HomeMy WebLinkAbout3050 CEYLON RD - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
BUILDING PERMIT
Job Address: 3050 C�YLON RD
Suite:
Vicinity:
Parcel Number: 13918110
Applicant CRANK, JIM
Address: 126 COMMERCIAL WAY
COSTA MESA, CA �
Owner: SCHWORER, THOMAS
Address 1816 KINGLET CT �
Zoning: R1 R1
Phone: 949-548-5569
� Zip: 92627
Phone: 714-545-7983
COSTA MESA, CA Zip: 92626
Contractor. CRANK BROS ROOFING CO INC
Address: 126 COMMERCIAL WAY
COSTA MESA, CA
Zip: 92627
Arch :
Address:
Phone: (949)548-5569
License: 794724
Eng:
Address:
Phone:
77 FAIR DRNE, COSTA MESA, CA 92626
ISSUED BY:
Status: ISSUED
Applied: 04/02/2002
Issued: 04/02/2002
Phone:
Zip: License: License:
SCOPE OF PERMIT
RE-ROOF. TEAR OFF, INSTALL FELT AND APPLY 30 YEAR SHINGLES. . �
Plan Check: $0.00
Permit: $125.25
SMIP Res: $0.55
SMIP Com: $0.00
Other: $0.00
Inspection: $O.Ob
Total: $125.$0
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Frant 0- 0
PARKING Existinq: 0
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Praposed: 0
Calc Valuation:
Claim Valuation:
Right 0-0
Right 0- 0
$s,sz�.00
$5,521.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitomia statutes and related
regulations. (Orcl. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a penod 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 Inapeetiona and final epproval must be obtained. Faiture to obtain inspections and final approval will result in the expiration of this permif.
� FOR INSPECTIONS CALL: (714) 7545626
�aau-an�r�oo�
WORKERS' COMPENSATION DECLARATION: �
I hereby aHirm under penalry of perjury one ot ihe following declarations:
❑ I ha a and will maintein a certificata of consent to self-Insure for workars' compensation, es provitled for hy section 3700 of iha Labor Code, tor ihe pertormence of the
, w tor which Ihis permit is issued.
will
s requiretl by section 3700 ot ihe Labor Code, for ihe pedortnance of �he work tor which this pertni� is issued.
mber are: J_ /� ��� N O�
— � Policy Number: O
ane hundred dollars ($100J or less.)
❑ 1 certify ihat in ih perfor nce of ihe work for w�c his permi ''ssuetl, I shall not employ any person in any manner so as to become subject to ihe workers'
compansation la of Ca tornia, entl egrea � 2fl ou ome sublect to the workers' compensation provisions of Section 3700 0l ihe Labor Code, I shall fotlhwith
Comply with �he5e ovi lon5. L�, y/ �/7
Applicant Signature: Date: ! ��� O l�
WARNWG FAILUR SE RE WORKE S' COMPENSATIQV COVERAGE IS UNLAWFUL AND SHP1L SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSANO E($ ,OW),INA�DITIONTOTHECOSTOFCAMPENSATION,DAMFGESASPROVIDEOFORINSECTION3]O60FTHELABORCODE,INTEREST,ANDATTORNEY'SFEES.
LICENSED CONTRACI
I hereby aHirm that I am
torce antl ettect. Lic. q_
Contractors SignaNre:
CONSTRUCTION
❑ I hereby aHii
Lenders Name:
Signature: _
with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full
class a
Date: � —
AGENCV:
s is a constmction lentling agency for ihe peAormance ot the work tor which this permit is issued. (Sec. 3097, Civil Code).
Lenders Address:
Date:
OWNER•BUILDER DECLARATIONS:
I here6y aHirm that under penalty of parjury t6at I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Business end Protessions
Code: Any ciry or county which requires a permit to consiruct, aiter, improve, demolish, or repair eny stmcture, prior to its issuance, also requires the applicant tor such permit
b file a signed statement ihat ha or she is licensed pursuent to lhe provisions of t�e Contractors License Law (Chapter 9(commencing with Section 7000) of Dlvision 3 of ihe
Business and Professions Code) or that �e or she is exempt thereirom and the besis for ihe alleged ezemption. Any violetion of Section 7031.5 by any applicent for a permit
su6jects ihe epplicant to a civil penalty of not more than five huntlred tlollars ($500J.):
❑ I, as owner ot the properry, or my employees with wages as iheir sole compensa�ion, WILL DO TME WORK, and ihe strucWre is not inrendetl or oHered for sale (Sec.
7044, Business antl Protessions Cotle: The Contractors License Law does not apply to an owner of propehy who builds or improves Ihereon, antl who does such work
himself or herself or through his or her own employees, provided that such improvements are noi intentled or oflered tor sale. If, however, Ihe building or improvemeN is
sold within one year oi completion, the ownar-builder will have ihe burden of proving thal ha or she did not 6uild or improve for purpose of sale.).
❑ I, as owner of the proparty, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct the prolect (SecJ044, Business and Professions
Coda: The contrectors License Lew does not apply to en owner oi property who builtls or improves tharaon, and who conirecls for such projact with a contrector(s)
license pursuant to the Contracbrs License Laws.).
❑ I am exempt untler sec.
Signa�ure:
Owner ID verified by drivers license. ❑ Ves ❑ No
Business and Professions Cotle for this reason:
Verificetion ot Ownership by (type of document, i.e. - pwpeny tax bill or tleetl):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
Drivefs License No.
Date:
Expires:
❑ I hereby cenity Ihat no excavation five (5) or more fee� in depth in�o which a person is required to descend, will be made in connection with work authonzed by this
permit, end ihat no building siructure, scaHolding, talsework, or demolition or dismantling ihereot, wili be more �han ihirry-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, TiUe 8, Califomia AdminisVa�ive Code).
❑ As owner-builder, I will not employ enyone to do work which would require a permit imm !he Division of Industrial Setery, as noted ebove, unless such person has e
pertni� �o do such work from �he division.
Signature: oate:
Division ot Indusirial Safery Permit Number:
CERIIFICATE OF COMP AND AUTHORVA710N OF ENTRV: I certify under penalry of perjury that 1 have read this application and stata that ihe information given is
correct. I agree to comply wrth a s;ate laws entl city ortlinances relating to b ilding construction, and authorize representatives of the Ciry of Costa Mesa to enter upon Iha
above-described properry or insp ction puryoses. I agree noJ.f�yccupy or�w wcupancy of any building authorizetl by �his permit un�il final inspec�ion.
LODE �,
1616
1266
Pinal Fire Prevention
Poal Spe Finel
200 Final Re-Root
201 Final BIocWRetaining Wall
202 Final Factory Fire Place
203 Final Sign
204 . Final Demolition
PA7F iK*mn�s
�-a '� �
Date
COOE 1 INSPECTION flPE
206 Final Mechanical
208 Final Plumbing
270 Final Electrical
212 Final Fire Preven�ion
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
PAIE II�d13
. .. � .
�AOJECTPDDPESS: 3OSO CEYLON RD
OWNEfl'S NRME: F7R�ED MORRISON
AO�flESS: 3 V SO CEYLON RD
COSTA MESA,CA
434-7832
� AHCM/ENGINEEfl:
FDUflESS:
�
�
�
�
UNIT;
92626
PEG.NO.:
UNIT:
PENMITTEE: FRED MORRISON ( 719 ) 439-7832
RODflESS: 3OSO CEYLON
CM CA 92626
LICENSEU CONTBACTOH �ECIABPTION: I hereby aflirm Ihai I am licensetl untler pmvisians oi Chapfer 9(commencing with Section
7000� of �ivision 3 0l Ihe Business and Professions Cotle, and my license is in full torce antl effect.
CITY LIC.: STpTE LIC.: CLASS:
Oa�e: Signa�ure:
WOBREPS' COMPENSRTION OECLFBATION: I hereby alfum that I have a certilicate oi consent to seli-insure or a certilicate ol WOBers'
Campensalion Insurance. ar a certi�ietl copy Ihereol (Section 3800. La�. C�.
POLICY NO.: E%P. DATE:
COMPANY:
❑ Cehihetl [opy is �ereby lumishetl. ❑ Cehilietl copy i5 �ile0 wilh the ci�y Builtling Division.
Oa�e: Applicanl:
E%EMPTIONFNO OHREHS'COMPENSPTIONOECIAflPTION: (i�issedionny� no�becamplet�bi�� rmili5foroneAun4re0�5100�or1e55�.
I ce�iiy �ha� in e petlor nce ot the work for which Ihis Oermit' iss e! hall noi employ a F�son in any manner 5o as Io become
su�lec� tp}'�e orkers' q��nsa�ion Laws ol Califomia.
(//� Z G
� oaie. r� Signa�ure:
NOTICE: I�. a��er making Ihis tleclaraiion, you shoultl become 5 bleci �o Ihe Workers' �ompensation pmvisions ol �he Labor
Cotle. you must fotl�with comply wiih such pmvisions or this Dermi� shall be deeme revaketl.
COhSTRUCTION LENUING AGENCY: I hereby aifirm �hat Ihere is a consimc�ion lending agency for the pedormance o� �he work for
which Ihis permi� is issuetl (Sectian 3W7. Civ. C�.
LENOEfl:
aooeess:
OWNEfl BUILDER OECLANATION: I here�y a��irm �ha� I am exempt imm �he Comracmrs' Slate License Law for lhe fallowing rea5on
�Seclion 7031.5 Business antl Pmlessional Coee: Any ciry o� couniy which reQuires a permi� ro consimct, alier, improve, tlemolish, or
repair any 5imclure, prior to i�s issuance. also requires l�e ap0licant lor Such permii �o lile a signetl 5�a�emeni �hat �GShe is licensea
Dursuam Io ihe pwvisions ol ��e Conirac�ors' State License Law (ChaD�er 9(commencing with Sec�ion 7000) of Division 3 of �he Business
anG Pm�es5ion5 CoOe) or Ihal �e/s�e is exempi thereimm and Ihe basis �or the allegeA evemption. Any violalion ol Sec�ion 7031.5 by
any applican� for a petmii sublects I�e applicant Io a civil Oenalty o� noi more Ihan live huntlre0 dollars ($5011).
I, as owner of Ihe pmpeny or my emDloyees wilh waAes as their sole compensatioq will tlo Ihe work, and Ihe
❑ simmure is nol imenOeA or ofieretl for sale (Semion 7044. Business antl Pmtessional COAe: The ConUacbrs' S�a�e License Law
Does not appty Io an owner ol a pwperty who �uilas or impmves ihereon, and who does such work himSelVhe�sell or �hrough
his ar �er own employees, pmvidea ��at suc� impmvemenis are no� in�endetl or otteretl tor sale. tl, however Ihe 6uil0ing or
impmvemenl is sold wilhin one year o� comple�ion. �he owner will have Ihe burtlen o� pmving he/she tliA no� 6uiltl o� impwve
lor Ihe purpose o� saleJ. .
I, as owner oi �he pmperty, am exclusivety con�racting wiih licensetl conlraclo�5 io cons�mq �he pmjec� (Section 7044, Business
❑ anA Professions CoOe: The Cantrac�ors' Sta�e License law tloes not apply lo an owner of property who �uil or impmves �herean
antl who canlracis lor such pra�ec�s with a conVactor�s) license Dursuan� �o �he Conbac�ars' Sta�e C e Law�. I am aware
Ihal pmo� o� Iheir Worker'S Compensation insurance 5�ou10 be pmvi0etl m me.
}� Iamexe unOerS ��o�:BP7044 B.BP.C.
ior nis ason: LL WORK BY O
,:
�a�e: 0� er.
I tlo nereUy cendy iha 1 am aware ol and unAerstan0 Ihe requirement of Calitornia Healih and Safery Co e Sections 25505, 25533, anJ
2553a antl ihat I or any luture buil0ing acwpanl will/will nol �circle one� nee0 io comply wi�h saitl state tles antl Ihe reQuiremems br a
permii foi con9mc�mn ar motltlicaiion Irom Ihe FIr Ouality Managemeni Dislrici. FeSitleNial coretmc�ion ap0lica�ian5 are exempl �mm
ihese pmvisions. '
�a�e: Appl¢anL
I �ere�y cenily I I I have ead Ihis application antl sta�e Ihal Ihe a�av ormation is correci.
. ortlinances ana alelaws ela�inglo builtling conslmc�ian an reby aul rzerepresenlatives of
I pmpetl r i pection wposes
Dale'. � � � SignaWre:
�„�,,.,
-
16aLa6 While—Bwltling; Green—Cotle Eniorcemen�; Canary—Applican�; Pink—Revei
comply wiih all ci�y and couniy
en�erupon��e a�ove-mentionetl
Goltlenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 06408
PERMIT NO: B 064089 PLAN CHECK NO; N GOVT: N SUPP; N
CONSTRUCTION TYPE; PERMIT TYPE; STR PURPOSE; ALT
JOB DESCRIPTION : CONVERT FAMILY ROOM BACK TO GARAGE SQ FT: 1,000
CLAIM VALUE: 1,000.00 CALC—VALUE; 1,000.00 GROUP OCC: M-1 /
COMMENTS: CONV, FAMILY ROOM HACK TO GARAGE, REINSTATE EXPIRED PERMIT#B56535
+r�r******x��rx�r*r+r*x�r***x�r**�x****+r�r����+r*�r�r***x�***�r�***+r+r+r*x�***��*+r*x�+�*****rx�**x��
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 IN REAR: FT IN
LEFT: ET IN RGHT; FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ� PROV; PARCEL: 13918110 ZNE: REF NO:
PLANNING N6'I'ES>
i
**+rx�rx�r��*���r*x�r*�r*�r**���*****rt+r+r*�r**��er�x�*x�*�rr�*�kx�rx*�r�x�x��x��r*****�r**��r**��+�+�
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 APPAOVED BY ;
APPLICATION ISSUED BY:
DATE;
if iF fE if iE 1f if if if 1f �It �f if 1f 1E 1t iE if if 1E iE 1E if iE iE if if iE iE iE 1f if 1F iFlf if iE if ft iE iE IE 3F iF iF it iE k K 1f iE if iF iE iE 1E iE if if iE iF �E iE iF iF iE iF i! If ip IE 1P IE K iE iF iE iF iF
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 25.00 .50
SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE pLAN—CHECK TOTAL PAID DUE
TOTALS----> 25,50 0,00 0.00 25.50 25.50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 25.50 OVER/SFIORT: ,00
BLDG PMT PLUMBING ELECTRIC MECRANIC FIAE SMIP/TOT GRADING PLAN—CHECK
25.00 .50
3f!! 1E it 1f it it i! if if iE iElklk 1Elf *!f ff if iE ik 1E i! itl4 iF iF if !F 1f iF 7E iE 1E if !F M!F!E!! if iF iF 1F 1f 1Elt fE 1F fF if iF M it i! It if iE IE if iF if iE iE iE iE ft 1F fF M �E iF if 1E iE 1E 1F if
I N D I V I D U A L F E E H R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 1000 ALTER BY VALUE RESIDENTIAL NOZONE 1.00 1,000,00
END OF FEES
EXPIRED
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o �� �
� SEP 21
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CITY Or ��� r V':ES
.
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° CONSTRUCTION ANOPLANNING
•��� APPROVALS Permit,f
� j i,^� emparary Eiectrical Service or Pole
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2. So.' P;�,,•�Undrgrrtd�
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.�: �ee� ��cin`orcait7ent
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r 3 Foundat�on
! 9 V;atcr P�P��Undrgmd.
: 10. S�ructwa' 'rlcar System
11. C�opc�ty Se�,9er �ir.l� & Nouse ConnecLon
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-i. F�i-i Ora�ns
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� �5 Ru:yh Eiectrical�Condurt
lfi. Ra,.qh Flect�ic?rViring
� 17. Rough !7�nnq $iyn
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19 Ruugh Hcanng � A�r Ca�o�hon�ng
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Dute Inspector AP?ROVAI_S Permit;�
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52. Pool & Equ�pment Locauon
53. Steci Re��forcemert
5G. ;nrn��,-----------
55. Eleclrica� Bond�ag
56. Rough Plumbing w Pressure 1�esf
5�. A°'RU\�Ai. ?0 COVFR GUi�;'�tE
58. EIecV�ca;Cordut�U^chgmn. �
$9. Gas �'pc:, '.= UndrG�nu.. Trst
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60 BaC�evash L�nes P-Trp -' U•�c1'��
Da!e �Inspector
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67. APPROVAL TO DFCK �
i T�__�
62. Back�aeah t4 R?ce�ro•�f��al � � �
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64. Plumb���g SVstem � Fn,.! . j � 1 I
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65. Eicctrical�Fina! '� � �
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G6. So�ur Sy�tem�Fino� � �� I
G7. Fencing LL Acce4, Auu�ooal
68. APPFOVEO FO,R PLASiERI�'G
69. POOVSPF�SYSTE.`.".S':��!AL
FINE UL-Pf. NEC]UIHEiV,EN i
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� ' . -_�; " - v..T_'• -_"T._____�_-_._____-. _�
;,,;� Gas cc +!ceS�naf1 . ~ y,r..� r ' � x . :i'� .�;ti II
-3.'-----•, . � �}: ' r -- -- 1
::41. Solai Oomes'.2-Pin6'� " '•� -I� � -
�� . t,+ ' t�# tr' -t_� _ �
� F., ' _i ,. . - ' _ __ _ __ __-_--�
1,42:'^uackflovr Preverj�A� 'i l
43. Bzckftow trrigati€n �.V . . ,
___ '.�5�_ '�
.. i:
_4<. i_zndsc�ye i��r�qatiqn SVstcrr�..,;�^,
'-4�.'So,:nd Attenua�Tit
_ " ."', 's
� 4c'��;H:.ndfrao Regul�!n`ns �
f�41: F I!SAL STF?'i'JC'F�1 & Bl
` �4
' 48..f-Ii�AL PLFINNI�(`p
�4C.-�Eler.ric Release:uxEdison
'5Q•6as Re0.'ase to Sou�hem Ca
..51. CERTIFtCATE OF (ICCUF
Date
7
�F . v p .
r_.RAt> ^ 1 ,-
7; , � U -•
Ct .
-----_-�'� `.�
� ---.i.. :'_-•
7• r
Gd5 CA X
r -'-
� y 7
�aaECTnooevss: �OSO CEYi�ON ttD
O41+ieP'S�NAI��. pnE:D N.ORR:Sl7N
AOUNESS: 3USO CEYi,OV RD
t
COSTA XESA,CA
ABCH/ENGINEEfl: �� 34 � �832
ROOflE55:
UNIT:
92626
flEG.NO.:
UNIT:
PEPMITTEE: �;REU YORCIISON ( 7i4 ) 434-7832
ADONESS: "j O J O C EYLOn
CM CA 92626
LICENSE� CONTHRLTOfl DECLAPRTION: I hereEy aftirm Itw1 I am Iicense0 unGer D�a�sions ol C�apler 9lcommencinq wiN Section
7000� a� Drvisian 3 DI I�e BUsmess anU PmI¢Saons Coae. an0 my li[¢n5e is in lUll forCe and efleCl.
CITY LIC.: STRTE LIC.: IXASS:
' Dare: SipnaWre:
�i WOflI(EBS'COMPENSRTION�FCLAflRTION: 1�¢r¢CyaltifmlhallhaueaC¢rli�iWleoltoRSenlloutl-in5ure0racerli�italea�WmkeR'
Compenution Insurance. or a cenilieE copY ��ereol (Section 38W, Lab. C).
�� POLICY NO.: E%P. ORTE:
COMPANY:
❑ CeNlietl cooY is AereEy Wmi5Ae4. ❑ Cenilie0 wpy is liled witA Ihe ciry BuilAing Division.
,. APPIiWnI:
k%EMPfION iflOM WOBREPS'COMPENSATION OECIAfl�TION: Qhi55etlion nee0 no�betomDl¢�edil IR permili5lorone hunGre0�3100)Orless�.
I ce�ity Ihat in Ih petlor tante o� Ih¢ work Ior whic� �hii permil is iSSUP . 5�all n0� ¢mpl0y � person in any manner so as �o become
5u01ecl lo Ihe V rkers' ompensation Laws ol Califomia.
, Oa�e: � SiqnaWre:
NO7ICE: II. after makmq tnis aeclaration, you snoultl became suelect to the Woder mpensation D��sions ol Ihe LaEor
Code. yoU mus� �otlhwi�� tomply wil� Sut� Orovisions or IhiS permil Shall Ue tleeme0 revoked.
CONSTflUCTION LENOING AGENCY: I hereby alfirm thal Ihere is a wnslmc�ion IenAinA agency for ��e pertormance o� Ihe work for
wnicn tnis oermit is issuea (section 3097. civ, c�.
IENOEfl:
AOONESS:
OWNEfl BUILDEH DECIABATION: I Aereby allirm that I am exempt fmm t�e Contracmrs' State License Law for t�e following reason
�Section 7031.5 Business and Pmfessional Cotle: Any ciry of counry which reQuires a permi� m conslmct. atler,improve, demolish, or
repair any slmclure. prior lo ils issuance. also reQuires the applicant br such permit to file a signe0 slatement that he/she is Iicense0
pursuant �o I�e O�ovisions of ihe Comractors' Stale License Law �CAapter 9 �commencinp wiih Section 7000) ol Oivision 3 of ihe Business
ana Pm�essions CoOe) or Ihat he/she is ¢xem0� iherelmm anA Ihe basis �or the allepe0 eaemp�ion. Fny viola�ian o� Seclian 7031.5 �y
any applicanl lOr a Dermi� SuDjetts I�e applicanl l0 a Civil penally ol nol more �Aan live huntlred tlDllars (5500).
I, as owner of Ihe property or my employees wilh wages as their sole compensalion, will tlo t�e work, and the
❑ s�mcmre is not intenUed or ollered for sale (Section 7044. Business an0 Pmlessional Cade: The Contractors' Stale License Law
Eoes not apply la an owner ol a pmDe�Y who Euilds Or impmves thereon, antl who does such work Ilimself/herself or Nmug�
his or her Own employe¢5. D�ovi0e0 I�aI Sut� improv¢menls are n0I in�entl¢tl ar ofleretl lor Sale. II, howevef Ihe �Uiltling Or
impmvement is solE within one year ol completian, ihe owner witl have Ihe Uurden ot pmvinp he/she Jid noi 6uit0 or improve
lor t�e Ourpose ol sale�.
I, as owner of the proper�y, am exclusively conlracting wilh licensetl conlractors to constmct t�e D�ole�� (Section 7044, Business
� antlPmlessionsCoAe: T�eComractor5'SlateLicenseLawAoesno�aDPly�oanownerofpmpetlYwhoUuiltlsarimpmveslhereon
antl who tonlraClS lOr SUCh proletls vnlh a Canlratlor�l) liCense OurSuan� Io ��e fAnlra[tor5' Slale Lltense Law). I am aware
I�a� O�ool o� lheir Worker's Campensalion insurance shoul0 �e DmviAetl la me.
� 0 i am e.empt u oe� Section: B p-� 0 q 4 B. 8 P. C.
mr mis aso . ALL WORK $Y U�lNE
oate: � �1 Z owner.
I tlo �ere�y cenily i ai I am aware of antl untlerstana iAe reQuirements ol Californu HealtO and Safery Catle tions 25505. 25533, antl
2553G antl that I or any luture OuilGing occupanl wilVvnll nol (cirUe one) neeA to compty with 5ai0 state coEes and the reQuirements far a
permil for cons�mction or mo4ilica�ion �mm I�e Air Oualily Management DiSVi[L NesiOen�ial cons�mction applications are eKempl �mm
�hese pmvision5.
oale: aOPlitanl:
I hereGy cerlity IAa1 I luve reaa I�is aD0licalion ana Stale Ihal I�e aCove inlorm n is cOrrttl. I agr¢e I mpty wit� all city antl county
ortlinances a� Sta lav5 �.aling Io Euilaing [on5lmclion anC her uI� ' e r¢senlatives of �h¢ ci� ter upon Ne a�ove-mrntwneU
pmperty Im m5D lion rposes.
Dale: � Signamre:
Uriver's �icense or Sacu� Secmity x: �<�
�6a1<6 WM1ne—Buildmg: Greon—Cotle EnlorcemonC Canary—Applicant; Pink—Revenue; GOICenrotl—Asseswr
CITY OF COSTA :�ESA - BUiLD�:7C PERMIT P�.Rv NO: 5 0�6�j=
FERN,i`f NO; B 056535 P1.AN C:fECK ;10; N COVT; N S.:P1 : A
CO\STR::CT'_ON TYPE; PERi!iT 1YPE: STR PURPOSE: A;,T
JOB DESCRTPTIOV ; COhVERT FAD:'.�Y ROO:! BACK TO GARAGE SQ rT: .,000
CLALv VALUE; 1,000.00 CA�C-VALUE: 1,000.00 GROUF OCC: M-1 /
COYSIEK'�S: CONC'n'RT FAh:ILY ROON: BACK TO GARAGB
tr**�+r*#��*#**�*��#*�r#��#�t�**####*�ttxx###��#*�����ut��cexA*����r�##��u��K���t#���u!:r'
Z O N I N G R E Q U I R E M E N T S
S E T H A C K 5
------------ MAIt� BUILDING ---------- --------- ACCESSORY BJILllING ---- ----
FRI�T: 20 FT TN REAR: FT IN FR1�T; FT �N REAR; FT �h
LEFi: FT IN RGHi; FT itv LEFT; FT IN RGH'P: r'" �1v
PAR�{ING i2E4• FROV; PARCEL• 13918110 Z.NE� R1 RfiF �O-
PLArN:�G NtSiES> CONVERT LiV_NG ROOM BACR TO THE GARAGfi BUIL':' W:TH ORIG=NAL
> CONSTRUCT'_ON,
tt#**�#tt*��ux#*�cex��*��tt��##�rtic�r�tt*tt**#*#tt**x x#�rtt�#�x-*�#��x*�����xa�k�*����ita�*#
D E V E L O P M t N T S E R V T C E S R E Q U I R E M E N i S
ZONING APFROVED BY DATE:
BUILDING APPROVED BY :
APPLICATIUN ISSUED BY __G�
iF 3FiE iF !f �1F #�# iE iE # N k� 7F 3f ##. # 1p H� #
if7e�lEic##���f aEifieiE# 3f3(�##iE3F##ii�##i'ri'r�fEififl[�ii�##�k?fiF###iE
LEGALZZATION:N F E E S i'
BLDG pMT' PLU�NHING ELSCTRi�
PERNTT 25.00
DATE:
�b'�TE• O3/ l"1?�
f �-F�'��3t�3t�' . �'�('7t'ii"K'iF+j'3�"R'JZ"��'jFR'�l'RK1C�.""�T'�l'�Citjl'
it� iF 3F # 9f iE iE iF iE # iE iE �1c # 3Fie �F iE�1E ## ii� # iE �Ie ##!E ## if 3c 3E ##�:� !i #
M M A R Y STRUC':URAL Sr.GMr.N^.';Y
MECHANIC FIRE SMIP/RES GRAC��NG
50
SM:P/NON-tZES
P I,AN I
ISSI7E FEE
HUILDING-DIV-> FERMIT ISSUE PLAN-CHcCK
TOTALS----> 25,50 0.00 0,00
REVENLiE DIVISTON TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC NECHANIC
2 ] . � Q
TOTAL PAID lltln
25.50 25.50 .00
25.50 OVER/SHOR'!': .00
F3RE SMIP/TOT GRAJ7�NG PLAN-CHECK
.50
ie iF iF ii ## iF If # if ie iE # iF iE i! 3E #�F ### iF i6 # 1F iF'7F # ic iF ## iE iE if� # ft if� ie # i� # 1(� �F iE #� iE i't 1F IF iE # iE iE %iF ii�-lf 7e 3't iE #!f 3F ie :k �� If N� 1'r ic 1(� 3e #+F i( 7E #
I N n I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R S P T I O N
SFR 1000 AI.TER BY VP:�,UE RESZDENTIAL NOZONE
� END OF FEES
� EXPIRED
� ete Inspections
�_. �"'�� S,�
� �'�r ��3
UNIT COS':'
1.00
TO � AI� COST
1,OOO.UO
{' _. �
CONSTRUCTION AND PLANNING r.�OL F \
•/ EIPPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
9. �;emporary Electrical Service or Pole ,.: 52. Pool & Equipment Location i.,
�2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement �' �
,
� •
3. Electrical Conduit UtilityUndrgrnd. 54. Forms . -
4. Electrical ConduiFUndrgmd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrica� UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footinqz 58. Electrical Conduit-Undrgrnd.
8. Foundation �. ' 59. Gas Pipe, O Undrgrnd., Test ,
9. Water Pipe-Undrgmd. 60. Backwash Lines, P-Trap, � Undrgmd. _.
�0. Structural Floor System �� 67. APPROVAL TO DECK ;,_� -
11. Property Sewer Line & House Connection 62. Backwash & Receptor�Final .
12. Sewer Cap 63. Heater & Vent-Final �%i .
73. Roof Drdins r � 64. Plumbing System - Final '
14. Rough Plumbing 65, Electrical-Final ' �
15. Rough Electrical•Conduit 66. Solar System•Final ,�����
76. Rough Electric Wiring 67. Fencing & Access ApProval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Fiough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
27. Dutts, in Structure 70. Underground Hydro .
22. DuMs, Ventilating 71. Product Piping O Gas ❑ Oil �
23. Gas Pipe�Rough & Test 72. Underground Flush �
24. Roof Fiaming 73. Undergrnd. Storage Tank O Gas ❑ Oi�
25. Roof Sheathing 74. Overhead Hydro
26. T�Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Ftashing 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 Coai � 79. PINAL INSPECTION
32. Electriwl Power Meter-Final i 80. FOOD CERTIFICATE ISSUED
33. Final Electric ,� Notes:
34. Final Heating & Air Conditioning ;�
i.
35. Final Gas Pipe-Test � j� �/�
36. Hood or Canopy ,��
37. Final Factory Fireplace �
38. Final Plumbing
39. Water Service-Final ,.
40. Gas Service-Finat
41. Solar pomesticFinal �
42. Backfiow Preventer ,
43. Backflow Irrigation
44. Landscape Irrigation System .
45. Sound Attenuation
46. HandicaV Regulations
47. FINAL 5TRUCTURE & BUILDING
48. FINAL PLANNING .
49. Elearic Release to Edison �
50. Gas Release to Southern California Gas Co
51. CERTIF�CATE OF OCCUPANCY
No. Date
JUL 2 1 �°u
OWNER ANDERSON, A. C
JOB ADDRFSS 3050 Cevlon Rd
FIAE
INSPECTIONS I DATE
SUBCONTRACTOR
OCCUPANCY
DATE 3-10-60
PERMIT
To Fam,
Rm
Form 210—SM-11-59 5-B P , � �[�
i
; ��`� 1�.;���'i
COSTA MESA BUILDING•SAFETY DEPARTMENT
P. O. BO% 917 COBTA MEBA. CALIFORNIA
For Applieanf fo Fill In Complefely
TYPE OR PRINT
ADDRESS '71V \ U l,. e�i l e N �d
COSTA MESA. CALIFORNIA
� MAIL
1 ARCHITECT
1 S7ATE
TEL.
TEL.
NO.
TEL.
SIZE �) /� � NO. OP BlDGB.
OF LOT / .(� , e OW ON LaT
USE OF
EXISTING BLOG. Q v� � , 3 PA�
9LT6ACN LINE PROM
eeNTep or arrsear REAR YAftD
SI�E YARD I LEFT I RIGHi
DESCRIPTION OF WORK
NO. OF
WALL
� �.EI RECEi1l ��
��` ��p11o0 .
APPLICATION FO(��;ERMI7 DEPT.
BUILDING 0� COSTA MESA
For Offiee Use Only
�R6GEIPT NO. P RMIT NO�
�f
REC81V6D BY DA PE N! D E IBp U —
rAa I �,n%E��I I �` /D/ �%
FIRE
LEOAL
COSTA MESA.
NO. OP I U86 OP N
PLANB BUILOINO
�, �s, -�
BT. )
0
I HERHBT ACKNOWLEOGE THAT 1 HAVE RGD THIB MPLIGTION TH8 AMOUNT 9HOWN UNDER VALUATION 19 POR�THe
ANO eTATe THAT THE ABOVH 18 COfiAEGT AND AGR¢E TO COM- pUIiPOB6 OF EBTABLI6HINO • P¢RMIT F¢E ONLY.
PLY WITH ALL GITY ONOINANC88 ANp 8TAT6 UW9 R80UlATINO
eu��ino coNBmuci VALUATION /�
�
SIGNATURE OF PERMIT PEE $
PERMITfE � � n � !f
/ S� J� PLAN CHECK $ � j �
AUTHORIZED AGENT
iOTAL FEE ��
!
: r • . 9r�_'12
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 31] COSTA MESA, CALIFORNIA
FOR' APP[/CANT TU F/LL /N COMPIETELY
TYPE OR PRINT
BUILDING 3OsD i�GGYIOlV
ADDRESS
c�
COSTA MES CALIFORNIA
MAIL �,e835 Santa Monica B1Vd.. pE"
ADDRE55
cirr L03 Angeles TNo$L'232$7 eui�o
ADDRF
ARCHITECT L.C. MdjOP ��c.
AR FN/:INFFR N!)
STATE
IQ NO.
�ec�� LOT ^
DESCRIPTION NO. LS BLOCK TF
A.P. NO.
5'ZE 94,56 X 79.65 I�O.OFa�o�s.
OF LOT now orv �
USE OF
EXISTING BLDG.
SETBRCN LINE FflOM �}� (
CENTEF OF STREET !lV '�j O REAR YARI
SIDE VARD ILEFT S� I ftIGHT ��
DESCRIPTION OF WORK
�ax.�i
r.r�r.�-r.
ROOF
CCO COVERING WOOCl
AND WORK TO BE PERFORMED
. �.t„�.��� � � -
, �,., 4�AY 2 o iy5��
;=:n;,,r;eE o��r.
L��„ �`� f�l1C�n. a1`_Ci
APPLICATION FOR PERMIT
BUILDING
FOJP OFf/CE USE ONCY
I RECEIPT NO. I MIT •O�
IVEu eY I S T�S� �7 I h�� �C, �J 1
�4
;s �G5 0 ��� ��/' �cI
i
COSTA MESA. CALIFORNIA
APPROVED
BY �'4 DATE
ZONING
20NE y� I I p�pNS � BUELDING
�l
f--�
APPROVED
BY IA w_ DATE
ICENTEF LINE STq
= FRONT �Z
�
_ R.SIDE S
I HEHEBY RCKNOWLEOGE THAT I HRVE REr�D THIS APPLICqT10N
♦ND 6TI.TE THAT THE ABOVE IS CORNECT AND AGFEE TO COM�
PLV WITH ALL CITY OpOINRNCES ANO STATE LRWS REGULqTING
BUIIUING CONSTflUCTION.
SIGNATURE _ �
•
PERMITTEE
AUTHORIZED AGENT
S
IN.
THE NMOUNT SHOWN IINDER VALUATION IS FOR THE
PUFPOSE OF ESTABLISHING A PEPMIT FEE ONLY.
VALUATION � � I
PERMIT FEE $
S /�/ y.l(�' PLAN CHECK S � O "
TOTAL FEE S `� T