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HomeMy WebLinkAbout254 SANTA ISABEL AVE - Building Permits CITY OF COSTA MESA , 4 BUILDING DIVISION Y •• (y,,,., ..�1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER � . PERMIT / .,. 1 / E05-00393 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaEa.u.s_ CAL PERMIT 77 FAIR DRIVE,E,COSTA MESA,CA 92626 LtuJob Address: 254 SANTA ISABEL AV Status: ISSUED Suite No Applied: 04/27/2005 • Vicinity: SIDE OF HOUSE Issued: 04/27/2005 Parcel Nunmber: 43933202 Applicant: MC CARTHY, ALAN ,rt 'v _ - ISSUED BY: Address: 3100 SUMATRA PL - - . .:. - Phone: 714-241-1946 , COSTA MESA • Zip 92626 . Owner: '. UBERT,.JANET K TR;% - - Address ' PO BOX 10064 - Phone: _ - COSTA MESA,'CA Zip: 92627-0012 Contractor: - ALAN J MC CARTHY ELECTRIC ' Address: 3100 SUMATRA PL _ ' Phone: 714-241-1946 ' - COSTA MESA ' 1 - : . - Zip: 92626 - • ^ License:461872 - " - - , SCOPE OF,PERMIT / - • . CHANGEOUT EXISTING:ELECTRICAL PANEL WITH NEW,100 AMP PANEL FEE SUMMARY • Quantity •_ Quantity • ISSUE FEE • $23.50 - Temp Dist System/Lighting - $0.00 0 777 'Temp service test ' $0.00 Busway/100 ft : $0.00 0 ` Res.a/c package $0.00 Standing Section . $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa. $0.00 0 up to 10 kva/kw $0.00 0. . . Lighting Fixts S0.00 0 • up to 50 kva/kw $0.00 .0 Recept Outlets $0.00 0 - up to 100 kva/kw $0.00 • 0 Switches ' , $0.00 0 • over 100 kva/kw $0.00- , 0 Non Res Appl • $0.00 -0 Low Voltage Equipment jj;,:--x $0.00 i 0 - - Res Appl - $0.00 . .0 Low Volt Wiring System/Ckt'^' - $0.00 0 Service to 200a .$30.50 1 Misc.`Conduit . • $0.00 " . 0 Service to 1000a • ,v - $0.00 �•''0 Misc.Conductor , -$0.00 Misc.Conductor y ,. -,- $0.00% '0 Service over 1000a $0.00 0 Circus(gen or ride)-' ' ' $0.00 0 Motors to 1hp ' $0.00 0 ' Circus(mechlide orlights) ' $0.00 0 • Motors to 10hp . $0.00 0 Christmas Tree Stand $0.00 "0 Motors to 50hp $0.00 0 ' ' Fireworks Stand . , '$0.00 '' 0 ' Motors to 100hp $0.00 .0 ' Other Electrical Fee . • $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 : 0 'Investigation Fee - "$0.00 Sub panel to 200a $0.00 0- '- - Plan Check Fee - $0.00 Pole Light Pkg $0.00 0 - , Reinspection Fee $0.00 Sign Circuits $0.00 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 fora.period of 180 days. ' INSPECTIONS: do order for the work'authorized.under this permit tobeconsidered 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 2446-46(6/00) DECLARATIONS 7 f`I WORKERS'COMPENSATION DECLARATION: • ' • I hereby affirm under penalty of perjury one of the following declarations: .• ' ' - ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) j;q-"_'I•yertify that in the perfo a of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the workers' ��..--'`'�cbbmpensation laws of Ca • 'a, d agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisi. _ -A� pplicant Signature: DC' i;D `�� -�5 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DO I ARE($100.000),IN ADDITION TO THE TMST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under rovisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business d Profen,•Ions Code,and my license is in full force and effect.Lic;M} Lfj-Yp( �2-- t Glass)} k. --k. ContrlactoesSg re: !'"a .. .�� - (Date_- t-t o S CONSTRUCTION LENDING AGENCY: ❑ I 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: Lender's 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 Code: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 file 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 penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,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 offered 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 property,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 property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivel's license. ❑Yes ❑No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify 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 demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,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 some 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 year a quantity of 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). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mese Fire Department by each business which at any one time has on hand a quantity of acutely 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 prepare an RMPP(Risk Management end Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety 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. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or 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 Safety Code Section 42303 been made? ❑Yes ❑No B (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: 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 state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspecti urposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signatu Le al Own Date ti! -OS And/OCA Ap tang..-ir fl Date"'^ pH 1 INSPECTION TYPE - D _ INTRUL$ 'CODED INSPECTION TYPE DAIS ' INITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical ' - 1266 Pool Spa Final 208 Final Plumbing• gal 200 Final Re-Roof 210 Final Electrical (V/X/,(YuKJ 201 Final Block/Retaining 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 Building/Occupancy • County of Orange •Building Department APPLICATION FOR Room 322 PERMIT PERMIT NO. !) e Court House Annex Santa Ana, California • Phone: KI 2-6211 [f /�JE — , 19 / I. OWNER'S NAME f hit P A L $ N PHONE: BE LI I I t /} MAILING ADDRESS a St 6.4 " tk. CITY ��' (Street or P. O. Box No.) NAME NAME (Architect or Engineer) (Contractor or Builder) ADDRESS ADDRESS CITY _ CITY State Lic. No. Phone State Lic. No. Phone 2. JOB LOCATION 1 £2 9 CvCt°' 11 14 4,4,. (crouse No.) (Name of Street) (Town or School District) 3. LEGAL DESCRIPTION: Lot 4 / Z Block Tract 3 0 O 4. Meets and Bounds Description — Use Reverse Side of This Form. 5. CORNER LOT ( ) INTERIOR LOT ( )0 THROUGH LOT ( ) SLOPE OF LOT THIS APPLICATION CANNOT BE PROCESSED UNLESS LEGAL DESCRIPTION IS ACCURATE AND COMPLETE. 6. PROPOSED WORK: New Building ( A.) New Structure ( ) Addition ( ) Repair ( ) Alterations ( ) Move ( _ ),y� Demolish��� �/ ( ) Conversion ( ) 7. PROPOSED USE:— P CA6Lo a�vtv�c7 �j 8. SIZE OF BUILDINGt),`Iy µA )r1.34AREA q(�tCi 1y,t3� SIZE OF LOT Lf N' X 1 3 7 AREA 9. CEILING HEIGHT TOTAL BUILDING HEIGHT / 2 it* t NO. OF STORIES / k LL 10. NO. LIVING UNITS / SIZE OF SMALLEST BEDROOM X I ( SIZE OF KITCHEN n {' 11. EXTERIOR WALL CONSTRUCTION: Brick ( ) Concrete Tile ( ) Monolithic Concrete ( ) Wood Frame ( %J Steel Frame ( ) Concrete Frame ( ) 12. WALL COVERING: Wood ( ) Metal ,( ) Stucco ( X) Other_[- s 13. FRONT YARD SETBACK FROM CENTERLINE OF STREET L �1 14. DISTANCE TO PROPERTY LINE: Side Yard S`i- Rear Yard 9. 0 15. SHOW ON PLOT PLAN EXISTING BUILDINGS NOW ON LOT, STATE USE OF EACH. 16. DISTANCE IN FEET FROM PROPOSED BUILDING TO NEAREST EXISTING BLDG.: 17. VALUATION OF PROPOSED WORK tta ling All Labor, Plumbin , Electrical Wiring, Heating, Fire Sprink- lers, Painting, Sewage Disposal $ (� 4 a D 67 �Q 0.--0 t,�+ 18. I HEREBY4C�EPTIFY THAT TO THE-BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN TI-IIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO. dt�yy ,�/ Plan Filed. • SIGNED: Tf 14 t ,� o� \ Owner or Authorized Agent Date / - - �1) BY FOR DEPARTMENTAL USE ONLY 19. GROUP / TYPE DISTRICT MAP C -�) 4' NO. -5 PERMIT FEE $ (e, tr'V RECEIPT NO. x -7, �t I X PAID TO /f DATE 7- ?-- CZ) CHECKING FEE $_ RECEIPT NO. , _ t !♦ TC . TI•FPSie l5r F COUNTY BUILD c PERMIT GRANTED Z� �q y�0 C. ft. DO,JOHUEtt IN ECTOR • PLANS CHECKED BY /� C� ��I `ss� - - - • APPROVED BY: HEALTH DEPT. STATE FIRE MARSHAL STATE DIV. OF HOUSING SM-I 2.49 11 3JECT PROPERTY INFORMATIO 1) Property: 254 SANTA ISABEL AV, COSTA MESA CA 92627-1562 C008 APN: 439-332-02 Use: MULTI FAMILY County: ORANGE, CA Tax Rate Area: 15026 Total Value: $113,613 Census: 631.02 Prop Tax: $1,336.80 Land Value: $81,885 Map Pg: 31-E1 Delinq Tax Yr: Impry Value: $31,728 New Pg: 889-C2 Exemptions: HOMEOWNER Assd Yr: 1997 Phone: % Improved: 27% Owner: UBERT JANET • Mail: 254 SANTA ISABEL AV; COSTA MESA CA 92627-1562 SALES INFORMATION IMPROVEMENTS LAST SALE PRIOR SALE Bldg/Liv Area: Transfer Date: 09/14/81 # Units: Sale Price/Type: # Bldgs: Document#: 1422901727 #Stories: Document Type: $/SF: 1st TD/Type: Yrblt/Eff: Finance: Total Rms: Junior TD's: Bedrms: Lender: Baths(F/H): Fireplace: Seller: Pool: Title Company: Bsmt Area: Transfer Info: Construct: SITE INFORMATION Flooring: Air Cond: Improve Type: Lot Size: Heat Type: Zoning: Lot Area: Quality: County Use: 2 Parking: Condition: Bldg Class: Park Spaces: Style: Flood Panel: 06059C-0047E Site Influence: Other Rooms: DEN;FAMILY ROOM;DINING ROOM;ENCLOSED PORCH;BONUS Phys Chars: Legal: L112 TR300/SELY 52 FT NWLY 125 FT SWLY 1 Comments: Copyright© 1996-97 Experian Page: 1 of 1 OWNER ZUPFER, OTTO J. DATE 1-12-60 JOB ADDRESS 252 Santa Isabel ;e. 1 ,DING PERMIT NO. 11237 GENERAL CONTRACTOR Armitage Bldrs. VALUE $ 660.00 AP.No.119-1110-19 LOT TRACT FIRE ZONE DESCRIPTION OF WORKDet. Gar. INSPECTIONS 1. — ' DATE I GROUP J TYPE V ZONE R-11 Underground Soil U.G. Water = SUBCONTRACTOR PERMITS ISSUED Underground Gas DATE NUMBER Overhead Water and Gas Rough Heating •tttcis ,-2, , - - . &- Sa ..9 Rough Plumbing 7 - c_. .. o,1\.. "/\liC< ad< /k% VV,..9�1 ,., Miscellaneous ti Prop. Swr.Pete- 114Con. St. Swr. d//S /GO S'-ptvwv )/Z4/L 0 19 OA Sprinkling System �/. Heating, xt ,\ c�'^'" y Plumbing Fixtures L �...,c (J„n�,,,i Final Gas Test / Nr Construction Pole / ii Underground Power /(� / // Rough Wiring 6� (7 V/id�ij Aa,L--XJiu.L/ A.6,i 3- 1-/On //f,t9 - Trenches Forms Steel(3 .p c- 2 —`6— (,.o Floor System Steel Reinforce Chimney Re-Rod Bond Beam _ Sheathing 13• I- 3 — 7 _ 6a Frame and Flashing }3 ./r7 3 — / 9- — Co Lathing, In r Out r �1 /_3� s-i n e— 7 r—CO ry Plaster, brown coat . r 2!Mt. 4.7- G — 6 v Plumbing Fixtures, Final Electric Fixtures, Final b2214:34/./5>6 Building, Final .G,(3 K L OCCUPANCY Form 2111-5M-11.59 S-B P - 11237 11237 FEE RECEIVED • COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 317 COSTA MESA. CALIFORNIA FINANCE EPT. SA FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOF COSTA MOR PERMIT E T� ><J CITY YtPE OR PR J BUILDING BUILDING ^ ADDRESS _4 -Y- - ✓`L COSTA MESA. CALIFORNIA FOR OFF/CE USE ONLY RECEIPT NO. PERMIT Ny OWNER n1,24. ,.:1.-1-*,4_/ I I N D' 5 MAIL /� RECEIVED BY CRTC RECEIVED DATE ISSUED ADDRESS /y-CL--.N�/ L.1- I i -/ �,)-e,0 TEL. BUILDING CITY NO. ADDRESS _ S nl_. I/- ' ARCHITECT LIC. COSTA MESA, CALIFORNIA OR ENGINEER NO. __ ADDRESS FIRE • (� FIRE TYPEpGROUP /r IT/,//ly// /� V LIC.SNTD. APPROVED JL' /BATE //� (� (,� CONTRAC •R _ `/ T -D ADDRESS vyRn .�� ZONING • LEGAL LOTA ," 1'G O Z/p1,�)E / NO.OF USE OF NEW DESCRIPTION I NOP" // y I BLOCK I TRACT '{ .� I PLANS I BUILDING 6iSIZ ^/���� p _ APPROVED I (/ A.P.NO. (,(,(/qi I / _/ �U9 BY �� /' I ( 1 -6 - SIZE E .Q/ S NO.OF BLOCS. / YARDS E ES OF LOT .tl"r'� 7 S NOW ON LOT REQUIRED ALLOWED USE OF Ste& / /�(CENTER LINE 8T.) 0 EXISTING BLDG. CQ C ✓ . FRONT t y FT. I. QJ� IN. SETBACK LINE FROM I ((/PPP CENTER OF STREET . REAR YARD R.SIDE FT. IN. • SIDE YARD (LEFT //y (RIGHT /J �4/ L.SIDE )'-t� ./SFT. j'/ �� lI, . �, DESCRIP N OF WORK REAR / FT. IN. NEW I ALTERATION I II ADDITION I REPAIR I II MOVING I II DEMOLISH I SIZENO.OF BUILDING / /� `( l ROOMS I STORIES I EXTERIOR WAfY� f- F. .„I ROOF /t _ COVERING COVERING V� ✓�' USE OF BUILDING AND WORK TO BE PERFORMED I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PLY WITH ALL C ORDINANCES AND STATE LAWS REGULATING COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CON RUC {ON. VALUATION SIGNATURE F i/ � _ - -t--� 0y')/ PERMIT FEE $ y/ PERMITTEE (� t_ -�1 C J / $ Af ({/ PLAN CHECK S AUTHORIZED AGE I�'f/Lt.1' (,[R----.`-✓ TOTAL FEE $ ---- if OWNER ZUPFER, OTTO J. DATE 1-12-60 JOB-ADDRESS 252 Banta Isabel 'e. 1 ,DING PERMIT NO. 11238 GENERAL CONTRACTOR Armitage Bldrs. VALUE $ 6,776.00 AP. No.119-140-19 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Res. att. to Ex. R INSPECTIONS �..154,,•,® DATE I GROUP I TYPE V ZONE R-ll Underground Soil,tt/5U.G. Water,IAbe n - PERMITS ISSUED Underground Gas /"'-� ''— SUBCONTRACTOR DATE NUMBER Overhead Water and Gas / Rough Heating Al fS a �O 7jc G-9 ( - ;; ,&c,-' /-2I-6 c ,g 3 S fl v r l Rough Plumbing /0 -5472, 67,4_,---(7-„ -rte i-a6-6c 51 3f'.,, 6t/''•� Miscellaneous .2%244.„,„,_,, o Q�� /2"--4 -(r`,4--c-,1.,,,-.7 u-7-Go z,? r7 Jib, 6DProp. Swr. Line Hous Con. Swr. // Y Sprinkling System Heating, Final kV- g 629 Plumbing Fixtures /I b✓ _i1_ P_LQ Final Gas Test , Air, 4✓ b-!_R F,d Construction Pole I Underground Power I/ / i Rough Wiring /A, ,63. E 3 -7-6d //iV4/(,. r Trenches / Forms °— Steel 0 . 771 2 — / 6— ,U - Floor System Steel Reinforce Chimney Re-Rod Bond Beam Sheathing /j. jO e— 3 — 2 (,,.QJ Frame and Flashing 0,22 o- _ 2 — /9— Lathing, In r/ Out fr /3, fl t-- 3 — / 5Z -- �A Plaster, brown coat 6.- v)7 ,-6.0Plumbing Fixtures, Final /4/1. - g-6', . _ Electric Fixtures, Final °din .� , /r.4o • Building, Final .,/}-4. ' , .l-,f-66- OCCUPANCY - Form 210-5M-11-59 S-B P 11238 1 ` 11238 111 F EC.;[i`IlLU COSTA MESA BUILDING-SAFETY DEPARTMENT Ot-* P.O.BOX 317 COSTA MESA. CALIFORNIA 3 FINANCE DEPT. i` FOR APPLICANT TO FILL IN COMPLETELY APPLuewtI&4c &A MaMIT TYPE OR PR! � �,�� BUILDING ADDRESS o-a C� 7 ' I ADDRESS COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY J.L. I RECEIPT NO. . I PERMIT NO. / OWNER .u. ..J-,-3 V MAIL RECEIVED BY DATE RECEIVED DATE ISSUED Sr ADDRESS .�/.C-1'VL-C j-r I-/.2- 4. 0I / /2-- GC TEL.CITY NO. BUILDING 0.2 5-...,.._ ,/ -y "'v ADDRESS ...c4,2.4... ARCHITECT LIC, COSTA MESA. CALIFORNIA OR ENGINEER NO. • r, FIRE • I GROUP ADDRESS ZONE TYPE /1 STATE APPROVED ,/ /��/ /a CONTRAOTO^, •1/(I ••,, -i`lLJ CIO.NO. : By ( TE V ADDRESS ' y aJ D /�CL�CJ C..�-dL.C,-t-� ZO TNG LEGAL LO f t"-; • ��-�Rf{/''O ZO� NO.OF USE OF NEW a J-r FP . DESCRIPTION I NO. / //a- ''I//BgqLOCK _ ITRADI Pr -<.. PL/ANS(..._.,0 By / A.P.NO. ✓, SIZE - /J I / - Jy'-(l �-J C APPROVED ( �V1/I' G1yw"� DA� t1.k.-% ) I OF LOT `J'e{ x i 3 -s- NOW ON LOTNO.OF B S. REQUIRED �/ 4 ALLOWED L/ (P� USE y�� • I �,. ' -� EXISTINGOF BLDG./21-477:71""`/�-" C - �i kit_ i 9 • IN. I SETBACK LINE TM (;/ /�a CENTER OF STREET J g��-tt�-- Yh- REAR YARD/0 i Me: R.SIDE FT. `-/��yry,�I�N. - ' SIDE YARD I LEFT / a 1/ I RIGHT 1. L.SIDE / .jj FT. 0/L. Lv,�'44-41N /' DESCR TION OF WORK I, J REAR 1�{/ FT. 'IQ IN. NEW I 1I ALTERATION I II ADDITION I LLL \\\ ' REPAIR I I MOVING II DEMOLISH ' BUILDING /I_/, X5/I! NO.OF- ROOMS 0 STORIES EXTERIOR W/A�4 /1Y+I ROOF Y ' COVERING COVERT ' USE OF BUILDING AND WORK TO BE PERFOR ED 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- _ PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH AL ITY ORDINANCES AND STATE LAWS REGULATING BUILDING C S UCTION. ,,pA�� VALUATION SIGNATUR OF , `r I PERMIT FEE $ `if PERMITTEE 'L•L �� $ 6, 77d X PLAN CHECK $ 91 - AUTHORIZED AGENT .-C-c-Pr �Cch^�--'-' TOTAL FEE S 7 i