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HomeMy WebLinkAbout1621 SANDALWOOD ST - Building Permits i• /KG- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. A -CITY OF COSTA M SA CONSTRUCTION PERMIT PERMIT NO. Q TRACT NO. t LOT NO. UNIT NO. ProleritfAddress / Z./ .��e11//-4/47417 /.�ir�./.t•'MOS' S' 6 ` !1 (J (/l�p .�3 Applicant3•Mail" g Address /6 �/ �' .di7f+;• Latera) Sf: : TYPE OF CONSTRUCTION ❑ NEW CV ADD U ALTERATION U REPAIR r 21 199 y�� �f�^ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER - 1 - 03 Zone R' Owner's Name 7✓1N-- VA A'✓21ezteb--phone 747— �'%rafv DESCRIPTION OF WO'K USE OF D A.P.AP ' ll� 1 ,„JJJJ Address /G 1-/ , rapt/ nt&l ° .— a Al . S Main Building: --- ccessory Building: E CITY OF COSTA ME&I� Z Arch/Eng. '� License No. - TYPE OF PERMIT ❑ GRADING ,FOUN• TION lb STRUCTURAL T Front or' O Address •� ❑ TENANT ❑ ELECTRICALw ❑ P U1MBIN ❑ MECHANICALECB Rear '°t± . N .�-'. ❑ OTHER —rorA-1 of bon - I [I A .t .... s.......... .. .. N Contractor's Name �---_ Phone 4, Address(mailing) - PROJECT DESCRIPTION OCCUPA CY ti�3�J K Right r/ Z$ G City License No. ^� • CONSTRUCTION TYPE VALUATIONS ) Q1QJ♦ _` $ Left [�- R ZONE GRADING CU.YDS. - ACRES Ping. Ref.# Parking Req./Provided Q LICENSED CONTRACTOR DECLARATION - I hereby affirm that I am licensed under provisions of Charter 9 (commencing / "� /1 �7 Remarks: Planning Notes: �� 101 flak_ �1)(P�X l.0 2 (O IIlY71t.t�{, T with section 7000) of a avi3 of the Business ono Professions code, and • �y- � CVJ my license is in full force and effect. ��_. L 4— e�'- itv I r �c—�� License Class License No. 1,,. ` LGoYtt.�[.".�yg Q' os Date Signature PLUMBING FEES 1 rvt ci, CD11. WORKERS' COMPENSATION DECLARATION ` (/ I hereby affirm that I have a certificate of consent to self-Insure or a certificat¢ • Bar Sink-. Showers _ ELECTRICAL s ,FEES of workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Backflow Preventer Service Sink Automatic Washer Transformer 0 15-50 KW Policy No. Company -1 Backflow Irrigation Sewer Ca• p Construction Pole Sub. 0 50+KW 8 Certified copy is hereby furnished. - �. Certified copy is filed with the city Building Division. Bathtubs) Sewer Connection CookingUnit- Meter Dula to 100 amps •Date Applicant EXEMPTION FROM WORKERS'COMPENSATION DECLARATION . • ' Clarifiers Solar Collectors Dishwasher .Meter Dover 100 amps (This section need not be completed if the permit is for one hundred($100) or less). Dishwasher Solar Piping Dryers ❑Gas DElectric Sub Panel • I certify that in the performance of the wor or w ich thJJjs,,permit' issue ''I shall not employ any person in any man so, to s ct to/q}(e• // Drinking Fountains Solar Tank Fan Motors DO-1 HP 01 -8 • Worker/y 4om n/la .Ye�vs of California U v i_/ Date / Signature /`�4l . — Floor Drains' Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP 016-15+ NOTI E: If,after making this deet you should b me sub' et to the Workers' Compensation provisions of the Labor Code ou m forthwith Floor Sinks - Urinal Fixtures Microwave comply with such provisions or this permit shall be de ed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole-Light • I hereby wormk that therewhiis a permit lending Sfor the performance.) of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name ` Interceptors Water Heater Outlets Range Lender's Address • i Kitchen Sink Water Service ' OWNER BUILDER DECLARATION Switches Sign I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories AUtO-Wash Garbage Disposal Standing Sections ' following reason (Section 7031.5 Business and Professional Code:Any city or county which requires a permit to construct,alter,improve,demolish or repair P_Trap Laundry Trays Generator ❑O-5 KW ❑5-15 KW Trash Compactor any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law (chapter 9(commencing with Section 7000)of _ Division 3 of the Business and Professions Code) or that he/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 _ ---- alty of not more than five hundred dollars($500). I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 compensation, will do the work, and the structure is not intended or offered Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES - License Law does not apply to an owner of a property who builds or improves _ thereon, and who does such work himself/herself or through his or her own - DEVELOPMENT SERVICES REQULREMENTS: (rf employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I ❑ a a O T sale. If, however, the building or Improvement is sold within one year of corn- - - Canopy Type II 0 Zoning Approved By Date 'I� pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By .�� �/ 1 Date�'t'�^! ' prove for the purpose of sale). ,/, ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By -_�i�I,4•---•✓-- Dam••._�{� tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating D0-100,000 BTU ❑100,000 BTU SUM Y OF - S , builds or improves thereon,and who contracts for such projects with a con- _ tractor(s) license pursuant to the Contractor's License Law). I am aware thatBUILDING PERMIT $ -OD SMTP $ .572 proof of their Worker's Compensation i surance should be provided to me. Exhaust System 0 Multiple 0. System Repair/Alteration ?S�0 PERMIT 0 1 am exempt under Section B. & P.C.for is reason Firepl/Fact.Blt. ICBG# Fire Dampers • PLAN CHECK $ J PLUMBING $ ISSUANCE $ — Date `�Owner t�a•`Ii Heating System & Ducting Registers ENERGY P.C. $ I hereby certify tha I have re • this application a •mate t e above PLAN CHECK 25% $ Information is correct. I agree to comply with all ci and c•,...0- ❑6100,000 BTU ❑100,000 BTL GRADING $ ordinances __ ELECTRICAL $ and state laws sting to building construction, an• hereb authorize repre- MICROFILM $ I sentatives of s ci to enter upon the above-mentioned property forPLAN CHECK 50% $ inspection p sesgAe_ Ye/nature • V _vC .- 55-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL& SPA APPROVALS Permit Date Inspector APPROVALS Permit • Date Inspector 1.-Temporary 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-Undrgrnd. 55. Electrical Bonding l 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. �j� 57. APPROVAL TO COVER-GUNITE 7. Footings - 0 0 /`+'�// 58. Electrical Conduit-Undrgrnd. � +'�^ . 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test .;i... 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK - .4 11. Property Sewer Line &,House Connection 62. Backwash & Receptor-Final - J ''"' ' r• 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final - - , ,• } r,. 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 19. 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 0 Oil 23. Gas Pipe-Rough&Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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: FS�,. tsk \\C eola 34. Final Heating & Air Conditioning \ s-\ t 35. Final Gas Pipe-Test 1 36. Hood or Canopy Y3 - (' g,g1% 37. Final Factory Fireplace / 38. Final Plumbing 39. Water Service-Final • .. 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer - 43. Backflow Irrigation • 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 7(b, t 48. Special Requirements Completed 49.6-Electric Release to Edison \ 50. Gas Release to Southern California Gas Co ,A. 51. CERTIFICATE OF OCCUPANCY No. Date - ' �, Lh /�,lcMEsp 61 City of Costa Mesa Building Dept. 6 3(‘Kg DEPT• BY -_-'�--f-_ DdTE�.�. 19.Q� ' , aEo. ST BE ON AT ALL ES E I 6110JECi`ga�"'M ti NOr ANc S `r+,!TH UT, PRIOR APPROVAL PPROVAL�OF DEPT. DAT j dr �F W,IyNLNO if THE;11;UAAICt C GRANTING OF A PERMIT OR APPROVAL OF D}� $ il PLA'.S.ANE.&'8.'F'CA.TICI S SHALL'NOI SE CO`ItTRUED TO SE A 1 _ 1 'S"..:T C 7 ON r''.! AltROVAL G�, ANY V::"`I.AI'Oi 1 OF ANY OF THE FURY'S E.PI'C°THIS CGDE.IC PEPMIT P:;SJMiNG TO GIVE 1 �- N®1c _ AUIHOF A ;C: V,':1_A(E OR INCEL THE PROVEEVON5 OF 145 ;.: SHALL t CODE S^A:I IIE ALO, EXCEPT SO FAR AS THE WORK OR USE . TIO S FI WHICH IT AUT:.0 iZES IS LAWFUL. EC pELETI�HE PLHNiVl' G DEPART t'1`ti4T ! ii ,..THE JR.?.U.' 'C[ O; ti')PEgr',ghfl.7 xD UPON, PLANS AND ADDITIONS 4 srtcri A •• " aP^Il. t,c, c. . i 1H: ELM:N; OFFICIAL , BE P4ROVEp BV !PROWW.3,. ;j�jLLEt IIR:NG THE CC Ec.:1ci•I GF ERRORS IN A D SPECIFICATIONS OR FROM PREVENTING BUILDING OPERATIONS EEING CARRIED ON THEREUNDER WHEN • • N VIOLATiO;N CE THIS CODE OR OF ANY OTHER ORDINANCE OF THE C/.\ • • ee IK= v •$•KNEE -',pit • .L IEsIuet II[$IOtNCI I. Ic�21 m W e it in 3 � O / ter`}i Q I N • • lam , r/!T ,L�� �(ot �c�2� 2 0 STRECT O tj'Ar A _ • _ ci, LD O • PARTY WALL AGREEMENT • THIS AGREEMENT, made and entered into this 10 day of ,,AbliGinty / 44E837, by and betweenL/69 W 4LIA.PtYdc,Pu NCj W1I/ hereinafter referred to as "LAND OWNER", and /2l e44 ,h 10 L Si LMweJT hereinafter referred to as "ADJACENT PROPERTY CWNER". It is hereby agreed/ that a party wall will be constructed on the property line between '671/ 54iv -c..ei/'1.7e\- ¢ /t.ar S4711/.19i 4rtn'd 37/3 ' e34 ,(?_ (4 Address Adjoining Properties) l�O r in the City of Costa Mesa, County of Orange, State of California, as per map / 3 6- /e recorded in Bock /4 , Page of Miscellaneous Maps, in the office of the County Recorder of said County. The party wall shall be permitted to encroach IN WITNESS %HEREOF, the parties have entered into this Agreement the day arca year first above written. LAND OWNER ADJACENT PROPERTY OWNER • Sign .re) / /-A9... f7 Signet �)'A / N 1/.5t. =,e et1 TOCII/v)04a) Ac 114---CTWfC Name (Typed or Printed) Name (Typed or Printed) /‘2/ egeba,t. L.1anc� .4✓ � /r /62 S S4- /PA.0 1w/0eV (Address) ' (Address) (NOTE: Please see reverse side for notary's statement) STATE OF CALIFORNIA ) • ss. MONT/ OF ORANGE ) On before me, the undersigned, a Notary Publi in and for the County of Orange, State of California, personally appeared known to me to be the person(s) whose name(s) is subscribed to the thin instrument and acknowledged to me that (he/she/they) executed - same. WITNESS my hand and official seal. (SEAL) Signature - Name (typed or printed) STATE CF CALIFORNIA ) ss. COUNTY OF ORANGE ) On , before me, the undersigned, a Notary Public in and for the Co y of Orange, State of California, personally appeared known to me to be - person(s) whose name(s) is subscribed to the within instrument and a owledged to me that (he/she/they) executed the same. WITNESS my hand and official seal. (SEAL) (Signature) Name (typed or printed) OWNER COLLINS, David E. DATE 3-29-72 JOB ADDRESS 1621 Sandlewood Street BUILDING PERMIT NO. 34506 GENERAL CONTRACTOR United Remodeling DESCRIPTION of WORK Add Family R m . AP No.139-213-03 LOT TRACT FIRE ZONE VALUE $2,600.00 INSPECTIONS Signature Date GROUP I TYPE V ZONE R'.1 SOIL SUBCONTRACTOR PERMITS ISSUED GAS Date Number I Signature WATER Plumbin. ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. ❑ SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND 0 �y POWER ROUGH WIRING4t&*/ Azcz•2C-/1 '(/, l 92- Heating and Vent. TRENCHES F FORMS j . STEEL REINF.d rf-1-Cf FLOOR SYS EM BOND BEAM n STEEL REINFORCE ❑ 'Q-J/ SHEATHING e7r FRAME AND FLASHING / , LATHING - IN n OUT n PLASTER, BROWN COAT STRUCTURAL. FINAL Elect/1MHEATING, VENT., REFRI G. AND A.C., FINAL /2&Jlt€ Elect/1M /A9).7.7 2 ✓%/ er PLUMBING, FINAL AND GAS TEST n ELECTRIC, FINAL 4e 5-/i',i- L/i]- 14 n. f 34506 PAU' r. n.7--- 301275r rca, 3i;.68 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RECEI V ED B DATE RECEIVED DATE ISSUED BUILDING .'' 3 —24-7 3-1-y_7 ADDRESS �y�On/s�wrn yUDt9� 1� PERMIT OWNER flu/o 6. a ,WS A.P.N / 3,-z) 3—O"S BUILDING 51/1.-07.1F- • �I{- MAIL ADDRESS/62/ ST/t•/r HF-wuCI N � Z ADDRESS S,94./c:- — n w w / TEL. TRACT !Sa-'i I LOT ZeJ& BLOCK a 0 CITY G c •4 �c- NO. ~ Z NEW AD ALTER REPAIR MOVING DFMOI ISH Z < CONSTRUCTION y ON LENDER _Acte.7,S Eri(lC J D BRANCH &Maar I G" alt ��0. 03r _ JN OWNER /n/J 03 J ADDRESS 7'co,/ E ,r�I�7E[/i/� �j'� I/. —' • �.�,�s VALUE / U' �i! J CO ARCHITECT! TEL. USE@�II7L7/IMKAy T// • '' — $.WOY Q OR ENGINEER -i N l/ U Q FIR T W Q ADDRESS ZOt E TYPE VROUP j �J A/Y,474st 1 APPROVED � [� - Z / -,7� UJ O CON TR ACTOR 44 neO 416,,,c t/N6 r$1072514 BY {v/ DATE 3 Z Jx ADDRESS 44)Q�O;,,�a-(- in; al01 w Z F CITY �//J�Gmi NO. � rlds20 ZONE�� PLANS a BUILDING NO.OF USE OF NEW iZtO o s-4 w O STATE / / CITY !O�/' 6 YARDS APPROVED YARDS APPROVED N CC LIC. NO.$! 1605.4, LIC. NO. MAIN BUILDING ACCESSORY BUILDING D O (FROM C/L STREET)SIZE NO.OF ,(, OF LOT N7 NOW ON LOT/ FRONT 1 I FT-FA-MAO AO FT. USE OF EXISTING BLDG. OA/tri--.1-/A.I Co CM-t/}LQv- R.SIDE /0 FT. FT. FSIZE OF ''// NO.OF ` t/ Z NEW BLDG./3 I2/ ROOMS / STORIES / L.SIDE 3 T FT. FT. Q EXTERIOR WALL ROOF // V COVERING (.!/000 COVERING We C0 REAR /4 FT.c FT. ' J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& a 1 -jf,4J/L y ,QD Ai MAIN BLOGS. ACCESS.BLDGS. a Q VAR.*R DATE 0 C.U.P. APPROVED I- U, ROVED j/ lU) _DATE ,..3/01 eh).- 2 o -"wir, UI hereby acknowledge that I have read this application and state ' 13 O that the above information is correct and agree to comply with / all laws regulating building construction, and I shall not employ • f H any person in violation of the workman's compensation laws of TAX N the State of California. / so 9 z I hereby certify that I am properly licensed as a contractor under SQ. FT. O the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; CC am exempt from the provisions of the State of California Business and Professions Code, Division 3,Chapter 9. VALUATION ^ B PERMIT FEE $ D Signature of zf/, 2 m Permittee _ (/(.l! ����[[[ $ • PLAN CHECKS /2•1E Authorized Ager e Q• a LL N. TOTAL FEE $ th Des o( . . . �J From . "-V4‘ 6 .'111CNEWTON CO 7/ �r / - Gia : r Co.(o ' /o-t- 4, a- a-t-cdal Sat-0 a.m.:And ./Leet yal a- a_ , , a4v€A5-K- 66- //Art X-eg-44, • de d1 fre bovei -tch-ce-14- 61-0, it Z 6)-c . c vaz, .. la �f G a Ie fc o 4 acid -7,-1'14a-7, a GNU%aa/ . ;4-e;2-ectler y w /en&t_ • priatce C-ef1yfV d° .' `;nom notaS7— tt0c3) � � OWNER ROSSLANE LAND CO. DATE 7/9/59 JOB ADDRESS 1621 Sandalwood St. BUILDING PERMIT NO. 9875 GENERAL CONTRACTOR Dike & Colegrove, The. VALUE $ 15,571.00 AP. No. LOT 203 TRACT 2$22 FIRE ZONE DESCRIPTION OF WORK Re,_._l/att.._ga '. INSPECTIONS 9_O-cy DATE I GROUP I & J TYPE V ZONE Rl Underground Soil fy..< U.G. Water/Up< p-7-I, SUBCONTRACTOR PERMITS ISSUED Underground Gas DATE NUMBER Overhead Water and Gas CO,h Heating /VHS- /p -/^y'0 if7//� s 129-“± 02-06 (0 V( 0 Rough Plumbing /64-‘ /0-6--.6 .Zctel.�., Vim-- . e 7-4.e/c`5 C/uC/ ' Miscellaneous _ t Prop. Swr. 'ne H. e Con. St. Swr. . I DAR'- PIC 7/iro(r in it) f/ Sprinkling System _ Heating, Final (// An(7 Plumbing Fixtures Af A. 2) O -, Final Gas Test /SA6, a f-/n-co Construction Pole _V� 2,,L9_r_p_27_7_4,31q/ Underground Power Rough Wiring 4et "CUP%9% (loin hjl)V/i). ..,.f r h, 9- 01-c?1,C? O Nf fl I/ Trenches Forms PC Steel 1\!Lk_ g -q-1 Floor System Steel Reinforce Chimney Re-Rod Bond Beam l /it d Sheathing dv 1't f o-2- 510U Frame and Flashing f'JU.'� (C-el-1-5k1 _ Lathing, In /� Out //044 (b -'1l -51 / Plaster, brown coat 43/, !/-I9-S9 _ ___} Plumbing Fixtures, Final - -/0-GO Electric Fixtures, Final SA Building, Final alreir Sim' _ OCCUPANCY I Form 210-3M-4-59 9875 • 989511_i; ._ • - - JUL 13 1959 COSTA MESA BUILDING-SAFETY DEPARTMENT -II '� '�F'CE DEPT. P.O.BOX 317 COSTA MESA. CALIFORNIA I -"I FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT BUILDING . BUILDING ADDRESS 1621 Sandalwood St. • COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY RECEIPT NO. PBRM1T)NO. OWNER Rosslane Land Co. �On j, MAIL 7 RECE WED BY DATE RECEIVED I -7TE ISSUED..5 ADDRESS µL9 E. 11th St. '- 7 / ,J^/'y BU DING CITY Costa Mesa TEL.NO.T 81159 ADDRESS ARCHITECT Carlson & LIC. COSTA MESA, CALIFORNIA o OR ENGINEER NO. Middlebrook FIRE - ADDRESS Garden Grove ZONE ,� cAR LIC.& Colegrove, Inc. STATE NO. 167293 APPROVED CON BY DATE ADDRESS 419 E. 17th St., Costa Mesa ZONING 203. LEGAL LOT 2822 ZONE NO.OF USE OF NEW DESCRIPTION NO. I BLOCK I TRACT I PLANS BUILDING APPROVED2/ ' D Q YyVDATE � G1 A.P.NO. BYL /�/jI13--• `! . SIZE YARDS EVES OF LOT 65 x 101 NO.NOW OF ON BLUGS.LOT 1 REQUIRED + ALLOWED USE OF (CENTER LINE ST.) EXISTING BLDG. FRONT co FT. IN. SETBACK LINE FROM CENTER OF STREET 50! REAR YARD �y 321 R.SIDE ✓ FT. IN. SIDE YARD I LEFT 51 RIGHT 101 L.SIDE ,J(` FT. IN. DESCRIPTION OF WORK X REAR O FT. IN. NEW 1 II ALTERATION I II ADDITION . REPAIR I II MOVING 1 II DEMOLISH SIZE BUILDING 1560 NO.OF ROOMS 7 STORIES 1 EXTERIOR WALL I ROOF • COVERING SLUCCO COVERING Shingle USE OF BUILDING AND WORK TO BE PERFORMED Single family residence with attached garage. ' r_ ►.i: . a I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONBTRUCTIO VALUATION )L : SIGNATURE OF / /� PERMIT FEE $ 31.00 PERMITTEE lI • PLAN CHECK $ 17.50 $ l5,571 AUTHORIZED AGENT Dike R. Cnlearnve Tnr TOTAL FEE $ 52.50 CITY OF COSTA MESA PLANNING DEPARTMENTPan, 29 77E-,:-5--01276.276 v*t**25.00 A.P. No. 139-213-03 Bldg. Permit No. 34/1-0 6 PARK AND RECREATIONAL FEES - Apartment Developments Fee Payment Receipt Project Address 1621 Sandlewood Owner's Name David F. Collins Bachelor or 1 - Bedroom Units 1 @ $25.00 = $25.00 2 - Bedroom Units @ $40.00 = 3 - Bedroom Units @ $55.00 = 4 - Bedroom Units @ $70.00 = 5 - or more Units @ $75.00 = $25.00 Total Number of Dwelling Units 1 Total Fee Planning Department Approval Date 3-29-72 Park Area No. 12 By WLD:rdb Applicant's Signature /l �h/ " 2 O-7;P)001276R***25.00 CITY OF COSTA MESA PLANNING DEPARTMENT A.P. No. 139-213-03 Bldg. Permit No. ‘16-U PARK AND RECREATIONAL FEES - Apartment Developments Fee Payment Receipt Project Address 1621 SandietlOOd Owner's Name CavlG F. Collins Bachelor or 1 - Bedroom Units 1 @ $25.00 = 4.25.00 2 - Bedroom Units @ $40.00 = 3 - Bedroom Units @ $55.00 = 4 - Bedroom Units @ $70.00 = 5 - or more Units @ $75.00 = 525.00 Total Number of Dwelling Units 1 Total Fee Planning Department Approval Date 3-23-72 Park Area No. 12 WLD:rdb By Applicant's Signature