: �The co�t�eF4rs Licens�oes no� apply!`o an owner of pmpeny who builds or improves thereon, and who contracts tor such project with a contraqor(s) at Ownership by (type Business and Professions Code lor this reason: tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cenify that no excavation tive (5) or more feet in depih into w�ich a person is requiretl �o tlescend, will be made in connection with work euthonzetl by ihis permit, and ihat no builtling siructure, scaHolding, falsework, or demolition or dismantling iheraof, will be more than ihirty-si: (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Celifornia Atlministrative Gode). ❑ As ownerbuilder, I will not employ anyone to do work which would require a permit irom ihe Division of Industrial Safety, as notetl above, unless such person has e permit to do such work from ihe division. SignaNre: Date: Division of Intlustrial Satery Parmit Numbar: COOE�, INSPECTIONTYPE 161fi Fiaetl System Final Fire Prevention 126fi Pool Spa Final 200 Final Re-Root 201 Final BIocWRetaining Well 202 Final Factory Fire Place 203 Final Sign 204 Finel Demalition I�Aj� 'INTRIALS COOE� INSPECTIONTYPE - 206 � ' Final Mechanical 208 Final Plumbing 210 Final Elecincal ' 212 Final Fira Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy ��}.�1��1�IILIbY �-��L��T ER E oucH o�urnaiuc AOP. $WR.LINE ROl1GM HEPTING ANO �IR CON�I TEmaORaqv SERVICE.OR.GOLE_ UNOERGROUNO � POWER � ROUGH WIRING TRENCeES � FORMS 5 F�OOR SvSTEM BON� BEAM [j STEEL REIN SNE>TMING FRqME RNO FLRSHING LATNING — I_� ( PUSTER. 9ROWN COPT HE�TING. VENT., FEFRIG. �NO �.C., FINAL PLUMBING, FINRL �NO GAS TEST (� BUILOING, FINAI DATE SUBCONTRACTOR ICHa . . :`" ��'� �6�3� -. . . . � � � � �COSTA MESA BUILDING-SAFETY DEPARTMENT �� . �.. � � � 7]22µ� 3/20/78 � �1�0.50 TL , ' P.O: BOX 1200" COSTA MESA, CALIFORNIA 92626' ... ' . - , . . -., . . '.,i .-: . For A Gcant to Fill in Com letel !�P�CA7TON FOR STRUCTURAL PERMIT . PP P_ Y— Uselnk Only -� .RECEI D V DATERECE D EISSVED • .BUIIDING .(`. T (7Arre.i� .��' S'1•� � � � , � ADDHESS- � V ' /�/� /4 .�j�jPE T O . . . OWNER ' / � 1RY � I /�7 AJ • 'IE� I �AF.�" . A.P: NO/�J ��JO ?. ^L � .. ADDRESS . .7. ,•� Nriel S'T. '� .ADDRIESS�(/U, �CITV `'QS � . Ji�E�SA �. NO`�Y.�' THACT 8 � . 'LOT f � BLOGK" . . 'CONSiRUCT10N . , . - . , 'A A . -LENDER ' � ' ' � , . � • • . BRANCH ' � � . . . • ,. � - - - - - OWNER � . ADDRESS ^ �� ' - . ' E ARCHITECT'� ,� " � - } TEL.. „ � $. ' � OR ENGINEER ' � . . . . ' . .. . FIRE. . . ADDRESS� � .ZONE TVPE ROUP� � ' � APPROVED "' ' CONTRACTOR � BV DATE . ADDflESS - • , � ,1 , , � . � - � , TEL. ' ' ZONE NO.OF � USE OF NEW - � PLAN!i � BUIL�ING- CITV� . � : . - .•. NO. t' . rFi STATE � ' CITV � • : VAROS APPqOVED VARDS APPROVED LIC. NO. . '� UC. NO. �� MAIN BUILDING ACCESSOFV BUILDING ' �_ SRE � ' � � NO.OF BLDGS ' (FROM C/l ST . ' � � 0. ' OF LOT ' NOW ON LOT , M FT. ' Q . USE OF . . . /7 . . • ' � EXISTiNG BLDG. � � � ' ' .LU - FT . y - . � , . - Sepaia[e peimits.are requiied for , , , . i sioe- - �GFT. �. ' � �Fr. : ' � � � electric; plucnbing and heating work.`, , n � WREAR KD FT. �� ' FT. [r USE OF BUILDING AND WOfiK TO BE PEiiFORMED DISTANCE BET. ' � BEf. MAIN & - . � ' i i�JC G3vcl' ' MAIN BLOGS. ACCEa. BLOGS.- � ' .. . VAR.�y' ' R4TE ' . •i � lasOilr- ' ' . ... . . C.U.P.yp APPROVED a � . . . � � • . . . APPROVE - � �� ' a, . . . . ' . . - . . , . . W � - I��eraby ecknOwlatlpe�thet,l have reatl thidapplicetion antl rtete � . ,- . � � � n p� Mat �ffie above. informatlon �� eaireet �and epree to compiy wlth _ , W . d all lews requletinp Duildfng eonstru<tfon;"andJ shall not amploy . � � . . �z any perwn In vlolation of Me workman�s compenaaiion laws of m � ffie Staia,of Celifoinia., , _ � . m ' 3. � I hereby certlfy ihet I em proDerly Iicented aa a contractor unEar . SQ. FT. w • � the Ste[e of.California Busineu entl Profeulona Cotle, Divialon 3, THE AMOUNT SHOWN UNDER� VAIUATION IS FOR m � Chhptar 9, end that +ucA IiGenus are In full force and eHxt, or I' TNE PURP06E�OF ESTABLSHING A PERMR FEE ONLV: . � ' . am�exempt from Ms providons of the Stete of Cellfomfa�Buslneq - '� VALUATION . PERMIT�,FEE E . entl Profeaslona Cotle, Dlvlsion 3, Cheptar 9. ' _. . ` l� � �fl m � � ro SlpneTure�of � / j�/ ��l^ � µw �-�' P�N CHECK E ^� � ./'}/ t, O ' . Permittea ��c�� . .. , . � $ . I� ✓ ✓ ✓ TAX . E �.�� i u :AuthOfl2atlApant � � TOTAIPAID E .. .,� . ._ . . . . � . , OWNER �T'1St01 EStdt85 � DATE lt-18-56 � - . � JOBADDRESS 930 Darrell Street BUILDINGPERMITNO. 283� � GENERALCONTRACTOR $+�%.HllI]S3�S2T' VAWE �8�8�6.� LOT 9� BLOCK TRACT �873 Single �.CS. W�att gar � GROUP I&'J TVPE V ZONE R4 FIREDISTRICT 2863 � PERMITSISSUED INSPECTIONS �i � ' � SUBCONTRACTOR DATE I NUMBER Footing Trench Foundation Formsand Rough Framing �'-'=Plumbing,-Rough o� �1: Plumbing, Rough Com� Temporary Pole Wiring, Rough Heatina. Rouah Sewer, Hause . �-.( Sewer, St. Septic Tank or Cesspool Lathing, In �� Out Plastering Plumbing, Final, Fixtures Complel Plumbing, Fin.al GasTest Wiring,Final a Occupancy � FORM 210 3M 10-55 - /1 - u — _ s_/- . Costa Mesa Building Department �; APPLICATION FOR PEIiiVIIT � y • . P.O.Box3�� 286� BUiLDING ' ' '!� �� COSTA MESA, CALIFORNIA b FOIt OFFICE USE ONLY FOR APPLICANT TO FILL IN � � _ Receipt No. _ Permit No. ' ndaress � 3c� 71 /{ 2TL�,�.,1, s i". � � ��-�% Costa Mesa, California ?a Receive Date Rec'd. Date Issued Nearest ' ' ��/�� T �/U y� CrossSt.'��-�d.)T!/-� l�� • ��f Building � '. ` � 1 7� Address t � : Owner�(LIS �'jl.. C'� —�..5 - ' , Mail p T Costa 1Vlesa, California � , Address`IOZ.C(i �. (.f�cS � U�k'S y�.� Nearest E Tel. y., Cross St � � City � E� L� � 1 No.%1-I �["��-�� Zone No.of Type � Grou Architector Lic. .I Plans I l� Engineer No. Approve ' ' by Date Address � � CORRECTIONS ' � J, uuse��c� ��,.��. /' ContractorS� � No. Zv�Q � ' � i Address S/4�:ii� � � ' Legal Lot () � Z 173 � j� � DescripSion I No. 7 � I Block •I Tract .---_� (Attach Metesand Bounds) � � , � � No. of Bldga � Size of Lot �O K 1�� I Now on Lot � � _,...:A i' =�`3� 1 v ' � ' 45e of � I No.of I No.of ' '� �'jj�/�� -'. � . -- . -- ' A Existing Bidg. ---� F,amilles Rooms �Ff �„ ,..-� .. . ; � � Setback Line from 1 Rear Vard Z$"'f 1 L�,I�'�"'� '� Z Center of Street Ci Side Yard C V`�"'� � � � " --� ` - ' '�"'"' ' '"-' D DESCRIPTIONOFWORH Nr ,; o.'.��;-� ,�, r New I� I Alteretion I I Atldition I r, - r.,�� Repair I I Movin9 I I Demolish I . ��" �L ��r�CTn� ^.-^��`��- Building �1 No.of + ��vV •• � �� Size � � � 1� Rooms � Stories 1 Exterior Wall - I Roof 9'�o CIL APPROVALS Covering �'jL�GCA Coverin Build�nge�j N C� LG �A.1vj �1.��1,V�livy Foundation Location Inspector � Date Forms, Materials, W � � Under-Pinning �_ Frame: Fire Stops, 8racing, Bolts I hereby acknowledge that I have read this Application and state that the above is�correM and agree to comply Lath. Int. with all Clty Ordinances and State Laws regulating — building rnnstruCtion. __p�. Lath. Ext. Signatureof �i�l.(O�LB�( � Y� Permittee ✓/ �� Plaster, Int. Authorized Agt. � � Plaster, Ext Valuation Per� Fee $ � Z•� O Masonry Reinforced $ � �S / '00 TIoa�Check $ � �' � � eond Beam Cp -? Fee $ ✓�. db FINA� FORM 204 10�55 O. P. 9 S. YLUT YLAN Show locatlon and distancea from property Iine and between bulldinpa � , �' �s3� • ;.. • .-� _ - ' :_� �� :,,, ..i� : - ,, CQSTf-. _.'; ; ,�P:478-56�Oi,�',F<,Z` .xt::;r-:�3.D0 . . , . >,, - �• �,. a -. - �� . ,� ; -. , i , ., '. , . , i ._ . , . _ , .,..�.: ;_- . ,_'�� — . ,. 1`. :•.: " . _...,1;..>�,�,�1 '�,_. _._. ,, ,. i . ' _ -\ \, . - . , �- � � ,.�,:i I - 'i"ri '".� i :� - �� <.. . I � � ...� , _ :�i 1 � I :> 1 , ...., '�. . , , - ;;._ ._' • �"�„_ -, . 1 �.;�;. i _,. \ 1-.� i-.' _ �., _ _ , I, \ ,.i, v- � � .;. � ,. '- •' � • - � ---. . ., _ . , , �, � . � �, -- ., . , . ,j .. .,. . - -�� :_� ' � i . � . . t., \.. � � - - �C. ', . . .