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Home My WebLink About234 CECIL PL - Building Permits(714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job nddress: 234 CECIL PL Suite: Vicinity: Parcel Number: 42607319 Applicant: FAUBERT, BRAD Address: 8902 SAILPORT DR � HUNTINGTON BEACH, CA Owner: HOUGHTON, FREDERIC J TR Address 530 PIERPONT DR - � COSTA MESA, CA Contractor: STAR COURSE ROOFING CO. Address: 8902 SAILPORT DR Arch : Address: Zip: HUNTINGTON BEACH, CA Zip: 92646-2664 Phone: License: Zoning: Fhone: (800) 854-0011 Zip: 92646-2664 . Phane: Zip: 92626 Phone: �(800) 854-0071 � � License: - 532778 , ' ' SC TEAR OFF COMP. 1 LAYER 15 LB:FELT, REPLACE DRY Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspectiorr Total: Eng: Address:' Status: ISSUED Applied: OS/07/2001 Issued: OS/Ot/2001 ISSUED BY: Phone: License: AS�NEEDED�AND INSTALL 25 YEAR COMP.. FEE SUMMARY ; "-, $0.00 - "-�--=_-- - - __ - - _ - _ : /,-� �=' .Calc Valuation: $139.25 �- � --- -' - -- . % ° ' Claim Valuation: ." $0.68 � � $0.00 � - = ��,` -";!� � - $0.00 - . _ _ %i ' . $0.00 - �' �`� -`'' �,. , ' , �, � $739.93' � � �� i% , .- ,,t, ._ . . - , .'a-,is`' ;/ .. _ .��j` . x^ - . . . , . ,. '- .: i .. . � �� o // /� \ SETBACKS \\v`/ `i � �� ' �^. MAIN STRUCTURE Front 0-'0 l�\ Rea� _� '0- 0 �, " � '- ACCESSORY Front�, -0. 0��" /,' . Rear �,0- 0 . .. ;� � PARKING Existinq:��0� �� Required: �0 � ;� NOTES: �LANNING'& ZONING � ' ' �� "� - �.�� ,�r.� , � <�j /,) �'� /'� � , - �. �: -�/�i ,��.; ��i i' _ . .� ,_ �, _ �Left � '0=0 "-,�' Righf %� �0.�0.� ' � . � �. . ,� i . Left , 0- 0 7 �\ Righk ' 0- 0,� . �_ .. � - �-/� . �/ � /, . , Pr000sed:' �0 � �-:;i',�' ' . ._... ., , • , i,-.- ` -- � , _.,, �_ '' \ss,aoo.00 ss,aoo.00 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, 72-21-92) 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 requlred Inapections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 244&48 (8�W) WORKERS'COMPENSAnONDECLARATON: � I hereby aflirm unCer penalry of perjury one ot ihe fallowing declaratians: ❑ I have and will meintaln e cenificate ot consent to self-Insure for workers' compensetion, as provided tor by section 3700 of ihe Lebar Code, for Ihe parfarlflaoce of ihe work lor which lhis permil is issued. I have erW will maintain woMers' compensation insurance, as required by section 3700 of Iha Labor Cotle, for Ihe pertortnance of the work For which this pertnit is issued. My workers' compensat�q Insurance carrier and policy number are: _ 9 Cartier: ��i ii ( � �i✓�' `�) Policy tJumber � �% 'I � �e '�i — O I (This secHon need nat be completed i/ the permit is ve/uetl at one huntlred dallers ($100) or /ess.) ❑ I certify peAormence.ofihe work tor which thia pertnit is issued, I shell not employ eny person in any manner so as to become subject to ihe workers' co ' lew of CeWoi renUagre that If t(ultl become subject to ihe workere' compensati ' s of Section 3700 of ihe Lebor Code, I shall forthwith y with ihe prpylB'ions. (��^ /' C( IcantSignetur . De . ARNINp: F O ECU RK RS' COMPENSATION COVERAGE IS UNLAWFUL NND SHAL BIECT AN E VER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNpRED OOL RE , ADDITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPFO SECTION�OfiOFTHELABOqCODE,INTEREST,ANDATTORNEY'SFEES. LICENSED with Settlon 7000) of BftBCL Lic. q of the 8u ine�and Plpfassions Cotle, end my license is in full Class r� � .._._ T_ i .� o i ❑ I hereby aHirtn Ihat there is a conslruction lentling agency tor the pertormance of Iha work for w�ich Ihis permit is issued (Sec. 3097, Civil Cotle). Lendefs Neme: Lender's Adtlress: Signature: OWNER-BUILDER DECLARATIONS: Date: I hereby aXirm that under penalry af perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reasan (Sec. 7031.5, Business antl Prolessions Code: Any_ciry or counry which requires a permit to construct, alter, impmve, tlemolish, or reDair eny stmcture, pnor to its issuance, also requires ihe epplicaN for such pertnit to file e signetl,atetement Ihet he or she Is Ilcensetl pursuant to the pravisions o1 the Cantrectors LJcense Lew (Chapter 9(cammencing with Sectian 7000) ot Divislon 3 of Ihe Busines4 �end Profe3sions ;Code) or that �e ar she is exempt therefrom end Iha besis for the ellegetl exemption. Any violation of Section 7031.5 by any applicent ior e permit subjects the"epplicanf;t�e c11� p� elry ot not more than five hundretl tlollers ($500).): ❑ I, as owner of t�e'propairy,;or my employees with wages es Ihelr sole compensatlon, WILL DO THE WORK, antl ihe simcNre is not intendetl or otteretl for sele (Sac. 7044, Business end Professioris�Code: The Contractors License Law does not apply to en owner of property who builds or improves thereon, and who does such work himself or herself or through,his or her own employees, provided ihat such improvements ere not Intendetl or ottered for sale. N, however, ihe building or improvement is sold within one year of completioq the owner-builder will hava the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe project (Sec. 7044, Business and Professions Cotle: The conirecmrs License Lew does not epply to an owner oi property who bullds or Improves thereon, and who contracis tor such project with e contracbr(s) license pursuant to the Conirectors License Laws.). ❑ I em exempt under sec. Business antl Protessions Cotle for ihis reason: Signature: Date: Owner ID venFietl 6y tlriver's licensa. ❑ Ves ❑ No Drivers License No. Verification of Ownership Cy (type ot tlocument, i.e. - properry tax bill or deed): Expire5: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereDy certify ihat no excavetion tive (5) or more feet in dapth inta which a parson is required to tlescend, will be made in connection with work authorized by this permit and ihet no building structure, scaflolding, talsework, or tlemolition or dismantling thereoi, will be more Ihan ihirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title B, Cellfomla Atlminl5ireilv8 CoOe). ❑ As owner-builder, I will not employ anyone to do work which would require e permit irom Ihe DiNsion ot Industnal Satery, as noted above, unless such person has e pertnit to do such work irom the division. Signature: Date: Division of Industriel Satety Permit Number: CERTIFICATE OF COMPLIANCE AND AlITHO OF ENTRY: I cenity under penalty ot perjury that I have read ihis epplication and state that the information qiven is correct. I egree to comply with all st s end city ordin nces ralating lo building constmction, end euthorize representatives ot Ihe City of Coste Mese to entar upon the ebove-tlescribed property for' ecfon�es. I agr ol to occupy or ellow occupancy of eny building authorized by this permit umil final inspection. COOE 1. INSPEC110NTYiE 1616 Fixed System Final Fire Prevention 1266 200 201 202 Pool Spa Final Fin01 RB-Root Final Block/Rataining Wall Final Factory Fire Place 203 Finel Sign 204 Final Damolition OATE UffII19LS v � � f�QQf,a INSPELTONTYiE �/1Yi/ �� v_�liull�vaa] 206 Final Mechanical 208 Final Plumbing 210 Final Elecinwl 212 Final Fire Prevention 220 Final Planning Approval 222 Final Si�e 250 Final Building/Occupancy �-. ADV��ant to fl11 in all spaces within heavy boraer Iines ana sign a11 apP�opNate tleclarations. Y OF COSTA MESA - PERMIT�NO. - - I �RAC .N .. LOT NO. � LDG. NO. - � � - - � - - - . _ �.9Q7 7/09/B2 ,_ 29.37 _ Tl� TRUCTION PERMIT ,Q — 5�% %D • ' IV "� � �' , . - , , • � . . Prolect Addrets � . �. - : � i � . . �I G�G I L TVPE OF CONSTRUCTION �p : , , . � • . Owner � �, . �- Phone - �NEW° '❑ ADD - ❑ ALTERATION Yi _ ' � . �- - . � � � ,Addres _ L�. O REPAIR ❑CONVERSION ❑DEMOLISH � � ' , ArchlEng. . . �..- _ ' . License No. , � �� OTHER • - _ , � REGULATIONS - � , . DESCRIPTION �F WORK � �� y+ � � A'P' � � � ' - ZONING ' ; Address - - �_ •. r .. � . . . . __ _ ' -CAntfector -. _Phone ^� IU. . ' .,."' ' 'ZONE --"'PLNG.REF.'�: . - . `S .+ �.v � OP ' TYPE OF P.ERMIT -" ' ---' - -' - a� BPI�i��ING `. ,� �-1 �`` : �,- �. •�SETBAC T. O V LIN � Addre55 - • � ' . � �� ❑ GRADING ❑ FOUNDATION + ❑•STfiVCTURAL � - -•SID yqqD -- � ��- - - - - � ._, . � LICENSED CONTRACTO �ECLAR ION ''' ' ' LE ❑ TENANT'p E ECTRICAL.OP.LUMB G.❑MECHANIC . 51DE Y �I hlreDy affl�m th:.t 1 am licens¢tl untle� provisions ot Charter 9(com- �I ,� 0��(� LG�� '� =b:v[ �� RIGHT � � � manCing wlth 5¢CtiOn .]000). o( • OlviSiOn 3. Ot _[he Bu5inG55 dntl - 0'OTHE� Roteisionz Cotle, antl my Iicense is In full torte antl eHetl. �• t � REAR VA0.D (TO P/L) ' ' �' ' "- �c� . PROJECT DESCRIPTIOM - ' - Litens�e fClast ' " �' ' ' Cicense N ' . ' ' • ' ' '- '- � ' - - '; PKGt SPACE'REQ' ' ' ' ' - P 0��. -. ' -' - DataJ 9- �"` Signature � 54: FT. •- ' •' ,^ ' WORKERS',COMPENSATION OE ARATION • OCCVPANCV_CONSTRUCTION TYPE .STREET WIDTH" PARK'FEE 5 - ' I hereby� aHirm tbat I have a certificate of consent to self-insure or a .VALUATION ��%�d •�C 20NE '' ZONINGAPPROVED�BV - DAT � '�azti(Iw[e of Workers' Compensation, Insurance, or a tertltieC copy � - _ _ - . - - _ _ _ _ '�' "�"' ;;,?`yaof (Sectlon 3800, Lab. C.). GRADING,CU. YDS. ACRES ' SVECIAL CONDITIONS' ' ' �`"�Y No.- . . . ComPanY . . - _ _ - _ _ " '" _ " '" " _ _ �]`Certltietl copy is hereby furnlshetl. � REMARKS: ' � �CortltieC copy is filed with th¢ City Builtling Divlsion � � - ' ' " - - ' - " , . _ . . . . _.. -.� .� „1. � . � • . � � EXEMPTION FROM�WORKERS'�COMPENSATION�DECLARATION • ' (This s¢ctiOn nlGtl not bG COmpl¢t¢tl if the pe�mit I5 10� one huntlr¢fl - � � _ 1, :„i'. � �,i - '(5100 or'leu). ' " '"'_ _ " "_' _ " _ "_ _' _ _ ' ' ' � ' ' _ _ _ _ - " _ I Cert�fy thdt In the pe�fo�mance ot the wo�k for whith thi5 p¢rmil IS l . , Issuetl7 I shal4not emptoyany person'in any manr�er so az to become PLUMBING -�- - • � -PLAN CHECK - ' - -- ELECTRICAL ' - - - -- PL•AN�CHECK -- - - SUGjet-t�t0q�❑ �e� W�o,.�.,ka��5' Compensat' s of Cali o� la. ' ' ' Date _L=../��Si9�ature � ' ' BATHTU85 "'" - SHOWERS ^" " - }-- - - --- - � � - - NOTICE: If aftar making this tle raUon, you shoultl become subjact TOILETS , ��„i� .. URINALS-•- -� - �- �-- --- GENERATOR --01 KW=1-30'KW' - - �- - to the Workers' Compensation pr isions of the Labor Cotle,-you must - TRANSFORMER � „y p, �,� (orthwith camply with such provislon5 or this pertAit 5hall ba tleematl LAVATORIES DOUBLE lAVS -}- -- ---:qppLIANCE- 10-SO�KW-_50+ KN%' - - ievoketl. � 1 ^ ^ ' - ' ''� : CONSTNVCTION LENDINGAGENCV '" ' ' ' - KIT:SINKS �- � ��DISNWASHERS-�-•-;- -----.,MOTORS -� � 0-1HP=1-lO�HP'•�•��-- � � �-��- � �.I� �i�r .!� (ormancedof�hthworkfror�which�thisctlonlentlin9a9encyfortheperv SERVICESINKS..�•�•��,,SUN1P5•--� --- --�-j---- .. jf�N0.50LAR�_-' 30-SOHP_SO.+.,HP _ _ g „ permiYis issuetl (Sectlon�3097 - � Lend r�'rName� � ' FLOOR SINKS'- - ' ' FLOOR-DRAINS� ^ -�� -- - �FI%TURES -- - OUTLETS - SWITCHES-�- - - - �i ' • ' " . i '.'�"' �% � '+' ` --- 'ORINK(fVGFOVNYAINS � --�---- - ---^ -GASTUBESIGNS---- �end¢Ys`Atltlress-'�� T - - ---- - - - OWNER-BUILDER DECLARATION-'�D'-_..Z L -- . -;' 1-�T ' Y - -5-- • - - -POLELIGHTS - -- � - � �� I.nereby aHirm lbai„I amexempf.fromthe�CONractor's License I.aw tor ��NTERCEPTORS '( v' 'CL'ARIFIERS"' �-^ - - �- tHe-following•reasob.(Sectlon.J031?5•BuS�ness.antl..Ro(es3loni°Cotle: SVJIMMING POdlt�O P�TRAP - - � Any city or counry which reQuires a permi[ to wnstruct, altoq _-- -- - . '� �' '-' - "-- POLES � ' 'METERED 'SVB' '--'- ---- '— Improva, tlemolish or.repair any structure,.prior to its.issuan<e; also re+. yyqTER SERV ICEi-1 �" ALTERATION� - --- - -- PANELS �^ MAIN-- -5U8 - � qWr¢s [hC ap.litan[ 10� such perTit [o tile a signetl statament lhat he � � � is_Ilcensetl pursuan[ to the provisions.of [he.Contra<torY Llcenzo.Law GAS'SERVICE' -OVTLETS - 'i -'- � SERVICE ---- --- - ----AMP �� - Sf M1apter 9(COmmencing with $ectlon J000) ot Division 3 Of th¢ � ess antl Professions Cotle) or that he iaexempt therefrom antl.the. yyqTER HEATERS �- 9TU OVTGUT -- � � - --- - - .; for the dlleg¢tl exemption. Any violatlon of SettiOn 7033.5 by � �` �� - �-� - applifant,for a permit subjects the appliwnLto_a civll ponal[ �SEWER�CONNECTIONS ---� - - - - - - � .l ot nOl mOrE ihan five huntlretl tlollars (E500). Y �� ` - -'" �� - - - ' � I, as owner �of �the� property,-or-my employees with�wages a5 their SOI:AR TANK - ^- � COLLECTORS- - - �•- - -- --- - - --- -_... _ .,„.. . s012 Compensa[ion, will tlo Ihe work, antl the St�uctu�e Is not intentletl � or offeretl'tor sale.'(Settion 7044, Businessantl'Profe551on5�Cotle: Tne - SOCAR"PIPING SYS.' - ' ' " -' '- }-- � -�ISSVE FEE --� --- - - -- -- - - - - - � Contraclor'S LiC¢ns¢ law tloes not apply to an Owner ot a property � who bui105 or improves thereon;'antl'who tloez such work blmseH'or ' ISSVE'FEE - �- ' - - � - - '�'- " - � - - ��/�P�LICATION APPROVED BV. pATE throu9h hls own em0loyeez, provitl¢tl Ihat such improvemenls a�e not intentletl'or'ofleretl'for sale'If, nowever, the buitaing or ImprovemanY' ' MECHANICAL PLAN CHECK � ' �� ' -`� - '" -' - is soltl within one year of completion, lhe owner wi11 nave tha burtlen . SUMMARYOF FEES, - . ' af proving he-tlle not' bulltl-or imProve for the'purpose of sale)- - - - - - - -- 'BUILOING - -� / ' � '_ _- : '�..�C:�' !. HEATING SVSTEM 0-300,000 BTU � ❑ I,_as .owner of the. property, am exUusively. coMracting with , qND DVCTING- � I PERMIT � E��' ',JZ Q�7'� �,� SMIP� � . E; �'s� � licensed contractors to construc[ the project (Section 7044, Business 100,000•+ BTV � ;pLAN CHECK E� PERMIS. •. � antl_Pro/esslons Cotle:.TM1e ContracroCs.License LawGoes�notappiyto ._ ISSUANCE..S" �� an owner oi property wM10 builtls or ImOroves thereon, antl who con- -REFRIGERATION 0-100,000 BTU .PLUfNBING E � lracts_ from .suc� projects�with a_tontractor(s), IiceSneQ pursuant lo _ SVSTEM. . .. _ .. �GRApIfJG' E" ' • ihe Contractor's License Law). �'300,000 + BTU � r•� ' �;� _ ,-'PLAN CNECK S - - "'} ❑� I am exampLuntler5ection - - - B. & P. C. �or this - -- - - � --�� •- • - - - 1EL"ECTRICAC S' ' - �, �� • E ' ' 1 ti � BOILERS BTV � � MICROFILM :§ - reason - -- - - � �PLAN�CHECK ��E �v.�� SVSTEINREPAIR,ALTERATION � 9'3; I Date Own¢r �TOTAL FEE S I her¢by CGrlify lhat I have reatl [hi5 aOP��ion antl state that [he abOve EXHAUST SVSTEM MUCTIPLE ' "' �MECHANICAL E - -- _ . Information is carrect. 1 a ree to com I w�th all �cit y ' LE55 AD- 9 P Y y-and counl .. - PLAN CHECK -S - -� VANCE PC E'_ ' ortlinance5 antl Slale laws rela0n9 to mnStruC[ion, antl he�e�y aulho�ix¢ , `, ' ,_. representa ves-of�thi5-city�to-enfer upon the-above mentionetl � � - - - . � . � � • oroperty in ectlon urposes. y � � '� p y �/ SlgndWre ° Date-�-5--�� ---' " ' ' � ^ FINALFEE E�-L�_L Driver5' CI nie or 55 � � � - - - �SSUE FEE . . ' _,. ' . . . . . , . _ CMF 0865-46 Wnite-Builtling; Canary-Applicant; Pink-Accounting; Goltlenrotl-Assessor . �U _ � -- - - - _ - , . �fJ CONSTRUCTION AND PLANNING � POOL & SPA' \ � - '.. _ APPROVALS Permit# � � Date ., Inspector �qppROVALS � � � Permit# � Date ` inspecto�, ,� � 1. Temporary Electrical Service or Pole , 43. Pool & Equipment' L'ocation � -� �- � ' -- . .Soil .ipe;Un rgrn, . � • 44. Steel Reinforcement " " � � "- ' - 3. -Electrical Conduit Utility: Undrgrn.. •_ �_ . . 45. Forms ,- � - - - - _ 4.__Electrical Conduit-Undrgm . �- _. - . • . �_. 46. Electrical�Bonding . - ` � - � - � . tee , ein orce' "' _ , - � _ 7_� 47. Rough Plumbiri & Pressure Test� " � - - - -� - ,. .6._ Electrical UF.ER Gm ,._ _ - � 48. APPROVALTO COVER-GUNITE' - � -L " .'Z._ .Footings y,,.. ' - ' .7-/y_,8A 49. Electrical Conduit-Undr rn " � ' � - 8.=- Foundation --- - _- -- _ .6 " 50. Gas Pipe, ��Undr in, Test � ' � ' -_9.•� Water,pipe=Undrgm _ _ � - 51. Backwash Lines P-Tra � 0� �ndr rn � - - � � •- --- � • - � - � .. _ ._ _ 10. . Structural Floor�System- 52. ��APPROVALTO DECK � � .._�. ._ .-" - -- � .. _ .�� . :, �, • • ! 11.- Property Sewer Line.&,.House.Connection � �_.:�. _ , � --- �- " . . - '�' 53. Backwash'& Rece tor-Final . � - � : ' ' � '' ' � � " , " . - �� . 1�2. Street Sewer Connection . ' �- �-- ' _ - - - - - - 54�. Heater & VenbFinal, ' � � � 13. .Rough Plumbing. _ _ ' � "� � �� 14. Rough ElectricConduit '� - - "" -- �56. Electrical=Final' ' �' � � � ' � - ' 15. Rough Electric-Wiring '� -� ' �' ' 57. Solar System-Final � - � - � 16: Rough �Heating & Air Coriditioning - -:- " � - encing & Access Approval . �. 17: Oucts in Structure� - -- -- - - - ' � . APPROVED_FOR PLASTERING ' 18. Ducts, Ventilating� � � - - - � � - . � - - - � . • � _ • . _ _ 19. Gas Pipe-Rough�&Test � ' - � �' - -- - - - 60• POOUSPA SYSTEMS FINqL � - � � � � 20: Roof'Framin9� ' - - ' - - - - � - � . ' • . . . 21. Roof Sheathin � - - � : " . � � - - ' � � 22; -Frame and Flashin - � - ' NOTES:' _ � Qa _ ' 23. Insulation � � - - - - - - - - --- .�e�acQ - i � 24. Lathing-& Siding - - � - - . _ - . -. .. _ �• ' • - ' - ' 25:-� Drywall�Nailing ---� -- � - ' 26. Plaster8rown Coat • � - � - � - - - _/ �_ � � � ' d 27. - Electrical-Power-Meter-Final -- � � � �- -- � - - � -- �- �- ' • � ' ' 28. � Final �Electric � � ---. . - . . . _ s - . . _ - . - - ' . ' ' . � ' 29. FinallHeating & Air Conditioning � - - -- - - -- � - � - - - ' � ' � � 30: Final Gas Pipe-Test � - - - -- - `- , -- ' � -- -- - �- ' ' �� ' 31. -Final Plumbing - �- - - - - - - - -, -- • .. . , . . �32. Water Service-Final � - - - - - - ->-� � - - • - - - � ' � . . � � . . 33.' 'Gas Service-Final - - - --- - - - � ' � . 34. Solar pomesficFinal " "� ' ' ' �� 35: landsca e S rinklin S stem� � } � ' - ' ' ' � � � � � 36. Sountl Attenuation • � ' � � � ' ' 37. Handicap Regulations � ' - - - � � ' ' ' ' ' � - 38. FINqLSTRUCTURE&BUILDWG ' ' 7-/S-$� ` 39. Special Requirements Completed � � 40. Electric Release to Edison ' - � '� 41. Gas Release to Southem Califomia Gas Co. � • � 42. CER7IFICATE OF OCCUPANCY . - - �'No� Date _ . . . � �.3'�8�i COSTA MESA BUILDING-SAFETY DEPARTMENT p, O. BOX 917 COBTA MEBA. CALIFORNIA For Applican+ fo Fill In Complefely TYPE OR PRINT BUILDING ADDRESS � COSTA MESA. CALIFORNIA 0 TE�. TEL. NO. OF � 88TBAGK LINe FHOM �Jl BUILDINGa/O'X7O / ROOMfi SIZE 7 EXTERIOR H7A�1.� I ROOF COVERING .J COVERiI USE OF BWLDING ANp'WORK Tp BE F�E RECEiVEp �` - � �I�AVCE DEPT. � � CITY OF COSTA MESA v APPLICATION FOR PERMIT � ' BUILDING For Offiee Use Only RECEIPT NO. I %E�2M11 yp� 3 %�� HEC81V BY I UATF RiCE�VED.� OATE ��`/� f� Il "� C�C �'d eui�omc ADDRESS COSTA MESA. CALIFORNIA , � ZONE TnYPE Y� GROUR� � � APPROVED �TM 7 /i/ � i � NO. OF ` U3E OP NEW PLANB 1/ BLIILDING L86AL A�PPROVED I . /1 `'� .r� �_Y �� 0 V OL ;�� L; .- L I HEREBY ACKNOWLHDOB THAT 1 MAV6 pEAD TNIB APPLIGTION TN8 AMOUM BXOWN UNOER VALl1Ai�ON IB FOR TNE ANO HTATG TMAT TX6 A90VE 18 LORIiECi ANO AGRBE TO COM- pUpP08! OP eeTABL16HING A PEFMIT FEE ONLY. PLY WITH ALL CITY OIiDINANC68 9TATE LAWB REGULATINO BUIlDINO CONBTRUGTION. VALUATION •I SIGNATURE OF �� y� _PERMIT FEE $ LJ�-� PERMI7TE �J{ �7� $I'T � � PLAN CHECK $ �•]�' AUTHORIZRD AGENT 70TAL FE MR. E.B. GENERAL DATE OCCUPANCY Form 210—SM-11-59 S-B P ZONE SUBCONTRACTOR VALUE 2-i5-6i / 13786