HomeMy WebLinkAbout935 SENATE ST - Building Permits(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.���LDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626
Jobnddress: 935 SENATE ST
Suite:
Vicinity:
Parcel Number: 42238317
Applicant: HALLEIB, JAMES
Address:
Owner: HALLEIB, JAMES
Address 935 SENATE ST
COSTA MESA, CA
Contractor:
Address:
Zip:
Arch :
Address:
Zoning:
Phone: 949-515-2723
Zip:
Phone: 949-5152723
� Zip: 92627
Phone:
License:
Eng:
Address:
Phone:
Status: ISSUED
Appiied: 04I07/2003
Issued: 04/07/2003
ISSUED BY:
Phone:
Zip: License: �icense:
SCOPE OF PERMIT
6' HIGH X 21' LONG BLOCK WALL ALONG IEFT SIDE LINE. �
Plan Check: $15.28
Permit: $23.50
SMIP Res: $0.00
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $38.78
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING Existinp: o
NOTES:
Rear 0- 0
Rear 0-0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
sazo.00
so.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, 12-21-92)
EXPIRATION: This permit shall automatically expire antl become void if work is not commenced within 780 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 Inspectlona 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) 7545626
2dd8�48(6/00)
WORKERS' COMPENSATION DECLARATION: -
I hereby eifirtn under penalry of perjury one of the following declarations:
❑ I have antl will maimain a ceniticate of consent to self-Insure for workers' compensatlon, es providetl for by saction 3700 of ihe Labor Code, for ihe peAormance of the
work for which Ihis permit Is issuetl.
❑ I have antl will maintain workere' compensa�ion Insurence, as required by section 3700 of the Labor Code, for the pertortnance of Ihe wo c for which this permit is issued.
My workars' comper7gatiq[� nsurence rler a policy number ere: � •
Il /.!
Carrier: \ �t PolicyNumber:
�(This sectlon need not be completed 1/ th�er if is valued et one huntlred dollers ($100) or less.)
rtity that in ihe ormance of the work for which t pertnit is issued, I shell not employ any person in any manner so as tqqbecome subjea ro the workers'
compenSatlOn laws o elitomia, and agre th t if I Id become subJact to the workers' compensetion provisions of Sa �700 o�the La�Cotle, I�
comply with these p r � i 1
ApplicantSignaWre: J Date: v
WARNING: FAIWRE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE MUNDRED
h10USAND DOLL4RE (5100,000), IN ADDIiION TO TME COST OF fAMPENSATIIXJ, �AMAGES AS PROVIDED FOR IN SECTION 3]Ofi OF THE LABOR CODE, IMEREST, AND ATfORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
1 hereby afflrtn ihat 1 am licensed untler provisions ot Chapter 9(commencing with Section 7000) of Division 3 ot the eusiness and Professions Code, entl my license is In tull
�orce end eRect. Lic. x Class #
Contrectofs Signature: pate:
CONSTRUCTION LENDING AGENCY:
❑ I hareby aHirm that there Is a consimction lending agency tor the peAortnance of ihe work for which Ihis permit is issued. (Sec. 3097, Civil Cotle).
Lender's Name: - Lender's Atltlress:
Signeture:
Date:
O W NER-BUILDER DECLARATIONS: i' j"(,'r
.. i .
I hereby aHirm ihet undar panelty of perjury�that I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professlons
Code: Any ciry or counry which requires a permit to conslmct, alter, impmve, demolis�, or repair any 5trucNre, prior to its issuance, also requires the applicant for such pertnit
to file e signetl statement �hat he or she is licensed pursuent to Ihe provisions oi the Contrectors License Law (Chapter 9(commancing with Section 7000) ot Division 3 of the
Business antl Professions Code) or Ihat he or she is exempt iherefrom end ihe basis for the alleged a:emption. Any violetion ot Section 7031.5 by any applicant for a permit
5yu,b�a�cis iha applicant lo a civil penalry of not more than five hundred dollars ($500).):
L]I� 1, as owner of �he propeny, or my employees wi�h wages es Iheir sole compensation, WILL DO THE WORK, antl ihe siructura is noi intended or o%ered for sele (Sec.
'� 7044, eusiness and Professions Cotle: The Contractors License Ww does not apply to an owner of property who 6uilds or improves thereon, and who dces such work
himself or herseN or �hrough his or het own employees, provided that such improvemeNs ere not intantled or oHered tor sale. If, however, ihe buildinq or improvement is
sold within one year of completion, the owner-builder will heve ihe burden of proving that he or she did not build or improve for purposa of sale.). �
❑ 1, as owner of ihe pmperry• am E%CLUSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS to construct the project (SecJ044, Business antl Protessions
Code: The mramors License Lew tloes not apply to an owner oi propeny who builds or improves thereon, and who contracts tor such pmject with a contractor(s)
license pursu t to ihe Contractors Lic nse ws�.
❑ I am exem er ec. Business and Professions Coda for this reason: _�
Signature: Date:
Owner ID verified Dy dnver's license. as ❑ No Dnvels License No. Expires:
Venfication of Ownership 6y (type of daument, i.e. - property tax blll or dead):
DIVISION OF INDUSTRIAIL SAFETY PERMIT CER7IFICATION:
❑ I heraby certify ihat no excavatlon five (5) a more feet in depth into which a person Is required to dascend, will be made in connaction with work authorizetl by Ihls
permit, and that no building sirucNre, scaHolding, lalsework, or demoiition or dismantling ihereof, will be more than Ihirty�six (36) tael high. (Chap. 3.2, Gry 2, Art 2, Sac.
341, Title 8, Califomia Atlministrative Code).
❑ As owner-builder, I will no� employ anyone to tlo work which would require a permit irom the Division ol Industnel Sefery, as noted above, uniess such person hes a
permit to tlo such work irom ihe division.
SignaWre: Date:
Division of Intlustrial Satery Permit Numbar:
CER CATE OF COMPLIANCE AND A IZA710N OF ENTAV: I certity under penalry oi perjury �hat I have reatl this application antl state tha� �he iniortnation given is
correct. I ee to comply with ell stet law d city ortlinances relating to building constmction, and emhorize representatives ot ihe Ciry of Costa Mesa to enter upon the
above-descri tl operty or'nspe io . e not to wcupy or allow occupancy oi any building authorized by thi permi until final inspection.
Signatura Of Legal Owner(s) �e
AnNOr Authorized Applicam
COOE �. INSPECTION TYPE
1676 Fixetl System Flnal Fire Prevention
1266
200
201
Pool Spa Final
Finel Re-Roof
Finel BIocWRetaining Well
202 Final Factory Fire Placa
203 Final Sign
204 Final Demolition
fj�jj INTRIALS
1 � /� �/11�� �
COUE 1 INSPECTION flPE
206 Final Mechanical
208 Final Plumbing
270 Finel Elecirical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Finel BuitdinyOccupancy
pAj� INTRLILS
St PE�{�M
21 � �fIT
GOn7G �I�
u�a�(.
�' �I�-i -
9
�. . �
� f� P �
�135 � �
Al'1't�t � `� 4:ll
CITY UI' CUS'I'A Mf:SA
PLANNING DIVISION
UBJECT TO BLDG. DEPT. REG.
OTE: ADDITIONS, DELETIONS,
OR CORRECT[ONS SHALL BE
�ROVED BY THE PLANNING DIV.
��- l F� (�Y�+P
Ap�R� EpSqA�TY
��3 _
,�`��� �b��w
� �.
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ADOFESSOFBNLqNp: 93S SENATE ST
o""E"g""�E"'Q'°"": MC DONALD SANET LOUISE
AD°"�� 935 SENAT� ST
COSTA MESA,CA 92627
�rr�.wuuxc woxess:
I) �xcxrt[cT ox �aq�x:
� ARCII.OX FNQ'S ADDIIES:
uc. xo.:
CONtPACTMS NAYE:
CONIFACLORS MNWlG
wo�ss: ue ra.:
°M' CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: B 079326 PLAN CHECK NO: N
uxr:
uxr:
LJCENSED CONlHRCTOPS OECLANATION: I hareby dlim under peneYy d perryry Ihet I am liceneed uMx pwiwna ol Cheqer 9
(oommeiaiq xi�h Seclion ]000) d Oiviaian 3 d ihe Buai�ae vk Pmfeesians CoEe. aM mY licerree o in I�II lau vd eRe�f.
cm uc. No.: uc. cuss: uc. No.: EXP :
ome: comreaor:
�WNER BUILDEN DECIARATION: I hereby effiim under penety d perlury �hm I em exemq Irom iM CaMredon licema lew la the
,wlexin0 reamn (5edion )0�1.5 &ninna eM Prdassions Cotle: AnY c�Y a coun7 whiN mVuiree a Vs^^I lo mm6uct. elim.'unVwe.
imolah, or rapei eny slructum, pnor io ip eauenw, elea repuiroa the epplifant lar such pem�n to fib e aiprieE etetement Ow he a eM
$� r�o.ee w�� �o ma ro++s� d ub comrea�. uoa,.e �.. �cneq,. a tw�me�� .an smo�, �0001 a o:m� s a�b
Buainaa uM Pro/eabns Cade� n thel In w aM ia a<emq therelmm eM Ihe beaie fa tM elbpeE mamqion. My violelion d Seaion
)031.5 by eny epdiranl for a permil eubjWa IM epDlicenl Io e pvil peneXy ol irol mwe Ihen (rve hundrad ddlen �5500f�.
� I. m mmar d iM propanY or my empbyms wYh wages m IMi ade wmpeneetion, wAI do Iha nork. vd Ihe evudure 6 ml intndad
or Mered la vele (�����. Buzrom vM Pmlessians Cade: TM Conved«a Lioaree LewEoes �wl eppyto en ow*wr d popeM
who Duih «inpmvn iMiem, uM xfio does eueh xwk limaetl or Mne1 a Ihraph ho a har oxn ampb/see. pewidad ihm arJ�
improvementa era not inleMed «dlered lor eale. II, howerer, tha WiMinq or improvemenl ia eok wnhin wr yeer d rompinbn, tlre
owmr-0uikm xill heva tM WrEm W pwirq he or eha dk rid buitl or impraa la tha puryme d eeb).
� 1, av avmar d tM prapeey. em e�dusrvey mnireqiq wnh licanaed convmtae to wn9rud Ure qopa (Seeion ]OId. Buvi�a erd
Prdeaeiow COCe: TM Comreaon Lken» Law doae m� eppy io an ax+w d popeny xho buitle « impove� ihxeon end wlw
conlracie M wch vroi�s �h e mnveaoKe) IcenaeA W�uenl lo Ine CaMreaore licenee Law).
$] i.m�amp��+aas«r«+$p7044 B.+P.c.�,}�,,F�a�,,,..F�0 R BY OWNER
oma: �i�e . �i � �O o.,�.: V N"'h� �
I do Mnby eerlily thet I ewere d uM wderslend ihe reyuiremenle ot Cellomie Heellh enE Sefety Cotle Sediom 25505. 25533. eed
255J1. ad Nel 1 a enY Mure buJdirp aa�pent vrill / wil rwi (arcb orre) need to canply wih uid ama mdo end iM nQuiremeMs iar
epaemillorwnnrveiionamaC�fieelianhwniheAk�ii%tyR%repa Dis�nd.ReekaMieleaMiudione ieetiwaereexmmqtmmNaee
�t�,_.av �� ��s �-I�G�
Dme: T_ AOW��'
W ONKEN'S COMPENS�TION DECl1flAt1ON: I Mreby elfirm uMer penelry d pa�ury ma d �M Idbvriip Ea�vetione:
� I l�m<eM xil meimen e cenicele d aovent ia vaXiiuum br wAera' cwnpanmian. n paidad b by Samm 9]00 d iM leEa
Coda, la the pe�lormenee M iM Moek lor wNeh thie peemn is ieeued.
o �n.V,�,�����,��n�����,�.m�������,�d��,�.�.�..b��,��a��.
work for whiM I�is permn ie ivued. My warken compeneetion inwrance famar eml pdiq numbar ere:
c.�.:
Polby Numbar:
(1h"rs seciion neeC rKK be canP'ered % UreO�i re M mro huMred ddlera (StcoJ w bu.l
� I mNh' ��� �ha pMormenee d ihe work br whch thie peemn is eeued, I a1W1 � empby ury pereon In em� mennm eo n �o
bacome aubjea lo ihe xorkeia' campanselion lewe d C+lilomia, arM pree Ihet if I e1wuM biw to tM v.orken'
pen ion provieions W Seeion 3]00 W ihe Lebor CaEe. I ah fo�hwilh �' ' iau. �
o�e: . 3 .����:
Waminp: F�llun b�xu worlrsn' compewtlon covenps /i un/awlul, enp�Mll �W/ec( en emp/oysr to Mmliul pwuMa �M
clvll flr�es up ro ms FuntlreC fMua�rd tlo/Mn (5100,0001, In etltllfbn ro M� rn�f ol romp�rwtbn, Wmep� u proWtletl br In
S�ctlon �](I6 0l N� LaDor Cods, InNnst, aM ettomsY � lsu.
CONSTIiUC110N LENDINO A6ENCY: I Mreby eifirm uMer pareXy d per'�vy il� IM1en u e m�e�ivaion Imdi�q epency M ihe
parlormenca d ihe work lor whid� thc perm� is aauad �Sed'on 309], Civ. C�.
lENOEP'S NANE:
LENDEF'S10�NE55:
I cMily ihm I heve reed Ihia epplir.etion vM pme Ihe� IM1e ebave iMarme�ion ia conea. I apree to wmply xith dl oy eM oouMy adiroricee
vM atete kx+relelip lo buildip conwudion vM Mreby eNMrrze rapresantetives d Ihia dry to enter upon Ihe eEwe-meMbnad papaM
i«irecea�wrw.ae. JAMES ALLEIB
S r,� Dme N�
. Sip^e�uredOwner/ApanUApplicenVConlraqor
(5151de.WP) W�do-Buildiq 8 Sefery: (3reerFle: Genery-�ppirem: Pink-Revenue: Gokenmd-bamwr
PERM NO: B 079326
GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
JOH DESCRIPTION : T/O EXISTING ROOF APPLY NEW 25YR COMPO SQ FT: 1,250
CLAIM VALUE: 1,250.00 CALC—VALUE: 1,250.00 GROUP OCC: R-3 /U-1
COMMENTS: APPLY NEW 25YR COMPO SHINGLES OVER EXISTING PLYWOOD SHEATAING
1E 1E 1E fE 1E iE It 1E 1f fE iE IE 1k iF 1F iF ik if 1E if 1E iI-1E jE'lE IE 1E 1E 1E 1E 1E iE i! iF 1E i! iE fE iE if'!E 1E 3E iE iE iE 1E fE'1('1! fE 1ElF 1E iE'N' if 1F iE 1E 1E iE if iE 1E 1E 1E'IE 1E 1E If 18 iE iE �E iE 3E'IE 1E
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT; FT ZN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PAOV; PARCEL; 42238317 ZNE; REF NO:
PLANNING N6TESY -
� ,
iE iE 1E 1E It if f! 1E iE 1E iF iF if iE�if.iF if ib if 1F if iE if 1E 1E 1E 1F 1E 1E if iE iE if 1E 1E iE if 1E if iE 1f iF 1E iE iE 1f iF iE 1E 1k iE 1E if iE ib dF If if if if 1k iE 1F iE iE IE iE 1E 1E iE iE 1E iE 1f iF iE iE IE 1k
D E V E;L O P M E N T S E R V I C E S R E Q U I R E M E N:T S
ZONING APPROVED BY DATE:
HUILDING APPRO�IED BY : DATE:
APPLICATION ISSUED HY: DATE: .3C7 %
it*x�**atitiEiEiEieit***f�it***ie* itieie�ritat**it* fFiF**
LEGALZZATION:N F E E S U M M A Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 43.00 50
PLAN SMIP/NON—RES
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 43.50 0.00 0,00 43.50 43.50 .00
REVENUE DZVISION TOTALS--> COLLECTED: 43.50 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
43.00 .50
1F if 1E 1E 1E 1E iE 1E 1E IE iE iE IE 1E fE 1E iE 1E * 7F iF 1E 1F �f iF if 1F 1E 1E if� iE 16 iF 1E 1E if iF 181F 1F ik 1E 1f if 1E iF ik iE iE iE �l(� iE'lE 1F iE If if IE 1f 1E 1E if if iF IE iE 1F if jf iF i(� 3E 3E fE if 3f 1E iE 1E
I N D I V I D U A L F E E H R E A K D O W N
TYPE
SFR
QTY
125�
D E S C R I P T I O N
REROOF HY VALUE RESIDENTIAL NOZONE
END OF FEES
UNIT COST TOTAL COST
1.00 1,250.00
�.�r^�
CONSTRUCTION AND PIANNING QO'' '� SPA
APNROVALS Permit # - Date Inspector qppROVALS .mit # Date inspector
� t. Temporary Electricai Service or Pole -� 52. Poql & Eq�ipment Location' "
. �
2. Soil Pipe-Undrgrnd. , 53. Steei Reinforcement � r.
�.3. Eiectrica� Conduit Utility�Undrgrnd. � -54. Forms .
�• 4. Electrical Conduit�Undrgrnd. _ ` 55. Ele�trical Bonding - -
�5.' Sreei Reinforcement 56. Rough Plumbing & Pressure 7est -- I
-6.':Electricai UFER Grnd. , 57. APPROVAL TO COVER�GUNITE -
7. Fooiings 58. Electrical ConduibUndrgmd.
�8: Foundation 59. Gas Pipe, � Undrgmd., Test
9. Water Pipe�Undrgrnd. 60. Backwash Lines, P-Trap, G' U drgrnd.
10. Svuctural Fioor Svstem 61. APPROVA� TO DECK
11. Properry Sewer �ine & House Connection _'�! 62. Backwash & Receptor-Fin�F-,
12 Sewer Cap 63. Heater & VenbFinal „
i3. Roof Drains ` 64. Pluinbin9 Svstem - Final -
74. flough Plumbing �� , 65.` E-0ectricai�Final .'
�;
75. Rough Electrical-Conduit _ , 66. Solar System�Final ��
16. Rough Electric W"ving �_ 67. Fencing & Access Approval .
17. Ro�gh 4Niring Si9n ' 68. APPROVED FOR PLASTERING -•
78. Rough Electrica6T Bar Ceiling 69. POOUSPA SYSTEAdS FINAL �
79. Rough Heating & Rir Conditioning FIRE DEPT. REQUIREMENT -
20. Rough Factory Fireplace . � . : _ �-: AppROVACS. _ Permit # - -
21 . Oucts, in Structure: "� ' `, '�. _ ' _ , . 70. -Clnderground Hydro �
22. Oucts, Ventilating- . . -, y . c F' 71. Product �Piping-�J"-Gas ❑ Oil
23. Gas Pipe=Rough & Tesc �_ ,', _ _' ` � 72, Underground Flushi ,r _
24. Roof Framing' �- �. ��' 73. Undergmd.5torage Fank C_ Gas f_� Oil
25. Roof Sheathing - y��G�. �/', /[L 74� Overhead Hydro ' _
- i � .�.wu'
26. T�Bar;Ceiling (Structural� & Monocoat � ,. - =, r 78. Dry Chemical - • - '
�
27. Frame and Plashing � ,� � 76. 'Dry StaRdpipe,_:- -
28. Lathing & Sidi�ng --� - �� �� r n �• � 7Z. FIXED'SYSTEM �FINAL
29. Insulatioir - ' � �� � ' ' �' .�. 78: FIRE PREV. FIN¢L
3p. Drywai! Nailing ; ' � �'r �HEAIT,H DEPS,REQUIREMENT
' 31. Piaster BfOtvn.Coaf ' . _ � � �" _ 7g. FINAL INSPECT:tDN , - -
�� 32. Electrical'Power Meter,-final ,� i � ;. �: 8�: FOOD CERTIF.ICATE ISSUED �
. ;r; I. � "?r n . r. £ m ^ ��r
33. Finaf Electric' � �, � � ,.5 � Notes: . _ _ � �, _ .
34. Final Heatinq & Ai5 �onditioriing�- �-� �; ' 1 � - �- _r • _ '
r
35. 'Final Gas Pipc�Test '� , - '� " ! � � ' � ' �-= ' " �
r - - - -
36. Hood Or CanOPY . - - _. ' ! ♦.� .r.._� _ � ' .-
Y G 1-_'. Y
� 37. Final Factory Firepl3ce �'• „ ' ' ` , ,
1 z
38. Finai,Plumbing . -` •• _ -. _ ,- -
� 39. Water Service�Pinal s ' � ;� � -r ,-i � ' - -
_�,� � . �. y �
40. GasService�Final:'�- ;„T - *,_ ' . � .'. .. ..
41. Solar pomesticFinal = � � . �'�,' - .- .1
- -. r� r -- ..
42, Backflow Preventer� " ', �� r � j -_ � �
43. Batkflow Irrigation • - - � � _ ' - -.
i
S :. r . , -
44. LandscapelrripationSystemi.-;,� . , -- - � " _
45. Sound Attenuation � - -. ' ` - - • `�- x'' V'
M ` �T T A �' I .
46. Handicap Regaiations ' � �' � �� �� - , " _ � ��
47. FINAL STRUCTURE & BUILDWG _{�� � �w� � �
4 T
48. FINAL PLANNWG; " ' - �� , _ - . -
49. Electric Reiease to Edison �
50. Gas Release to Southem Califomia Gas Co : ' , :_ . -� �
51. CERTIFICATE OF OCCUPANCY , ,
No. Dace
'VWIVCK ,S` �� F1TiNSAKFR R R(lN5 un1� 5-ji-5(
JOB ADDRESS 935 Senate St. ' BIIILDING PERMIT NO. 521i
GENERAL CONTRACTOR Gamp _ VALIIE S 9,904.00
AP. No. LOT KA TRACT �� qK FIRE ZONE DESCRIPTION OF WORK Res w/att ¢ar
.r �P T R� J TYpE V ZONE_ RL PLAN NO. K�(1K
INSPECTION$ I DATE I SUBCONTRACTOR I DATE PE�M'TSNUMBER
coat
P �
Fin... Gas
� ''r `' ,
. J2�rJ
. r-�
COSTA MESA BUILDING DEPARTMENT
P. o. eox 3 n
COSTA MESA, CALIFORNIA
FOR APPLICANT TO FILL IN
�
OWNER A �
�Por
MAIL Q
ADDRE55
QTY �
ARC C�
OR . NEER
ADDRE55
A MESA. CALIFORNIA
LEGwL ILOT � �
OESCRIPTIOrv NO.
A.P_ NO.
�LE RE�'E;�'':��
MAY 2 1 1957 �.
FINANCE DEPT.�
APPL��IICA7'I�IVTFC7R"�ERM IT
BUILDING
FOR OFFICE USE ONLY
FECEIPt NO. PE�F1�fY1�
nec[�vEo ev o>re nece�vco 0
7_,�.K,aa or�/ s = _ - ma
TEL�;+ �`�s' BUILDING
NO// / � ADDRE55
ua COSTA MESA. CALIFORNIA
NO.
cirv No:-S�r%d�p
a X lav ��awo„�o;� a
SETBACK LINE FflOM
CENTER OF STaEET
6 / REAF YA
�/ �
SIDE YARO ftIGHT J LEFT
DESCRIPTION OF WORK
NEW ALTERATION ADDITION
REPAIR MOVING OEMOLISH
6UILDING (/ NO.OF
SIZE �/ 0 ROOMS � STORIES
E%TERIOR WALL�-_` ROOF
COVERING �N-LL�-� C,,,,,,O///VERING 1
USE OF NEW ' D' n 'y� , lp _ .,)
6UILDING �� .//� 6��eLU�tL
�YotY_�� ;,..SZ
APPROVED
BV DATE
CORRECTIONS
STiTE THPT TME /�BOVE IS CORRECT AND 4GREE TO COMPLY WITM iLL
CITY OROINANCES �1ND STRTE LtWS HEGULITING BIIILOING CONSTRVC�
non. VALUATION
SIGNATURE OF 1� PERMIT FEE S �, �
PERMITTEE -<J � ,/
�� y� � PLAN CHECK S � � —
$ / /
AUTHORIZEO AGENT TOTAL FEE 5 3� SM�