HomeMy WebLinkAbout696 DARRELL ST - Building PermitsApplicant.lo till in all sDaces exceot thaze wilhin heavy Dortler Ilnez.ana sign all apv�opriate Geclarations.
CI7y oF COSrA M(E_SAl1 ONSTRUCTION PERMIT
Proi�,�Address - "'�1��40 YiA6�+4�'E�L ' Q '
"•AP��licant'sMailingAddress �D� p05�—� O �N/� IZ��z
Owner'sName 'JA+hFS I,t)."'� SEND Phone��7%��ffny
Address ��� OR�'TO ANIQ C�iA �JLS'UL'=
Arch/Eng. � License No. �
Address
Contractor's Nam Phone
Addres5 (m�'�'���
Ciry License Na t � �
LICENSED CONTRACTOR DECLARATION i '
I hereby affirm [hat 1 am licensetl untler provisians o( Charter 9(commencing _
with section 7000) of Division 3 of the Business antl Professions Cotle, antl
my license is in (ull force antl etfect. . � ' _
License Class LicenSe�No.
Date Si9nature �'
�
WORKERS' COMPENSATION DECLARATION /
'•ereby atfirm that I have a certificate of consent to selt-Insure or�a certiticate '
Workers' Compensation Insu�ance, o� a certitietl copy thereot (Section
.00. �ati. C.) .� ' {
Policy No. Company
8 Certifietl copy is hereby fumishetl. r' �
Certifietl copy is filetl with the tity Builtling Division. ,t _
Date Applicant +� �
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION � �
(Thissection neetl mt be mmpletetl if ihe permit is for one huntlretl ($100) or
less).
I[ertify Ihat in the performance Of the work for which tM1is permk is issuetl, I
shall mt employ any person in any manner so as to become subject�to [he
Workers' Compensatlon Laws ot California.
Date Si9nature
NOTICE: If, afle� making this tletlaration,-you Shoultl bewme SubjeCt to the
Workers' Compensation provisions of the Labor Cotle, you must for[hwith
rompty with such provisions o� this permit sM1all be tleemetl �evoketl.
CONST0.UCTION LENDING AGENCV
1 M1e�eCy affirm that there is a const�uction lentling agency Po� the pe�fo�mance
of the work for which this permit is issuetl (Section 309] Civ. C.)
Lentler's Name
Lentler's Atltlress '
OWNER BUILDEN C�EGLAHATION
I hereby atfirm that,l am exempi from the Contracior's License Law for Ihe
followin9 reason (Section 7031.5 Business antl Professional Cotle: Any city or
county which �equites a'pe�mit to construct, alte�, impwve, tlemolish or �epai�
any SVucture, prior to it5 issuance, also requires the applicant for SucM1 permit
to file a Signetl statement that he/she is licPnsetl pu/suant to [he ptovisionz of
tne ConVactor's License.Law.(Chapter 9(wmmencing wlth.5ection 7000) of
'�ivision 3 of the Business antl Profe55ion5 Cotle) or that he/she is exempt
^refrom antl tM1e basis for the alleqetl exemption. Any violation of $ectlon
3L5 by any ap0�icant fo� a pe�mit subject5 the applicant to a civil
�dlty of not more Ihan five huntlretl tlollars ($500).
I, as owner of the property ot my employees witn wages as their sole
compensation, will ao the work, antl the structure is not intentletl or ofteretl
for sale (Section �044, Business antl Professional Cotle: The Contractor's
license Law tloes not 5pp1y to an owner of a property who builtls or imoroves
thereon, antl who tloes sucn work himself/herself or throu9h his o� her own
employees, provitletl that such impravements are not intentletl or offeretl fo�
sale. If, howeveq the builtling ov improvement iz soltl within one yea� ot com-
pletion, [M1e owner will M1ave the burtl¢n of proving he/she tlitl not builtl or im-
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively cont�acting with IicenSetl con-
trattors t6 cons[ruct [he O�oject (Section ]044, Business antl Professions Cotle:
The Conlractor'S Litense Law tloes no[ apply to an owner of property who
builtls or improves tM1ereon, antl who contracts Por.such projects witM1 a con-
tractor(57 license purouant [o the ConVactor'S Lioense Law). I'am.aware that
proof'o( [hei� Wo�ker's Compenzation insu ance shaultl be providetl ta me.
❑ I am exempt untler Section ZaLL� B. & P. C. for tnis reason�
oate [� /_�J'?n
1 h¢reby certify tha�
iniormation is correc
anC state laws relatii
�sentative5 of. Ihis ci
inspection purp
5ignature
' Drivers' License
CMF OB65-46, rev. ]0/84
. owner Ly�,.(�k
have rea�is application
aqree to comoH with all t
to enter
i3 31 �S � ��vv�e,.�`�`tv� �'�rrL.-F�1 � ' _ ... __.
TYPE OFCONSTRUCTION �NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH- ❑ OTHER
, DESCRIPTION OF WORK/USE OF BLDG. �
i.
TVPEOF.'PERMIT ❑GRADING � FOUNDATION STRUCTVRAL .
❑ TENANT ❑ ELECTRICAL: O PLUMBING ❑ MECHANICAI
❑ OTHER
PRQIECT DESCRIPTION 5[�. FT. � OCCUPANCY �
.CONSTRUCTION TVPE ' �J N � VALUATION $ • I���
.'ZONE � GRADINGCU.VDS. ACRES
:��� ' �Ll.�i`
'� � r
� Bar Sink � �
Backflow Preventer
: Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
� Drinking Fountains
Floor Sinks
Gas Service
Interceptors .
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspec[ion Fea
dBING
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar. Piping
Solar Tank
Swimming Pool w/Spa
Urinai •
Outlets Water Closet
� - Water Heater
' ' ' Water Service
� Auto-Wash
Laundry Trays
$15
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑ a i oo,000 sru O i oo;000 sr
Reinspection Fee � $15
White - Builtling; Canary - Applicanh Pink - Acmunting; Goltl¢nrotl - Assesso�
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System .
❑0-100,OOOBTU ❑700,000
System Repair/Alteration
Fire Dampers
Registers -
Issue Fee
FEES
$ 3
FE
$ 3
A.P. # , - i
S Main Buildi
E
T Fronf
B Rear
.A
C Right
K Left
S
Ping. Ref. # �
Planning Notes:
3218 I/j,4/80
i %� Z .�-- S Zone
��J�..L
' Accessory Building: �
M ��
� �
Automatic Washer
Construction Pole Sub.
Coaking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outlets '
Swi[ch¢5 � �
Garbage D.isposal .
Generator.00�5 KW C
Fee
ELECTRICAC -
Transformer ❑ 15-50 KW
,� 50+KW
Meter ❑up to 100 amps
Meter ❑oJer100amps .
Sub Panel
� MotorsDO-1HP�1%-8
InaSolar �9-75 HP �76-15+
Microwave �
Pole Light
' Ran9e ,
58.25 TL
FEES
Standing Sections
5 KW Trosh Compacmr '
$15 Issue Fee ' $
DEVELOPMENT SERVICES REQUIREMENT�S I _`��p
Zoning Approved By Date D'0
Building Approved By � Date � �
BUIL�ING PERMIT $
PLAN CHECK $,
PLUMBING $
PLAN CHECK - 25% $
ELECTFICAL ' $
PLAN CHECK 50% $
MECHANICAL $.
PLAN CHECK Z5%' $
OF PEES
�— . SMIP
— PERMIT
ISSUANCE
ENERGV P.C.
GRADING
MICROFILM
— TOTALPEE.
$ ��
Z
O
N
I
N
G
R
E
Q
M
T
S
� CONSTRUCTION AND PLANNING . . . � POOL & SPA � •
' ti Date Inspector ' .� Date Inspector
,APPROVALS Permit.# ' APPROVALS Permit# � .
�7i iTemporary Electrical'Service or Pole � 52. Pool & Equipment Location �\
�2. Soil Pipe-Undrgrnd'. � • 53. Steel Reiriforcement
3. Elecvical Conduit Utility-Undrgrnd. . 54. Forms _.� •
4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding '
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test
6. ElectricalUFERGrnd. , '� 57. APPROVALTOCOVER-GUNITE �
7. Footings ' r� -c� � _ 58. Electrical Conduit-Undrgmd.±�
8. Foundation�� � � 59. Gas Pipe, � Undrgrnd., Test �'
�'
9. Water Pipe-Undr�grnd. � -- � 60. Backwash Lines, P=Trap, O Undrgmd.
10. Structural Floor System 61. APPROVAL TO DECK
11. 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 �. I
16. 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 �
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' � �
,� i
20. Rough Factory Fireplace ' APPROVALS Permit #�
21. Ducts, in Structure 70. Underground Hydro .
22. Ducts, Ventilating 71. Produci Piping O Gas ❑ Oil �;
�23. Gas Pipe-Rough & Tesi � � 72. Underground Flush ,
24. Roof Framing � 73. Undergrnd. Storage Tank � Gas ❑ 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. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing , HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final ' ' 80. FOOD CERTIFICATE ISSUED - . .�
33. Final Electric . Notes: O ��2UV � N, C'
34. Final Heating & Air Conditioning ^ -
T o 5' �✓
35. Final Gas Pipe-Test � . �
36. Hood or Canopy ,
37. Final�Factory Fireplace - , e �4 �� • .
38. Final Plumbing . . 3J'� gg `�
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 � � •
i47. FINAL STRUCTURE & BUILDING � a� �
'.48' Special Requirements Completed �
49. Electric Release to Edison _ � � �.
50. Gas Release to Southern California Gas Co ;
51. CERTIFICATE OF OCCUPANCY • �
. �.
No. Date � '�„
OWNER �;�.1__;�j T_Ir. .'_ i;::"� i� �_ :'[_ DATE �_?1'�7
JOB ADDRESS ��?�_-=+21'-?'61�.--=-..". _ BUILDING PERMIT NO. 1^2'�'
GENERAL CONTRACTOR '(i�:^.': .� �-'7�'n'-. VALUE $ 1CO'7�C'O __ _ ___
. .-. _ , ---- `
,n N„ ,. ._.- _: " I.oT TRACT FIRE ZOVE DESCRIPTIOA* OF WORK '�et. �_��.
owNEx c�z-n Tr�c
JOB ADDRESS
GENERAL CONTRACTOR !?1
AP No. _lj-(�l2-�.tn LOT
INSPECTIONS
Soil
Gas , �. .. , __. , .- ,
coat
OCCUPANCY
'fiFM H116 . 5M �
G' �`� i� C�Cr/�< <-17 �1' DATE 6-21-62
�• BUILDING PERMIT NO.
;. ?alliet VALUE $ 20�2�.00
TRACT FIRE ZONE DESCRIPTION OF WORK -'�
Signature DATE GROUP 7 TYPE ZONE
n � '/.
� ��� ` SUBCONTRACTOR PEFtMI'
�' �'. =" r' DATE
i / :. I. , . l�—
,7.
Applicant to fill in all ipatts except t�ose wit�in �eavy OorOer lines an0 si9n all aDGropriate tleclaralians.
CITY OF COSTRI M�SA �O STRUCTION PERMIT PERMIT N0. 7RACT N �} OT NO. UNIT NU.
7roje Address y4 �9� �A3�^-E � �- � 3 � �5 iYv�Q.w (Y� \d
A/itanYsMailingAddress �U� �0;�—\G A(�� �Z-S� TYPEOFCONSTRUCTION NEW 'ADD A�TERATION REPAIR
JQ�KFS �.T tiSEN✓ � CONVERSION ❑ DEMOLISH ❑ OTHER qp # �
Owner's Name Phone%��-%7K—ffn DESCRIPTION OF WORK/USE OF BLDG.
Address
�.0 ( 02'j U f%�JA �./Q 9L�0 Z� S Main Buildi
ArchlEng. License No. TYPE OF PERMIT GRADING FauNDqTIaN STRUCTURAI T Froni
Addreii ❑ OTHERT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL A Reaf
Contractor's Nam Phone C Right
PROJECTDESCRIPTION $Q.FT. � OCCUPANCV � K
Address (mailing)
CONSTRUCTIONTVPE �L� VALUATIONS ��� g Left
City LiC¢nSe No. .-ZONE GRA�ING CU. VDS. ACRES p�ng. Ref. $
LICENSED CONTRACTOR OEC�AqATION
I nereby al/irm Chat I am licensetl untler orovisions o1 Charter 9(Commencing Remarks: �� ,}� � � �[Z,J � Planning Notes:
wilh settion ]004) of Division 3 of [he Busine55 antl Professions CoOe, antl
my Ilcense is in tull torce antl eifect.
�.ICElISC CId55 License No. .
Date Signahre
W00.KER5' COMPENSATION DECLARATION '
:'�a".$'�ereby affirm tnat I have a certificate o( consent to Self-insure or a certitiGdte
Workers' ComPensation Insurance, or a certifietl copy thereof (Sectlon
..'80Q �ab. C.) - �
Policy No. Company
8 Certifietl copy is �eteby (urnish¢0. ,
Certifietl copy iz filetl wit� the city BuilCing Division.
Date Applicant
EXEMPTION FqOM WORKERS' COMPENSATION DECIARATION
(Thissection nee0 �a� be compietetl il Ihe parmit is for one �uneretl �E100) or
less).
I certify that in the pertormance ot the work tpr which thiz oerm�t is izsuetl, 1
shall no[ emo�oy any person in any manner so as to become subject to the
Worker5' Comper�sation Laws of Califotnia. - � �
Date Signa[ure
NOTICE: If, afteY making this tleclaration, You shoultl become 5u0jett to tne
Workers' ComOensation provisions of the Labor Cotle, you mu5t fOrthwith
comply wi[h TU�h O�ovisions o� thi5 pe�mlt shall b¢ tlGem¢tl �evoketl.
CONSTRUCTION LENDING AGENCV
I herety affirm ldat th¢re is a mnstruclion lentling ag¢ncy io� the per}Ormance
of the work for which this permit is i55uetl (Section 309] Civ. CJ
Lender's Name
LenCer•s Atltlress
OWNER BUILDER DECLAf2ATION
I hereby at(irm that I am exempt irom the CONractor's License 12w for the
following rea5on (Sectfon ]031.5 Business antl Profeszionat Cotle: AnY citY or
county which requircs a permit to constru[t, alter, improve, tleTolisb o� repal�
any itructure, pYio� to it5 i55uance, also �equire5 the applicant (Or suc� Oe�mi[
to lile a signetl Statement that he/she is litPnsetl pursuant to �h¢ O�ovisions of
�he ConVactor's License Law (Chapter 9(commencing with 5ection 7000) of
'ivision 3 of tde Business antl Professionz Coae) or tha[ he/she is exempt
erefrom antl the basis for the alleged exemptlon. Any violation of $ection
J31.5 by any applicant (or a permit SUDjectS Ihe applicant to a civil
�alty of not mwe than five huntlrea tlollars ($500).
I, as owne� o( th¢ Oroperty o� my employee5 with wage5 a5 tnei� sole
compensation, w�ll tlo the work, antl tne structure is not intentlea or otferetl
for sale (Sectio�� 7044, Busine55 antl Pro(essional Cotle: Th¢ Conbaclor's
License Law tloes not apply [o an own¢r of a pro0erty who builtls or imprOvlS
thereon, antl who tloes wch work himself/herself or tnrough nls or �er own
¢TOIOy¢25, p(Ovid¢tl thdt SUCh ITO�Ov¢T¢OIS dI¢ f10t ini2ptl8tl O! O(t¢Ietl f0!
sale. 1t, howeveq lhe buildi�9 or imprOvement i5 sot6 wifhin One Yea� of wm-
pletion, [he owner wi11 have the burtlen Of proving he/s�e tlitl not Duiltl or iT-
prove forthe purPose of sale).
❑ I, as Owner of �he O�operty, am exclusively contractinq with Iicense0 Com
[ractorsto tonsVuct the project ($ection 7044, Businesz an0 Grofessions Cotle:
The COMractor'S Licenze Law tloes not apPly to an owner oi property who
builtls or improves thereon, antl who contracts for zuch proiects with a con-
tractor(s) license pursuant to the ConVactor•s Lirense l.dw). I am aware that
pr0of of thei� Worker's Compensation insu ance shoultl be provitletl lo me.
� I am exemOt Jntler Section � � B. & P. C. fo� this reason
Oate �_
I hereby ce
information
antl state la
sentatives c
in5pection p
Signature
Drivers' LiG
= 6A65.GF r
— Owner
I have rea is application antl siate [I
I a9ree to comply with all tlty antl wun
to bwltlmg conSttUctmn, antl hereby au
� to enter upon tne above-mentXSnBtl
Sinic
Preventer
Irrigation
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavatories
'—Trap
RoOf Ora�ns
Reinspection Fce $15
Boiler
Duct-UnderGround
Duct - SVuctural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact Blt. ICBO #
Heating Sysrem & Ducting
❑ 0.100,000 BTU O 100,000 BT
Reinspection Fee � 575
Showers
Servire Sink
Sewer Cap
Sewer Connection
Solar Colleclors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Hearer
Water Service
A�to-Wash
Laundry Trays
Isue Fee
HooC or Typel ❑
Canopy Type I1 ❑
Retrigeration System
❑0�100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
3 3
ES
$ 3
i
Auromatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec�
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generator L�0-5 KW �
_.:I, , .i..
'1-.- i— 2jr I zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
5-15 KW
Meter Uup ro 100 amps
Merer ❑over100amps
Sub Panel
Motors �0-1 HP �1 %- 8
Inc. Solar 09-15 HP 016-15+
Microwave
Pole Light
Range
Sign
Standing Sections
Trash Compacmr
FEES
Z
O
N
I
N
G
R
E
Q
M
T
�
� Reinspection Fee �$15 � � Issue Fee I $ 3 1
DEVELOPMENT SERVICES REQUIREMENTS: l (�
ZoningAppraved8y � Date I�1�"�
8uilding Approved By Date
Application luued By Dat � � 8
SUMMARV OF FEES
BUILDINGPERMIT $ � SMIP $ D�
PLAN CHECK 5 227 �ERMIT
PLUMBING S �SSUANCE $
PLAN CHECK 25% 5 ENERGV P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $ �
MECHANICAL S TOTALFEE $ �Q"'
PLAN CHECK Z5� $
OWNER CAL-D INC. CG��y�j�E �Jp+,/tJ�L��� DATE 6-21-E2
JOB ADDRESS '�;, " ^^� � �+ � BUILDING PERMIT NO. 17270
GENERAL CONTRACTOR �Gelnn K. Salliet VALUE $ 1600.00
AP No.115-612-L{S LOT TRACT FIRE ZONE D�SCRIPTION OF WORK Det.Crpt.
INSPECTIONS Signature DATE GROUP J TYPE V ZONE R-Z
Snil PERMITS ISSUE7'
G� SUBCONTRACTOR DATE NUMB�
coat
1
r~' ' ��Z;o
��'
COSTA MESA $UILDING•SAFETY DEPARTMENT
P. O, BOX 917 COBTA MB6A. CALIFORNIA
Fo� Applieanf fo Fill In Complefely
� TyPE•OR PRINT
BUILDING i�
A�DRE68
COSTA MESA. CALIFORNIA
OWNER /�
AODRE55 � I � � .�
TEL.
��n �0.<9�.s e3
........�..� tY. . .(6 � ..�. / A i. _ _
FE/E REC�i�IEl�
�,�/ JU1V 131962
�b FINANCE DEPT.
CITY OF COSTA NESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
FECE�PT NO. /Pqp�T�00.
I
Eq BY I DATE REJCEIVEO /f��ATE 19SUED
O ���J��.l.+l W"�'�
G � % � s�.�knn.e Q��.
ADDRESS O .(, � O�- ZONING `Q�
ZONE .�{ NO. OF � I USE OF NEW
cirv oTPLANS �L�aWLDING
STATE TEL. 4
LIC. NO. �� / N0. 1�� Q pEBCRIPTION ( �
SIZE (` ! I � no. oF B�ce. c /q�
OF LOi V NOW ON LOT p, p, NO. U— V
U6E OF YARDS EVES
EXISTING BLDG. APPROVE� ALLOWE�
64TBACK LINE FROM �J (CENT¢R LINC BTJ /!
CEHlew oP BTR[ET II REAR YARD FRONT FT. UN.
� �
SIDE YARD I LEF7 I RIGHT R. SIDE ���T. �IN.
DESCRIPTION OF WORK L. SIDE FT. �IN.
NEW I IIA4TERAiIONI IIADOITION I REAR � FT. dIN.
REPAIR I IIMOVING I IIDEMOLISH I BYPROVED %/� �� DATE lD. �
�i(/
BUILDING � I NO. OF ' �y��
SIZE � �� ROOMS STORIES I
EXTERIOR WAL ROOF
GOVERING COVERING - �1 � .
USE OF BUILDING AND ORK TO BE PERFORME� `S. �y �
1
:l
1 HEREBY ACKNOWLEDGe THAT 1 HAVE REAO THIB APPLIGTION THH AMOUNT 6HOWN UNDER VALUATION 16 FOp THE
ANp BTAT6 THAT TME A9aVe I8 CORAECT AND qGREE TO COM-
PURPO6E OF E9TABLIBHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCE6 AND BTATE LAW9 PPaULATiNG
9u1LDlNo coNBTRU N. // �J VALUATION G �
' �� � //� ]� PERMIT FEE $ I
91GNATURE OF
PERMITfE X �� / /� / � n
$ / C `/ � PLAN CHECK $ � �
AUTHORIZED AGENT '71 5� 0
TOTAI. FEE 4
V VV 1V GS4
JOB ADDRESS
GENERAL CONTRACTOR
AP No. 115�12– i LOT
INSPECTIONS
�
C
�
DATE 6-21-62
�• - BUILDING PERMIT NO.
K. Balliet VALUE $ 20�2g0,00
TRACT FIRE ZONE DESCRIPTION OF WORK �
_ Signature DATE GROUP j TYPE V ZONE
PERMI'
— � � , � „ SUi3CONTRACTOR —t
{I'
D
!� .
��` � �� �zss
�.
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C06TA MEBA. CALIPORHIA
For Applicant fo Fill In Complefely
COSTA MESA CALIFORNIA
ADDRE55 U / C
c�n
8TA7E / Ji TEL'. �
LIC. NO. V NO.
SIZE p C � u l�i.-A i .I No. OP
BETeACK LINB FNOM � (� �
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SIDE YARD I �EFT �`� I RIGNi �
DESCRIPTION OF WORK
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FINANCE DEPT.
CITY Of COSiA h1ESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
PECEIPT NO, �P�RM,�T�
�/ d
��Y � �ATE RECEIVED I PATE 188
COSTA MESA, CALIFORNIA
ZON ` '� /� NO. OF
V I rurae
�eae� �_
(( . ICBNiER
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C
DATE �/�� �
ING.
E OF-NEW
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EXTERIOR WALL ROOF
COVERING COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
��'xa� �' �
u � +e+++- �
1 HEPEBY ACKNOWL600E THAT 1 HAVE RHAO THI9 APPLIWTION � TXE AMOUNT BXOWN UNOER VALUATIDN 16 POR TX¢
ANp BTpT¢ THAT TXE A/OVE 19 CORPECT AND AGPEB TO CON- pU1�O6E OF EeTABL�BH�NG A PERMIT PEE ONLY.
PLY WITM ALL CIiY RDINANCE9 ANO 9TRE LAWe R86UUTING
6uILo1No CONeTRU oN. VALUATION ��
61GNATURE OF o PERMIT FEE $ �C ��
PERMITTE $�/,, � p O / pLAN CHECK $ � 3 ��
AUTHORIZED AGENT � p
TOTAL FEE y