HomeMy WebLinkAbout3069 TAYLOR WAY - Building Permits t ,
k CITY OF COSTA MESA
4 BUILDING DIVISION
F i , DEVELOPMENT SERVICES DEPARTMENT PERMIT MBER
4. %
PERMIT
"'bo.�mnonlwl�" i 05-01849
(714)754-5273 • Fax(714)7544856 • www.cl.costa-mesa.cILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 3069 TAYLOR WY Status: ISSUED
Suite: Applied: 10/14/2005
Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 10/14/2005
Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N
Parcel Number: 14160440 Zoning: R1
Applicant: DICKSON, MARK
Address: 816 E ADAMS AVE
Phone: ' 714-366-5663 ISSUED BY: /i
ORANGE,CA ,- Zip: 92867 - "i•-,••••
Owner: MC ARTHUR, WILLIAM
Address 3069 TAYLOR WY - - ..
Phone:
.COSTA MESA,CA Zip: - 92626
Contractor AUSSIEBLUE ROOFING •
Address: 816 E ADAMSAVE ' .
Phone: 714-366-5663
ORANGE,CA. `
Zip:/ 92867. . License: 834789
Arch : - Eng:
Address: - Address:
Phone: - - Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF RESIDENCE AND ATTACHED GARAGE:T/O 2 LAYERS COMP SHINGLES,REPAIR/REPLACE SHTG AS NEEDED, 1 LAYER 30#FELT,
i' APPLY"30-YEAR COMP SHINGLES'AND NEW DRIP EDGE AND FLASHINGS.3400 SO FT _ -
.. FEE SUMMARY .
Plan Check: $0.00 Calc Valuation: $9,200.00
' Permit: $181.25 Claim Valuation: $9,200.00
SMIP Res: ... . $0.92
SMIP Com: $0.00
Other $0.00
. Inspection:• -$0.00 -
Total: $182.17
' PLANNING &ZONING
SETBACKS .
MAIN STRUCTURE'Front 0-0 Rear 0-0 Left . - 0-0 . ,Right '0-0
ACCESSORY Front 0-0 Rear 0-0 -'% Left 0-0 • Right, 0-0
PARKING Existing: 0 ' Required: 0 . " Proposed: 0
R
Alp .
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
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
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
244846(aroo)
DECLARATIONS
WORKERS'COMPEN ATION 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.
O 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:
((TTh ,seition need not be completed if the permit is valued at one hundred dollars($100)or less.)
CB)certify that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers'
----- compensation laws of California,and agr e tha ' hould come subject to the workers'compensation provisions of Section 370ppp of the r Code,I shall forthwith
A comply with these provisi /0 //'T 1 _5"
ppllcant.Sl nature' ,/ rOate:, ` /
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADDITION TO THE MKT OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37060f THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licen ed under Rrovisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business gOd P_rpfe;cions Code,and my license is in full
force and effect.- 01-pk : raw-- i Class: n C C.S 't
Contractors-$ipnature:- se-
�0— /4— OS
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: Lenders 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: `1 Date:
Owner ID verified by driver's license. .)Yes 0 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(38)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:
I 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 0 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? 0 Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa 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 and 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 Duality 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 0 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 Duality Management District, -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 H081t a d Safety Code Section 42303 been made? ❑Yes ❑No
8 (If"yes",attach certificate of compliance from the uprtropriate aj ontrol officer).
CERTIFICATE OF COMPLIANCE:I certify that. rpenalty of juryklbe information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions('
Signature: fi!'ra- Date:
-. rvR
CERTIFICATE OF COM PeflgNGE'%7}tN1D 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 complyt iffiv$Ilfstate 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 inspd'ction purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
r / re• Legal Owner(s) Da—t77 ^GS
And/Or'Authorized Applicant.k.,-,
•
g,ODE 1 INSPECTION TYPE PATE INTRIALS CODE! INSPECTION me PAIL UTITIALS •
1616 Fixed System Final Fire Prevention 206 Final Mechanical •
1266 Pool Spa Final 208 Final Plumbing .,
200 Final Re-Roof I9'L7-D, `6 t" 210 Final Electrical
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
APPLICATION FOR A BUILDING PERMIT
Electrical
BUILDING PERMIT NO. CC
Tract 5/562 Block Lot '50 Per it No. 0
=
o /9 Me nanical 0.
PIu Ping =
Building 3 0
Address Ooty 7,-Ivi_a_ A}A,/
.,5 aPer It No. to
>
Cross
Area Street Pe mit No. a
P.
Owne4EQ €2)e: (4-Aft Type of Project: 0 New D !ter 0 Addition :
,
I
0 Repair 0 Convert 0 Dern: 5 occupancy Pmt. I
Address ?OG g _7-ffzet wily
$ P. DiSt./
Citye,s:7 x/ties, Zip qD6,-?6Pnone:#53-70 .,cA.P. In p.Area I
I
I
ArChlter Zone So .Pmt. No.
Designer'Synte Ac Afry,;ez, License NO.
Setbacks P/L Front CIL -t. Street Width
Address
Yards Left nigh Rear
City Zip Phone
Cave Proj. Left Righ
t Engineer A1,4 License No.
I
0 / Parking Spaces 1 kequirea I I'Idvi'e I Covered
.-
a Address
=
Struct No.of No.of
a City Zip Phone Height Stories Family
a
(.3 LICENSED CONTRACTOR'S DECLARATION Park Fees H Yes Fee
to Required No C.T. Receipt
cT, I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000 of Division 3 of the Business and
.0 Zoning Approved BY: Date
.... Profesubns Code,and my license is in full force and effect).
License Class License Number
Misc.
d- Date Contractor
E Address Proposed Use
L of Structure
LT. City ano Zip Phone
in CONSTRUCTION LENDING AGENCY
vi
I hereby affirm that there is a construction lending agency for theTyPe Cooe
..9- Performance of the work for which this permit is issued (Sec. 3097, Cons:. Year .
" Civ. C.). .C°IcaCs;
6 Lender's Name USE/OCCUPA Y SIZE SO. FT.
c Lender's Address
OWNER-BUILDER DECLARATION
-Y
... I hereby affirm that I am exempt from the Contractor's License Law
at
\fin the following reason:
C)
N I, as owner of the property, or my employees with wages as their 2.
c sole compensation, will do the work, and the structure is not
intended or offered for sale.
... r
LI I, as owner of the property, ern exclusively contracting with
licensed contractors to construct? the pr j ct.
0 I am exempt/ under Sec. ) , yr this reason
, ,,
Datitan-h/o"Sf Owner otga_ . tivry
E WORKERS'COMPENSATION DECLARATION Total Valuation
8 I hereby affirm that I have a certificate of consent to sell-insure.
Encroachment Permit Required 0 Yes D No
or a certificate of workers' Compensation Insurance, or a cerlif led
E Copy thereof. Grading Pmt. Eves S
3 Policy NO Company Required Lives El No Pmt. No.
= 0 Certified copy is hereby furnished.
0. r Rough Grading '0
a L.1 Certified copy is filed with Orange County,EMA.
edC Approved by: Date Et
Date Applicant =-,
-.
CERTIFICATE OF EXEMPTION .-
FROM WORKERS'COMPENSATION INSURANCE 2
(This section need not be completed if permit is for $100 or less). c
I certify that in the performance of the work for which this permit is 3
Cr
issued, I shall not employ any person in any manner so as to become nt
subject to the Workers'Compensation Laws of California. PERMIT FEES ,
Date Applicant I
NOTICE TO APPLICANT: If, after making this Certificate of Structural $ Plan check $ I
Exemption, you should become subject to the Workers'Compensation I
provisions of the Labor code, you must forthwith comply with such Electrical $ Special
$ I
Provisions or this permit shall be deemed revoked. Invest.
i
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE I
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO Plumbing 1 I
COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS 1
RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTH- Mechanical $
1
ORI R PRES' -cATIVES OF THIS COUNTY TO ENTER UPON
TH ABOVE 'E
$
...
TIO ED PROPERTY FOR INSPECTION PUR. Pre-Grade
$
I
.1.1 f aisa.1-......... 41/(0:I/ Inspection
7
Pre-Grade 17 Permit I
Date ReC.No. $ Issue $
i
sig141SAirl
Print Apnlicant's/Arrd's Verne
Plan Issuance i
Ai spaces within this box must be completed to process check BY: Approved: I
l
CMF 0335-46(BU-28) rev.6/80
-
OWNER ROGER R. YENNY DATE 6-16-81
JOB ADDRESS 3069 Taylor Way BUILDING PERMIT NO. 9201
GENERAL CONTRACTOR Owner/Builder DESCRIPTION of WORK Garage expansion
AP No.. 141-604-40 LOT 30 TRACT 4565 FIRE ZONE VALUES 3,000,00
Signature Dote TYPE V—TVGROUP M ZONE Rl
SUBCONTRACTOR PEpMITS ISSLED
GAS • Data l Number Signature
WATER - Plumbing
ROUGH PLUMBING
PROP. SWR. LINE n HOUSE CON. U
SPRINKLING SYSTEM
•
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
Q UNDERGROUND f 'POWER
ROUGH WIRING q1-
Heating and Vent.
j
=TRENCHES IJ FORMS STEEL REINF. Q' J S -a'1
r-I
FLOOR SYSTEM
Z BOND BEAM [1 STEEL REINFORCE n
JSHEATHING
a_FRAME AND FLASHING / h-t4- .
n R
LATHING - IN OUT e.
PLASTER, BROWN COAT Dsj 1
STRUCTURAL, FINAL • IIC)5 / Electric
H G, VENT., REFRIG. AND A.C., FINAL
IL....BING. FINAL AND GAS TEST n
ELECTRIC. FINAL {�
BUILOINSH FINAL PS J0/7J(7}7
c.
V
✓ I Sa0//
•' COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
RECEIVEq2V ,PERMIT �-�., t (J
• For Applicant to Fill in Completely— Use Ink Only r X41 1■
BUILDING may' /'j /� /^ A,P-NO. //// 56W6/I F(/�°.d 61 .02 TL
ADDRESS 3067 OytC i/�M< i (
BUILDING /
OWNER
OR D' 1 r / ADDRESSC o 6 7 /A7Loe km y
Tn UNIT OR
MAILING ADDRESS %Z V.,/ 1/.�G &AN SPACE NO.
TR.NO. LOT 90
BLK,/ NCITY &gf/ //�S/} o.q1 -ra .4.5 / 5
NEW ADD ALTER REPAIR I MOVING I DEMOLISH
CONSTRUCTION
LENDER &A,
0
BRANCH
OWNER R . • ytelotML
ADDRESS VALUE
ARCHITECT TEL. USE6(.4•CI4, tbCP• s3coo' )
OR ENGINEER NO. ,^ /
•
ADDRESS ZONE K/ ITVP N GROUP ('/
l/ APPROVED/ ' // [7�
CONTRACTOR (9/OA/FQ_"/'Ysct It' 7C/4.arti BY /,�if DATE dn/J// -
ADDRESS.'7.,,I�n9f /N'/fp,Q �A1 / ///
/q //, /� / TEL.
CITY ( i-)37-4 �•t-IA NO. 51-/cp.x
.F-, STATE CITY APPROVED SETBACKS''11 /� (`,r
LIC.NO. LIC. NO. Mot I-1T fec1 eJ
Imi SIZE / IND.OF BLOCS. (FROM C/L STREET/
P. OF LOT /JOa t� ,NOW ON LOT / FRONT FT.
Q USE OF //
En EXISTING BLDG. /C S$/OC/V,'s R SIDE FT.
N
9 Separate permits are required for L.SIDE FT.
C electric,plumbing and heating work. REAR FT.
(W., USE OF BUILDING AND WORK TO BE PERFORMED
PLANNING ACTION
Q
'
.0„DATE /AvrJ�/J)/./ or4..1446 St ( 5O APPROVED 6
—12- DIQ /i
>. �/amiN// ,r(L/S [ Q . LS/G.H� ROVE ` DATE
/
C 71
W
0 I hereby acknowledge that I have read this application and state n
pv that the above information is correct and agree to comply with
Of all lows regulating building construction, and I shall not employ S
Z any person In violation of the workman's compensation laws of e
S the State of California. �J .:
1 }�� m
I hereby certify that I am properly licensed as a contractor under SQ. FT. N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force end effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: to—
am
am exempt from sne'provision3gf the State of California BusinessVALUATION ^ Y
and Professions Code, ivisiorG3„Chapter 9. PERMIT FEE s 3g.� v ,a
/ m
PLAN CHECK $ ,p 2 m
Signature 2
Permittee rrr� � $ �oO� ..T TAX $ }
LL
/ v -
/ Authorized Agee Date U .....,-g \ TOTAL PAID s 6� o z U
OWNER Seaview Homes, Inc. DATE 6-19-62
JOB ADDRESS 3069 Taylor Way BUILDING PERMIT NO. 17321
GENERAL CONTRACTOR S. V. Funsaker & Sons VALUE $ 114253.00
AP No. LOT 30 TRACT 1f565 FIRE ZONE DESCRIPTION OF WORK res watt gal
INSPECTIONS Signature DATE GROUP I&.T TYPE aV ZONE RI.
"`L�.yF t_i -2., -li 7i /Ms�7-1-0i - PERMITS ISSUED
7YT{f g-4-ea SUBCONTRACTOR DATE NUMBER
Nr,ater •..,'/ .Z s( _
Rough Com. Re rig. 0 Air Cond. 0 /
Rough Heating (,( J _ y./
Rough Plumbing 1144-5 ?-?/- 6-2.•/ (iY _ ! .7712— ✓�
Miscellaneous f eLe t/ 6-2-'—s: 3 -$' i 1�
Prop.Swr.Line R-House Con. 0-St.Swr. 0 pV %d e.�cv.4 4, }f19 (17-C. )'ti $U gID',�1n
Sprinkling System ,/
Constructio�olc
{ '51i
Underground ❑ Power ❑ _ _ \ 0 �'
Rough Wiring �r'!i l'el,,/7."e ,,//-927�hr:; ire., 7-f, a/W/
Trenches 0 Forms 0 Steel Reinf. ❑ 46 7=_C_ y a,_...-
Floor
iFloor System
I3ond Beam 0 Steel Reinforce 0
Sheathing , Zh�yi
Brameme and Flashing
�y !j'
Lathing — In [�—Out O' /r E- 7-2-0-61,
Plaster, brown coat N*mod v-1f-(>v
Refng. 0 Air Cond. 0 Final
Nang, Final / J2 /6 GL
F7,7t',Thing Fixtures, Final Anse ���'��
Final Gas TestIS- /�' /.7
Electric Fixtures, Final k-t7 /O-/9-=v
Building, Final 444 C To 221i
OCCUPANCY 17321
FORM BU4•5M - 7.61
FEifr RECEIVED
17321
COSTA MESA BUILDING-SAFETY DEPARTMENT 'i FINRIV5d ? -.
P. O. BOX 917 COSTA MESA. CALIFORNIA
- CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT t C
UILDINGBUILDING
ADDRESS
306 '7 77.1-F/49 .- g/4-y
COSTA MESA. CALIFORNIA For Office Use Only
1 RECEIPT NO. I PERMIT NO.
OWNER SeavieW /IMPEL Inc.. f §'2I
ADDRESSMAIL 1602 w. Almond RECEIVEq�: DATE REC9IVEy_ DAT. I B
[icy I Ce /774' JUN 1 0 7962
TEL. BUILDING
CITY Orange NO. ADDRESS
ARCHITECT DD TE I
OR ENGINEEIi`RElbe Ig & Lowery N 1.76131 COSTA MESA. CALIFORNIA ,'
ADDRESS 2127 N. Main St., Santa Ana FIRE
ZONE TYPE GROUP
CONTRACTOR S.V. Hunsaker & Sons APPROVED
BY DATE
ADDRESS 15855 E. Edna P1. ZONING 1
ZONE NO.OF Use OF NEW-1-'4) L As
CITY TSWincla 1e • !\ —j I PUNS Z I BUILDING W/
STATE
164929 TEL. f-ED. 87361 LEGAL L o 3 a TDP v SLs—
NO. DESCRIPTION
SIZELOT /�./6 O /D Z I NONow. OPoN BtoiIDGE. O
OF A.P.NO.
USE OF YARDS EVES
EXISTING FLLDG. --- APPROVED ALLOWED
SETBACK LINE FROM . .51/ (CENTER LINE ST.)
CENTER OF STREET CO€ O / REAR YARD`T� FRONT SO FT. IN.
SIDE YARD ( LEFT C.i I RIGHT C.
R.SIDE -S---- FT. 6 — IN.
DESCRIPTION OF WORK L.SIDE � FT. N.
NEW I X II ALTERATION I II ADDITION I REAR a. 8 FT. IN.
REPAIR I II MOVING I II DEMOLISH I BYPROVED
L< /B
�/4L/c4'/^^ DATE
SIZE
LDI /y !/ NO. OF
ROOMSSTORIES 1
EXTERIOR WALLStucco I ROOF omp• J �'-7 7�
COVERINGy4({{AQ COVERING { />Y/VSFi .. � //(IQ
USE OF BLUCDTRCAND WORK TO BE PERFORM
.. :Ali_ dwellin. with ' a 4 „e .7 _ . i
attached garage
Plan Oo p- Y
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- PURPOSE OF ESTABLISHING A PERMIT PEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION
SIGNATURE OF S. V� VAKER .. SNS PERMIT FEE $ f�
ci
PERMITTE ,/
�a $ / / � PLAN CHECK $ A27 r x
AUTHORIZED AGENT 6
TOTAL FEE $ 72 --- 0
r COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ^^^^ •"r '^^ "'^ 23 TL
RECEIVED Y (PERMIT N° 49967
For Applicant to Fill ink/Completely—p Use Ink Only 4//
/ x(11
ABDIDRESS / D69 / // VLoF iv" / A.P.NO. / / /-/(r�X./ Cr(/stt— TO�����j
TEN NT 5TF--0E (� fu ■I Y ADDRESS 3i 6/7y TRY or wadi
TENANT / L tV� G [/ [i V 1V
UNIT OR
MAI LING
ADDRESS S 441..,t SPACE NO.
h23-7OL re
TLG�f 73 v
LOT 3 /•, (ELK.
CITY
NEW ADD ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION
LENDER C A/,l 4rti.
BRANCH �/
OWNER S4-eVt- /` ea de %
ADDRESS1 , VALUE
ARCHITECT TEL. USE Ae.c, ,CLe n4-/W i E )
OR ENGINEER NO. �j _J
ADDRESS {{�� /J�/ Q p s---R.
�/� ZONE � 1 TYPE__ GROUP R•-3
CONTRACTOR�r .(� I• ` LT /t At p {�[<S
APPROVED V DATE Li.I 7-go
ADDRESSJq`' .s rt. CT,f'RR ley.I/- ii, �j �I�/�
CITY ITN II L•/ eJ(/V. 779/790
I. p.,(y APPROVED SETBACKS
�0.�y+ LC NO. /7ZCo , LIC4/,S? / (FROM L7STEE ).74
(4 SIZE /�
0 OF LOT ‘e '( L o o f I NOW ON LONO.OF BLOT ! FRONT C ( /RFT..
Q USE OF
ti /
/ /�j1 EXISTING BLDG. _p 4- . Re
-s _R.MP FT.t
/�F74gfr.T.•••••••"..-
Separate permits are required for L.SIDE /1Jfa electric,plumbing and heating work. REART. VFUSE OF BUILDING AND WORK TO BE PERFORMED PLANNICTION
0
.7 Apo •.lU KA., g PI NLf-sG RA._ TE
APPROVED
y, 5 KTLt c qr.: (y 2- a(-T�s . "�RO(�[) P DATE 7'/!
IX
W
0 I hereby acknowledge that I have read this application and state n
y2 that the above information is correct and agree to comply with
0i all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of o
the State of California. ��� / -CO /,
7v m
I hereby certify that I am properly licensed as a contractor under SO. FT. N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: '-
am exempt from the provisions of the State of California Business
and Professions Code,Division 3,Chapter 9. VALVATION PERMIT FEE $ $(�..
In
PLAN CHECK S L//L-�- z
Signature of 77 IL
Permittee s� $ 7 TAX $ is
or .�j� ^7 Pill l I �� r I ' Z3 V' V
Authorized Agent Date / — /7— v TOTAL PAID E 12 1. 2 3