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Home My WebLink About383 ROCHESTER ST - Building Permits,1 AOP�icant to /i11 in all soaces excev< <�ese within heavr �ortler Iines ana sign all appropriate aeclarations. CITYOF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT N0. LOT NO. UNIT NO. Projet�f�r¢*s ��.3 ��Cf�E,CT�, C%. ApFiicant's Mailing Address Z�� • �i�� l'i% T Owner's nlame ��'-K wFl f iEN��l� Phon ��4 � Address 3S3 �C�i�si� Sr Arch/Eng. Licenu No. � Address � ConVactor's NamP �� E�-{'�i� Phone S� Addresslmailing122Q� p.�wC1• .��C/�1�SI- .S191I�Ji0/QN/� City License No. 33 D'TD Q27�s IICENSED CONTRACTOR �ECIARATION 1 hereby atfirm tM1at I am licensetl untler provi5ion5 of Charte� 9(commencing with section ]000) of Division 3 of the Business antl Professlons Cotle, antl my license is in fup force antl eHect �.325� 9 LiC¢f15¢ CIa55 � Li<2 NO. Date �'rg' 7 5'9 [ WORKERS'COMPENSATION DECLARATION 1e�eby affirm inat 1 M1ave a certifiGat¢ of mn5¢nt [0 5¢ILInSure or d certifitdt¢ Workers' Compensation Insurance, or a certifietl coOY lnereof (Section Ia800� Lab. ) y".�—./2 �-0, � �1 O �K PolicyNo. �'2�i�42'�1n'Eompany �'r"� I � Certifietl copy is hereby fumishetl. Certitietl copy is filetl with lhe Ci[y Bui in ' ision , Date Q'/-P'g7 APPlicant I EXEMPTION FROM WORKERS' COMPENSATION DECLARATION � �(This section neetl not be completeE if the permit is tor one huntlreA ($100) or less). I<ertity that in the performance of the work (or wnich this permR is issuetl, I shall nol employ any pe�son in any mdnner So a5 lo b¢Come SubjeCf to (h¢ Workers' Compensation Laws ot Califomia. � Date $i9nature NOTICE: 1(, atter making this tleclaration, you snoultl Decome subject to tna Work¢rz' Compensation provisions of the Labor Cotle, you must torthwi[h com0ly wi[h such provision5 or this permit shall be tleemetl revokea. CONSTRUCTION LENDING AGENCV I nereby affirm that there is a construction lentling agency for the performance ot Ihe work for which [his permit is iszuetl (Section 309] Civ. CJ LknOer's Name Lentler's Atltlress OWNER BUILDER OECIARATION I hereby at(irm that I am exempt from the ConVactor's License Law for t�e following reason (Section ]031.5 Business antl Profess{onal Cotle: Any city or county wbicb requires a permit ro cons[ruct, alter, Improv¢, tlemolish or r¢pair any 5[�ucture, prior to ils is5uance, also �equireSlhe applicant for Suth permit to file a 5i9ne0 statement [ha[ he/she i5 lirensetl pu�suant to the provisions ot the Contractor's License Law (Chapter 9(commencin9 with Section ]000) ot `�vlsion 3 ot the Bu5ine55 antl Protessions Cotle) or [hat he/she is exempt :�eM1om antl the basis for Ne alleqetl exempliOn. Any violation of Section :31.5 by any applicant fOr a pe�mit Subjects tlte aOPli<ant to a civil �enalty of not more than tive huntlretl tlollars (g500). I, as owne� of the Prope�ty or my employees with waqes as their sOle compensalion, will tlo the work, antl the st�uctur¢ i5 not intentletl or ofteretl for sale (Section 7044, Business and Professionai Cotle: The 'Contractor's License Law tices no[ apply t0 an owner o( a proper[y wM10 builtls or Improve5 thereon, antl who tloes SucM1 wOrk himselt/hersElf ot [hrough hls o� he� own ¢mployees, provitletl LM1at such imProvemen[s are no[ intentlatl or offer¢tl for sdl¢. Ii, howevet, the builtlin9 0� improvement is Soltl within on¢ y¢ar ot com- pletioq Ne owner will nave the burtlen ot proving he/sne Eitl not builtl or im- �rove for the purpose of zale). 1, a5 owner of the Oroperty, am exclusively contracting with lic2nsetl con- tractors t0 mnstruct t�e project (Sec[ion 7044, BuSin¢ss antl Protessions Cotle: The Coniractor's License Law doe5 mt appry to an own¢r ot property who builds or improves lnereon, antl who conVactz for such projects wltn a can- tracior(s1 ucense pursuant to the Contractor's License Law). I am aware that prooi of their Wotker'S CompBnsatlon insu�ance shoultl be provitletl to me. ❑' I am exempt untlet $eclion B. & P. C. for Ihis reason Date Owne� I hereby certi(y that I have reatl this application antl ztate that the above information is mrrect I ag�ee to comply with all City dntl county OrtlinanCes antl state laws relating t builtlin9 construction, ana hereby author'ze repre- sen[alives of thi5 e� up n the above-mentionetl Pr er for insPectlon Purp e ' Siqnature � � oaia Orivers' LicenSe or SS � E 9- b' I _ TYPE OFCONSTRUCTION NEW %�DD ALTERATION REPAIR ❑ CONVERSIpN ❑ DEMOLISH ❑ OTHER q p# DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT �ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Reaf ❑ OTHER A PROJECT DESCRIPTION $p. FT. OCCUPANCV C Right K CONSTRUCTION TVPE VALUATION 5 g �eft ZONE ORADINGCU.YDS. ACRES ping.Ref.# Remarki: TwIQ�Af / n��w) �/�(IAM� �liCn?Y7//'M/ PlanningNotes: Bar Sink Backflow Prevenrer ' Backflow Irrigation . Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Dreins Floor Sinks Gas Service Outlets Kitchen Sink Lavatories � P—Trap . Roof Orains Reinspectian Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. BIL ICBO # Heating System & Ducting ❑ a i oo,oao eru O i ao.000 ar Reinspec[ion Fee � $15 OB65-46, rev. 10/84 White - Builtling; Ganary - Appllcant; Pink - Accounting; Goltlenrotl - Assessor Showers Service Sink Sewer Connection $012! COIICC[O!5 Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auro-Wesh laue Fea Hood or Typel ❑ Canopy Type I I ❑ Refrigeration Sys[em ❑aiao,000eTu ❑ioo,000 System Repair/Alteration Fire Dampers Registers � Issua Fee FEES $ 3 $ 3 Aummatic Washer Construction Pole Su Cooking Unit Dishwasher Dryers ❑Gas ❑Eb Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Dispoul Generator 00.5 KW �/J� O�ILHi�../ �L'f.� ?�. Zone Accessory Building: Z O N I N G R Parking Req./Provided E � M T S ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter up to 100 amps Meter ❑over 100 amps Sub Panel Motors �67 HP �7'r4-8 Inc.Solar �9-15 HP �1G75+ Microwave Pole Light Range I � Standing SectiOns 5 KW I I Trash Compacmr I Reinspection Fee I$15 I I Issue Fee DEVELOPMENTSEHVICESRE�UIREMENTS: 2oninB APProved By Building Approved 6y FEES $ 3 SUMMARV OF FEES . BUILDING PERMIT $ SMIP 3 PLAN CHECK $ PERMIT ' PLUMBING $ ISSUANCE $ PI.AN CHECK 25% S ENERGY P.C. $ ELECTFiICAL 5 � GRADING $ PLAN CHECK 50% S 2•'S� " , MICROFILM S MECHANICAL 5 TOTALFEE S iO• y� PLAN CHECK 25% $ CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 7. Temporery Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-UndFgmd. 55. Electrical Bonding 5. Steel Reinforcemen[ �� 56. Rough Plumbing & Pressure Tett 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings � 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trep, O Undrgrnd. 10. Structural Floor System . 61. APPROVAL TO DECK 71. 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 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 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. DuCts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush ' 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑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 _ J L 80. FOOD CERTIFICATE ISSUED _ 33. Final Electric _ � 7 � Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test ' 36. Hood or Canopy � 37. Final Factory Fireplace 38. Final Plumbing � 39. Water Service-Final " � � . 40. Gas Service-Final � 41. Solar pomestic-Final � 42. Backflow Preventer ' 43. Backflow Irrigation ' 44. L.andscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations � 47. FINALSTRUCTURE&BUILDING - ' 48. Special Requirements Completed � . 49. Electric Release to Edison � !". 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY . � No. Date ' i ` .� - .. , - � , CITV OF COSTA MESA �7 CONSTRUCTION PERf��IT Projett Addresr �83 .CQCeU- i E� C% Appl+:��'sMailingAddress Z�b �• �1��f{T j'T Owner's Name 1�1k'_I� ��{ f T�hi�'7a L� Phon�� Address �g� �C�'%�si� sT- Arch/Eng. Licenu No. � Address Contractor's Name ��fi ��- E�c-c�i� Phon �S� Address (mailing) �Q� s/�J �jC�% S1 • �A/1�ii7 AN/�Q City License Na. 33 � TO �%27�5 LICENSED CONTRACTOR DECLARATION I bereby a�ti�m tba[ I am litensetl untler provi5ion5 ot Cnarter 9(commentlng with section ]000) oi Division 3 ot the Business antl Prote55ions Cotle, antl my license is in tw� rorce ana errect. �3ZS � y License Class � Licer�5e No. Oate �'��' S9 f � WORKERS' COMPENSATION DECLARATION ' i nereby aftirm tnat I have a certificate ot conzent to sel/-insure or a certiticate Wo�kers' sCompensa[ion InsuranpGe, or a certifietl coOnY the�eot (SectiOn POI�YNo.WLZ��OZ�OJO/EomP�Y� �.IVc„�a 1 IM�.'t�.Il �Certifietl mpy is hereby furnisnatl. Certifietl wpy is �iletl with [he city 6ui m9 ision Date �'��'d'7 Applicant� EXEMPTION FROM WORKERS' COMPENSATION OECLARAiION (Thissec[ion ne¢tl not be wmplete0 it the permit is for one hunaretl (§300) or less). I certify thal in tne performance of the work for which this perm�t is issuea, 1 shall not employ any person in any manne� so as [o become SUDject to the Workers' Compensa[ion Laws o( Califomia. Date Signature NOTICE: If, after making this tleUaration, you shoultl become subject to the Workers' Compensalion provisions o� the Labor Cotle, you mast forthwith comply witM1 such provisionz or Nis Oermit shall De tleeme❑ revoketl. CONSTRUCTION LENDING AGENCV 1 M1ereGy affirm [ha[ there is a conSVuction lentling agen[y for ttle performance of Ibe work fo� which tbis permi[ is issuetl (Seclion 309] Civ. CJ Lentler's Name Lentler's Atltlress OWNER BUIL�EN C�ECLARATION I hereby affirm that I am exempt fwm the ConVacto�'s Liceree Law for the following reason (Section ]031.5 Business antl Protessional Cotle: Any city or counly whicM1 requires a permit to construct, alter, imOrove, tlemolish or repair any struchre, prior to its issuance, also requires tne applicant for such permit l0 fil¢ d signetl s�atemen� ihat M1e/she i5 IiC¢nsetl pu�5ud�t t0 thC p�Ovi5ion5 ot tM1e Contractor's License La'uu (Cnap[er 9(commencin9 wiN Section 7000) of Division 3 of tbe Business antl Profeszions Code) o� Ihat he/zhe is exemOt �efrom antl the basis for the allegetl exemption. Hny viola[ion of Section 1.5 by any applican[ tor a pe�mit subjec[5 [he applican[ to a tivil .alty ot not more than five huntl�e0 tlollars (5500). U I, as owner of the property or my employees witn wages as iM1eir sole compen5ation, will tlo tM1e work, antl [he structure is no[ intentletl or offeretl (or sale (Section J044, Business antl Proiessional Cotle: The Contractor's LicenSe law tl0¢s n0[ aOpty [o an owner of a property wbo builtlt or imp�ov¢5 � thereon, antl who Ooes wth work M1imself/herself or through ni5 or her own emD�oyees, provitle� that sucb improvements are not intentletl o/ oHereO for sal0. It, bowever, the builtlin9 0� improvement is sold wilhin one year of com- pleti0n, Ne owne� will have the burtlen O( proving he/she tlitl no[ builtl or im- proveforthe purpose oisale). ❑ 1, as owner ot the property, am exclusivery contracting with licensetl con- tractors to construct the project (Sectlon ]Oa4, Business antl Professions Cotle: The Contractor's License Law tloes not apply to an owner ot property who builtls or imprav¢s thereon, antl who conVacts (or sutn projecb with a con- Vactor(s) I¢ense pursuant to the ConVac[or's Litense Law). 1 am aware that prooi of their Worker's Compensalion insurance shoultl be provitletl lo me. ❑ 1 am exempt untler Se�tion B. & P. C. for this reason Date pwner I hereby certify that I have reatl this application antl state Ihat the above information is correcL I agree lo wmpty with all ci[y.antl county ortlinances antl state laws relat�i��ng t bwldmq cons[ruction antl hereby autM1orize epre- sentatives of tnis er u0 � the above-mentioneC pr ert for inspec[ion purp n � Si9na[ure �—� Oaie 6 Drivers' License or 55 qf "�'' � r�ni^r�.� � I inr�i rv�. � �vi i�v. I UNITNO. d- �, TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTFIER DESCRIPTION OF WORK/USE OF BLDG. TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT �ELEGTRICAL ❑ PLVMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCV CONSTRUCTION TYPE __ VALUATION $ 20fJE GRADINGCU.VDS. ACRES Remarks: T7� S�Q LL Backflow Preventer " Backflow Irrigation Bathtubs Clarifiers Dishv2sher Drinking Fountains Floor Orains Floor Sinks Gas Service Outlets Kitchen Sink Lavatories P-Trap Roof Drains Reinspaction Fee � $15 8oiler Duct- UnderGround Duct - Structural Duct - Ventilating Exhaust Sysrem ❑ Multiple ❑ Firepl/Fa<L BIL ICBO # Heating System & Ducting ❑0-100,000 BTU 0700,000BT Reinspee[ion Fee � $15 CMF OB65-46, �ev. 10/84 Whi[e - Builtling; Canary - Applicani; Pink - Accountinq; Goltlenrotl - Assesm� Service Sink Sewer Cap , Sewer Connection Solar Cnllecrors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Warer Hzater Wacer Service AU[O-WdSh laundry Trays Issue Fee Hood or Typel ❑ Canopy Type II ❑ Fefrigeration System ❑0.100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fea $ 3 $ 3 A.P. # S Main Buildi E T Front B Rear A C Right K Left S Pln9. Ref. # Planning Notes: Automatic Washer � Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan f.A.U. Fiztures Device Boxes Outtets Switches Garbage Disposal Generaror �0-5 KW � _i :.. I i � Zone Accessory Buildin9: . 2 O N I N G R Parking Req./Provided E Q M T S ELECTRICAL Transformer ❑ 15-50 KW ❑ SO+KW Meter up to 100 amps Meter ❑over100amps 5 KW Sub Panel Motors00.1 HP �1Yh-8 Inc.Solar �9-15 HP O1E75+ Microwave Pole Light Range Sign Standing Sections Trash Compacmr � Reinspectian Fee I S15 � � Issue Fea DEVELOPMENT SERVICES REQUIREMENTS: 2aning APProved By . Buildin9 Approved By Application luued By FEES $ 3 SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ �SSUANCE $ PIAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ $•��- GRADING $ PLANCHECK 50% $ �-•SU MICROFILM S MECHANICAL $ TOTAL FEE 5 �V • 5� PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APBi;OVALS Permit # -y 1. Tamporary Electricgl Servicc or Pole -�i 2. Soil Pipe-Undrgrnd, 3. Electrical Conduit Utiliry�Undrgmd. 4. Electrical Conduit�Undrgrnd. 5. S[eel Reinforcemen� � � 6. Electrical UFER Grnd. 7. Footings 8. Foundation ' 9. Water Pipe-Undrgrnd. 10. Structural Floor System 1!. Property Sewer Linp & House Connection 12. Sewer Cap 13. Roof Drains 14. Rough Plumbing ' 15. Rough Electrical-Conduit � 16. Rough Electric Wirinq , 17. Rough Wiring Sign 78. Rough Electrical-T Bar Ceiling 19. Rough Heating & Air Conditioning 20. Rough Factory Fireplace 21. Ducts, in Structure 22. Ducts, Ventilating 23. Gas Pipe�Rough & Test 24. Roof Framing 25. Roof Sheathing 26. T-Bar Ceiling (Struccural) & Monocoat 27. Frame and Flashing 28. Lathing & Siding 29. Insulation 30. Drywall Nailing 31 . Plaster Brown Coat 32. Electrical Power Meter-Final 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer � 43. Backflow Irrigation 44. Landscape Irriqation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to &dison 50. Gas Release to Southern Glifornia Gas 51. CERTIFICATE OF OCCUPANCY o. Date Date POOI ;PA Inspector qppROVALS Permit # 52. Pool & Equipment Location 53. Steel Reinfarcement 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER-GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, � Undrgrnd. 61. APPROVAL TO DECK 62. Backwash & Receptor�Final 63. Heater & Vent-Final 64. Plumbing System - Final 65. Electrical-Final 66. Solar SYstem-Final J 67. Fencing & Access ApProval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hydro 71. Product Piping O Gas ❑ Oil 72. Underground Flush � 73. Undergrnd. Storage Tank O Gas ❑ Oil 7-0. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: Date � Inspector V �II\ Li� �JOB ADD GENERAI AP No. t yINSPECT �s� GA_ _ � WATER FOUGM PlL � PROP. SWR SPRIHKLIN� VVGRqT� K. _75 LOT 116 TRACTNwot. ROUGH HEATING r1ND A�p �pN01T10NING TEMPORARV SERVICE OR POLE UNDERGROUND � POWER [� FOUGH WIRING STEEL REINF. :J FFAME RNO FLqSHING LATMING — IN PLASTER.BFOWN COqT MEATING, VENT., ftEFRIG. ANO A.C., FINAL PI 'NG, FINAL ANO GAS TEST � BUI SUBCONTRACTOR J�1G .,� `�A ---.:4:�9.7� COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BVILDING�..,�, �, , \ _ C�r OWNER MAIL ADDflE CITYC BRANCH' �Q ADDRESS '',� % AFCHITECT OF ENGINEERF A�DRESS�,u CONTRACTOR ADDRESS"�� pTV F STATE � LIC. NO. �y (z� 51 Z E � �. OF LOT C,. ` a USE OF � EXISTING BIOG. � TE ''AY 12-7C�A�.�� 561� '�'••"` � ��:.3� AP L ION FOR STRUCTURAL PERMIT RE I �V OATE RECEIVE� DATE ISSU -a�-� _ P r� 4 A.P. NO. BUILOING ADDFESS r RAC `�• LOT BLOCK W AD A P OWNER � ,� VALU$ " 5 �DU FIRE / ZONE YPE GROUP APPROVE� /1� / ---/777L/ eV !JI � DATEIn' IL—f'[ ) ��'� 20 NO.OF TE L�..+�� ^�r P�� N��U'`�U7 �\ CITV �ARDSAPPROVED LIC. NO. MAIN BUILDING ! NO.OF BIDGS. (FROM GL/y/�g/ E�T NOW ON LOT � _ PRONT // FT. FSeparate permi[s are required for � electric, plumbing and heating work. W USE OF BUILDING AND WORK TO BE PE FORMED � 00 � ' v� '�� . �G cil =� G <-� b ;, a2x �C DISTANCE BET MAIN BLDGS. VAR. y� f USE OF NEW BUI LDING /�� I VAROSAPPROVED ACCESSORV BUIIDING BEf. MAIN ACCE�. BL DATE a ��J D �- x�'O -. HOLD FOK JF'tL� � rc��vuc��r►�� w pI hereby acknowletlge that I heve raed this epplicatlon antl state � y� that She obove Information is correct and apree to comply with m( 4 all laws reguleting b�ilding consiructlon, antl I shall not emplpy _A�� `' Z any person in violaUon ot tha workmen'a compensetion lews af Q�u.O m�, � tha State ot California. ^� u� m 3 I hereby certlfy that I em p�ope�ly Ilcensetl es e conSrector undar SQ. FT. 3 �v� the State of Californie Bustness antl Professions Cotle, Divlalon 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m\ Chapter 9, and that such licenses are In full force and Bffect, or I THE PURP�E OF ES7ABLISHING A PERMIT FEE ONIY: � am exempt from i�a provisions of the Stata ot California Business VALUATION PERMIT FEE $ ap end Profassions Cotle, Dlvlsion 3, Chap[er 9. � �\ m^ � �'\ PLANCHECK E LL�^ SlBnature of \( � �% � DO D a Permittea �-'�/'�� $ G TAX $ ,� U Authorizetl Agant TOTAL PAI D E � .,, r% { 88""/,�3 COSTA MESA BUILDING DEPARTMENT P.O. BOX 31] COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN j �.,J �9:rnC57Gr � � COSTA MESA. CALIFORNIA MAIL O AODRE55 ,3 t> > CITY r05�3 ARCHITECT OR E`"-'NEER ADDF�oS L—. ��/ c- 5 � � vS.%�1 .e-5 �-.�v� TEL. G.> .L NO.n LIC. NO. 1 CITV LIC. �i..: I C+.v NO. LEGwL LOT oesce�Priorv NO. � E A.P. NO. ! / — � ( SIZE oF �or i:3-3 x �di use oF �/ EXISTING BLDG. `Toc�'b >>>c SETBwCK LINE FROM��iS/l CENTER OF STREET �� j� SIDE YARO RIGHT �/ LEFT �,/ DESCRIPTION OF WORK NEW ALTERATION II ADDITION REPAi�. MOVING II OEMOLISH BUILOING / / NO.OF SIZE �� ZZ� ROOMS I STORIES EXTERIOR WALL ROOF COVERING ST✓GCO COVERING USE OF NEW BUILOING C.'2.rJSC� . NO. O� OGS. �s �� R��9�� . � � � � APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY RECEIPT NO. PEPMIT NO. W e. COSTA MESA. CALIFORNIA t� li ll i 1 CITY 0= !. 4IVI UBJGCT TO � �. i n STATE THAT TME ABOVE IS CORRECT AND 4GREE TO COMPLV WITH 4LL CITY OFD�Nl�NCES AND STATE L<WS REGVLATING BVILOING CONSTRUC� iiorv. VALIJATION SIGNATURE OF � 1�� PERMITTEE s %�� ) OATE J �.�+Z. ' _ �%� IONS ;�, R�?C�A L( ^. DEPT. REG. PERMiT FEE 5 Q � PLAN CHECK S � ...+ TOTAL FEE 5 /a - �,