HomeMy WebLinkAbout2958 CEYLON DR - Building Permits-- . ... . .. . : _ . ,
PflOJECTA00BE33: ZCj!j8 CEYLON ntz .��F uxiT: • • . "�. ` ' � �CITY C)f' CO5'rA �MESA �-'BUILDING PI:ItMIT PERM �NO: �Fi 096"If34 ��
OWNEP'SNRME: C.ASSANDRA FRA'LELLE • � � ' � � ' � ��
. eooness: �g�g ,�EYLON DR , � PF.RMIT" NO: B � 046784 ' � PLAN :CH�ECK'��NO: � j D! GOVT: 'DI SUb'P: N'' �`
. COST11 MESA . ' �„�.; ..� � . . : �: , • � . I _ ` ', . . . , .
CA 92626 � r '. , CUNSTRUCPIODI 'lYPE: S=DI � � PERM7T TYP��: S?SR t; .,, ; PURPOSE. ALT� '
(� � (714)595-1221 � a : � , i... t .
.ApGI/ENGINEER: • ' ' ' flEGNO.. . ' ' " !-JOB �DESCRIPTIGN R�-ROOP IivUSI:/ADD �.' 2'X�l'; SlCYLIGI�T.S , � � SQ C'T:• � 7;800. :
, aooxess . , , . , - uxrt: . . , � , . . ' , S . . ' .
�'s � ' • CL�IM VALUE:. ' 7.f300.00 'CALC-VALOE: 71,II00.�00 GROUP QCC R-3 /' . , �
PEpMiTTEE: RAI�IPROOP ROOFING, ' • ( 77;4 )-�36--8`702 . � ' ' • - .
�.�� IIDDBESS: ' �Ej�J P:O.�. BOX � . . . COMMfiNTSc '5KYT r.c,xa� re�Bo# �l7.38.•' � � � . , � � .. � ' � � . � ' ,
� [lONTINGTON. BI•:ACIi •. CA 92E48 � ' .. �x�.�a���.***�t�r**N*r�.**����r*�**�r��a���c*a�*���**�s��!�**��c*��**�x'*�**.�i�i�x-�'��*�*-�**a����*+t�* �
�LICENSEO CONTMCTOB OFCLAM710N: I hereby aflirm that I am'Iicense0 dnCer pmvisions of Chapier 9(commencing with Section . ; .. ' . Z � T� I N� G' , R E Q` U� Y R E� M� E� N T S' ' � ��.
7000) ot Oivision 3 of the Business antl�Protessions CoOe, antl my license is in full force anU eflect., . � , ' ' S F_ T B A C K S � . � ' � . � ' � � �'
cirr uc.: 0 4 9 4 A 7. STRTE 11C.: S S�� �� ��� / cu s: �-: L�/� ���% � � � . '- :
oate: � — 2 —g � : siqnamre: 7�-� �, S��L?�o✓1p'�-�-1' � `''-- =----"--=- MAIDI BUILD;I:D1G -=--'------ ------�-- ACCESSORY BUILDIMG' =--------- .
WOPNFBS'COMPENSRTIONOECIAMTION: Ihere6yaifirmt�atlAaveacehiticateoicon nttoseu-insureoracertiticateotWorkers' ;'�FRDI'P: FT � IN REkR: ' FT � IN ; 'FANT: ' P'I', IN REAR: i � L'T �� IN •�
somvanution�nsurance,oracenitieacony�hereot(sec�ion3eoo,�ao.c� - � LEFT: PT ' IN RGHT': FT IN LEFT: • I'T IN F2CHT: - FT IDI
oucr ua.: 1 18 2 4 4'1- 9 0 ' exa. onTE: 0 4/ 01 ( 91 . . - � � i .
COMPRNY: $�j�j�1TE F'UND � : ' � r � � ' ? . 1�ARKING REQ: i?ROC�; ' � PARCEL: 1392?1U< ZNE: � -REF NO�: . �
� Certilietl copy is hereby tumisheJ.' ❑ CertifieA copy is tileU witA the ciry Buit mg �ivis' n. � P LANN I NG ridT r s> -.. .� ., � � .��, � .. � . , .• ;
. _p , _���.-��D' .:. . :> . .. .. . _ . . . � -
Date: � �•�•..� ( O A'pplicanL . �� � 3E�1EiE�K�1E�)F�)EiEiEiEif.iE3f+E3EiEiEiE3E3EiE�iE-%�iEjEiEikjEiEi(���iEihi4dEiEiflE�EjFiEiE9hiEiEjEiEIEiEihi(ifiE�fjEi(-iCiEiE*K�iFiEi(-iEiti6�E#'if±Fdfik�il�k�)E�F9E.�k- r :
E%EMVfION FPOM WOBKEIIS' COMPEN&17ION UECUUUTIO .(This section neeA not 6e completeU ii Ne permil is for one hu�reA (510� ar less�. � �� D E �� E L, �' F� M F N 7� � � Fi . �� I C E � ki E. Q T) I� R � j�i F; N`::�'. �
i ceniry t�at in tAe peAormance ot tAe work tor which tnis permit is issueA, I shall not employ any Darsan in any manner so as ro tiecome i � ' , . , . ' . . . � � � � . '
sabiecuotheWorkers'CompensationLawsotCalitomia. � _ . � � � ZONING AFFR6C�ED BY; ___ __________ f DATE: '' ' ,
Oare: . ' . . . _. "' SlgnaNre: . . ' .- • �� . . � - ' . 4 . _ ' _ _,.i. . : ' --. .
NOTICE: If, alter malting ihis tleclaration, you should 6ecome suhlect ro ihe.Workers' Compensation pmvisions of the La�ar ��� r T,D T NC> Ab',PROV EU Ti Y _____ '___ _ __ '_� __ _; DATE :_ __ _ �
COEe, you must fortAwith comply wiID suc� pmvisions or this permit shall 6e aeemeU revoke0. � i . :.
CONSTPOCTION LENUINO AGENCY: I �erehy, attirm that ihere is z constmc[ion IentlinA agency for the pedormance of the work for A'P PL I CA�P ION 1$ �(,j L;Z' � f:� � ' (��9�� �
*�� ' DATE i �#3�`
whichlAisPermitisissueAl�ction3097,Civ.C1. . itiEiE�(-3(if1E�EilitiP3(-itiFifitfFiE3t1E1E�%'iF�iF �� Tl-'3F±f .�it iFiF'" ic ��'iFdE{(-�{.�(.�..�(�*{p.�.K-��. .7�.'�(��x- 1
' LENUEfl: � ' , �' � if3EiE1h�1F�3FiEiEMiE*�lEiEifif�iEikif9EdEiEi(-iElEiE�lEiEihiEjfiEk�kiEiE%-)EiEif3E-1fiEit�IEiFiE�14 .if��lhiEil3Eif3h#fiEiEiE?Ei(��iE#iEiEif%��fiEiE3F�iEK�?4if�1E?.(-
- nooxess: - � ' ' - � , LEGALI7.ATIOD] : N F ;E E S? U M M "F: ,P.,: Y' � ' '{ S'PRUCTURP.L S�GMF.NT : Y �
, ; ' . . . - . � ). ; , � : : � , ' � ' _r' '
OWNEBBUIlOEBDECUMTION: I�ereUyattrtm��a�l�amexemp��romlheContracbrs'SIa�eLicenseLawlorthefollowingreason � � � BL,UG .FMT -.PI�C1M$TiJG £LECTRI�C�e�'M�CHAN�IC , FIRE, � SMIP/RI:$ GRADINCi
(Sectian 7031.5 Busine5s and Pm�essional Caae . Rny city o� counry whicA requires a De�mi� �o construc�,.al[er, improve, demolish, ot pERM 11`; -� � 9 9. 0 0 � � '' r �' � ' '. S 5 � ' �
reDair any stmcture, O�or to As issuanca, also requires the ip0licant /ar such permi[ to file a siAneA statement Nat he/she is Iicense0 , � , - - � � � , , ,
pursuant�olAepmvislonsoltheConi2pors'.Sia�elicenselaw(Chapter9�commencingwi��Sec�ion7000�oL0ivision3of�heBusine5s �y � i '� � .. � ' � " , :. � ' ''F -•';, , •' � ,SMTP /D]ODI--RES� .
ana Professions Code) or that Ae/she is exemD� ��ereirom and ihe 6asis for the alleged exemption. My violation of Section 7031.5 �y .PL�AN � .. � _ • ; i -� ;,� � . . ' � r � � ,
any apDlicant toi a oermit sueiects the applicam ro a��ciJil penalry ot not more tnan five hunarea eollars �5500�. ; , " I S�S �E' F' EE I '` �� � �r )'' ` � ' ' , ' , . ' � ,
I� as owner oi ine pmperry or mY em ioyees�wnn waAes as iheir sole,compeniaiion.'will ao ihe wor�,'�ana me .�BUILD�ING-DIC'-> �PF.RMI�T' ISSUE , PL'ADh;CHECK - TOTAL � PAIll � ` DUi? -
� simcmre is not intenAea or otteretl ror saie 1s�ecnon 7oa4. Business ana Pmtessional Coae: Tne Comracmrs'.State License Law T OTAL S: -=--�?. , ��• 9 3. 5 5' �, 0. 0 0. �. .:'0 :�0 0 ':a 9 9: 5 5 � 9 3. 5 S , � . 0�V� �
tloes not aDPly to an owner oi a proDerty who builds or impmves t�ereon, and who does such work himselVherself or ihmuA� ` t � '� ' ` �- �
�is or her own employees, Droviaetl that suc� imOrovemenGs are not inten0ed or biferetl tor sale. If, however the buiiAinA a� R F.V EN D E -D I L'�I S I OTI TOT'AL S--> '. - COL L EC T ED :' '. . ' 9 9..`i 5,� OV E12 / a HOR'C : � 0 0
., impwvement issoltl wit�in one year ot completion, t�e owner vnll �ave I�e �ur0en oi pmvinp he/she tli0 not build or impmva � � �
� mrmenurPoseatsa�e)., ' r :. HLDG PMT I'LUMBI•D1G FLECTRIC-MECFIANIC FIR� SM.IPLTOT 'GRAL�TDIG PLAN�CHEC3<
I, as owner of ihe D�oDerry, am exclusively con[racting wi�h licensetl coniractors to consimct the pmle�� (Sec�ion 7044; Business � • �� 9'�� � • , � � � ,,P 1 f� � , • 5 5 • ' ' � '; , i
❑� and Pmfessions COAe: The Contractors' State License Law tloes nat apply to an owner otpropeity who bmltls or improves tAereon ' ' .� �. • � � ' , � � i
andwhocontraci5forsuchpraieciswitilaconir2ctar�s)IicenseDursuanttotheCaniractors'StateLicenseLaw).�lamaware ..�JhiE�iE;Ei(K�-IhifiE�EiEiEiE�dEiE�lt,iEiE3f�)(��IEititiEMil-3EjE�kiflEjE3fiEiEiE34�)E1EiEif9FiEifN�if?E3fif-iEitiEiEifiEi6�a�#ifiEiEk3f�'R�'R�3fiF?E3tiE?E3Fi�iE�%��43f3E3E '
thai proof o� Iheir Workei s ComDensatian insurance s�ou10 be pmvidetl to me. , . � '- � ` � j h) (t I; V I D U A 1� F.-E ;E A�R ' F, A F< D O W N � ' �
� I am exempt un0er Sectian: . . B. 8 P. C. . ' . . , . ' � , " , . , ", y ' ' ' t
rounisreason: : . , . TYL'E QTY D E 5 C R I P T I, O id f� . UD1I7'; COST' TOTAI, rOi1' '
• , , , , , ,:- ; ,, , 1
oate: � • ownec :iFR 7000 P.LTER BY VALUE I2�SIDEN'r1 �G` b1U7.OT1E 1. 00
I Eo hereb certi tAat I am aware ol an0 unAerstan0 tAe reQuirements oi Califomia Healih an0 Salet CaOe Sections 255Q5,�,25533, anE, � � . q ,� '/` £j ��,��
25534 and t�at I or any �Nure �uilEing occupanl vnlVwill not (circle one) neea to comply with said sta�e coAes antl ��e repuiremants tor a. -. .. � , � . - . ' E'I�n �r F E:F � , , .`
permit for consiructwn ocmotlifica[ion irom the Nr Qualiry ManaAement Disirict Nesitlential constmction aOPlications are exemD� �mm � . . . � . � �� � � ' j_ . �
, �• I
these Provisions. . ; � " ' � ' , .� � �� `} .� !' . ' , .
9
Oate: - • � � Applicanf. . � • . � ; � . � .
. . . (.,. i
I �ere6y certiry t�a[ I �ave reaa ihis a00tication an0 state that the above iniormation is correct I aAree to comply wit� all ciry anA counry � � •� ' � � ' '; �� � '- �,'' � . . ' ' � � . . + .
ordinancesanUstateWwsrelatinptobuilAinAconstructionanCherehyauthonzereDresntativeso tAiSciryroenteruponNeahove-mentione0 . �- � . . ... � ... . . , (• a� � � ' _ • �
propeM �orinspection purposes. ' , • , _ . ' • . , �
[� � t +
Date: — L — i�— q U Si9n Ni� � I . . . . . . ' _ ' . . I
Dnver's License ar Social Secunry q.� � ' j . � ' � � � ' . ' � � �1 ��05]s�a-4eo.`+7`74 �i't11' i�.,'�i°.� '
� OATE: 04/02/90 TI�4E: 13:22
'1661dfi W�ite—Builtling; Green—CaEa Enlo¢ement; Canary—ApO��cenl: Pink—Revenue; Galtlenrotl—Asseswr " ' ' ' ' ' " " - ' �' " - . . �
. .. . ._.�... ... .,'(? .. ..' " '.._._ . __'_'_ '_' ' . _ '
CON$�RUCTqN AND PLANNING � ' ' � = � �' ' ' �� f � � & SPA -� ' ' .' ; � ,
' APPROVALS Permit # - " - Date Inspector pppROVALS . Permit # , Date � Inspector. -_
1. Temporary Electrical Service or Pole � " . 52. Pool & Equipment Location ' �
2. Soil Pipe-Undrgrnd. . �� . �+ "�• 53.-Steel Reinforcement - _ N '
� 3. Electrical Conduit Utility-Undrgmd. � � � 54. Forms � . �� �
� 4. Electrical Conduit�Undrgrnd.�. ' , � 55.,Electrical Bonding ' �.}
5; Steel Reinforcement � ' ` ' � .- . 56. �Rough�Plumbing & Pressure Test
.�,6.-Electrical UFER Gmd: � 57. APPROVALTO COVER�GUNITE � �
7.,Footings � � , . , � � . 58. Electrical Conduit-Undrgmd. '
�8. Poundation � �' � 59. Gas Pipe, O�Undrgmd., Test
9. Water Pipe�Undrgrnd. �� . 60..Backwash Lines, P-Trap, O�Undrgrnd.
10. Structural Floor System � ` ' . � � 61. APPROVALTO DECK . ` �
11. Pr1perty Sewer Line & HouseConnection '. . 62. Backwash &.ReceptorFinal�
12. Sewer Cap . ,•j . • ' 63. Heater & Vent-Final
..
.��73. Rr�if Jrains _ :« - 64. Plumbing System � Final ��
' 14. Rough Plumbing � - � 65. Electrical-Final . �
15. Rough Electriral-Conduit . - 66. Solar SYstein-Final ,, ,
- 16. Rough Electric Wiring _- 67. Fencing & Access ApP�ovil . .
17.'Rough Wiring Sign � � . 68. APPROVED FOR PLASTERING �
� 78. Rough Electrical�T Bar Ceiling ' . � � 69. POOL/SPA SYSTEMS FINAL �
19._Rough�Heating & Air Conditioni�g� -� �� � _ PIRE DEPT. REQUIREMENT �
20. Rough Factory Fiieplace _ � __ � APPROVALS ._ Permit #
21. Ducts,in'Structu�e' � ' ' - �: �'70. Underground�Hydro
22. Ducts, Ventilating �� ' . . 71. Product Piping � Gas ❑ Oil
23. Gas Pipe-Rough & Test .� �'' 72. Underground Fluth ' '
24.'`Roof Framing � . . � �� � � ..73: �Undergmd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing� -� � ' 74. Overhead Hydro..
26.'T-Bar Ceiling (Structural) &-Monocoat . „ �� 75.' Dry Chemical � - -
27:.Frameand Flashing '. � 76. Dry Standpipe � ' '
28. Lathing & Siding�� ; ' ' _ � �' ; x 77 . FIXED SYSTEM FINAL . �
29. Insulation � • " 76.,FIRE PREV. FINA'L
30. DrywalliNailing �- � _ �,;j;, ; • , HEALTH DEPT. REQUIREMENT
� 31. Plaster Brown Coat� . • . 9� 79. FINAL INSPECTION
-'32. Electrical Power Me'ter'-Final , ��' �80: FOOD CERTIFICATE ISSUED
33. Final Electric • � � �.1�`~� " Notes: � �
S .Q-.
34. Final Heating.& AirConditioning � ! ;�", � ' � ��
� .
35. Finel Gas Pipe-Test., � ` , '� d
�. v � S�
- 36.. Hood or Canopy • � ' � ' _ � � � �
U
�-37. Pinal Factory Fireplace. � • � ��.� -
' i,. . .
..38. Final Plumbing ' ' � " y�'^ - � ' ..
!'•� ' , a G� .�
39. Water Service�Final - ' . ; � �T . .
' 40. Gas Service-Final - � �; � . �
_ �i
' 41. Solar pomestic-Final _� � . ' � , 1. - ' ,
42. Backflow�Preventer' � . ! ' -
43. Backflow Irrigation , : � . � �
• 44._�Landscape Irrigation System, � _ �.' -' �' � ' - _ � � -.
� 45. Sound Attenuation � y . ' ., ;��; � - �� - • � - . .
�� �46. Handicap Regulations _. „ • �' - � � � �
47`FINALSTRUCTURE&BUILDING � , �
, `
..
48: FINAL PLANNING - � � '
:
49: Electric Release to Edison � � � ;%� `. . � ` �
50. Gas Release to Southern California Gas Co '�' �. -
_ ,
51. CERTIFICATE OF OCCUPANCY � • � � •
No. ' Date . ' �
C�Y OF COS' 'A MESA
G/�LIFORNIA �2828 P.O. BOX 1200
FROM TME OFFICE OF TME DIRECTOR OF BUILDIN6 SAFETY
i
' • •�• •
/
._ C/ l �i
�•�� : --
O�mers Name
Qaners Address �,� �Cl�-2�
Oaners Telephone
��
'" �� --' ��
�
City Ose Only
I� �� ,Sl9,.-✓Iq„y as (�aner� Contractor, Sger+� (strike out all
except one) do hereby attest that employment of any person, or persons, is not
anticigated at the tune of seeking the above-referenced permit. In the event that
any person, or persons, are e�loyed under the provisions of this permit, I shall
i�diately cause a val.id Certificate of Worlanens Con�ensation to be filed with the
Costa Mesa �ilding Division.
I agree to defend at my aan wst, arrl to indemnify and hold hazmless, the City,
its officers, agents and/or e�loyees, from and against, arry and all liability,
damage, costs, lcsses, claims and expenses, howscever caused, resulting directly
or indirectly fran, or connected with the improvement under this permit.
I further state that I have read and fully �mderstand the i.mplications and re-
sponsibilities of the above state�nents, and will crn�ply with all provisions of the
Contractors State Licerise Law found under the Business and Professions Code,
Division 3, Chapter 9, of the State of California.
TV((�) S�Ahi7qN/1 �
Print Name
w_
Sig ature
CMF 0777-46
No� — 7— / 9' �v
[�te
OWNER �ILTER, GERPRUDE DATE
JOB ADDRESS 2958 C�
GENERAL CONTRACTOR J�
APNo. 139-271-02 LOT
�NSPECTIOwS
sm�
GAS
W�TER
ROUGH PLUMBING
PROP. SWR. LINE
SPPINKLING SVST
MISCELLRNEOUS
M
ROUGN NEATING ANO �IR CONOITIONIMG
UN�ERGROUN� U POWER U
ROUGH WIHING
� TRENCHES FORMS STEEL REINF.
� FLOOR SVSTEM
(� BONO BEAM [� STEEL REINFOPCE n
h SMEATNING
C FRAME ANO FLFSMING
r��rpppI IATHING - IN n OIJT �
� PlnSTER.BROWN CORT
� STRUCTURAL, FINAL
(]� HEATING, VENT., REFRIG. RNO A.C., FINAL
PIUMBING, FINAL ANO GAS TEST n
F�NAL
BUILOING, FINr1L
SUBCONTRACTOR
.. . . . , tx x:s 5"'.
�' COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFOHNIA 92626
i.
For Applicant to Fill in Comple[ely — Use Ink Only
BUILDING
ADDRESS CU /�%
OWNER OR � /fe /
TENANT p(�
MAI LI NG
ADDRE55 '� s � pw,
TEL
CITV NO. p
CONSTRUCTION
APPLICATIOP�F�jp jT$�J�j�J�7. PERM[T 20'.00 Tl.' �
� _ i.... . . .. . _. . . _ ..
RECEIVEO�i ERMIT 1�T0 50959
�r.� ��i
A.P. NO. � �� —
B UI LDI NG q•
ADORE55 2 / �
UNIT Oft
SPACE NO.
TR.NO��, _„ LOT
NEW I ADD IALTER IREPAIR IMOVI
BRANCH E_ -� �af ,
OWNER �.•;�� "� �
ADDRESS , VALUE
ARCHITECT TEL. - USE � $
CONTRACTOR y BV DATE
ADDRESS
TEL.
CITV NO.
.F.. STATE CITV . APPROVED SETBACKS
LIC. NO. O QL LIC. NO.
{ij SIZE NO.OF BIDGS. (FROM C/L STREET)
0+ OF LOT NOW ON LOT RONT FT.
a USE OF
',�. EXISTING BIOG. p
�
FSeparate permits are required for �. sioe �F .
� electric, plumbing and heating work: REAR FT.
F USE OF BUI�DING AND WORK TO BE PERFORMED PLqNNING ACTION
Q
� �� DATE
a O �� C AP7ROVED
� APPqOVED
%"
.d
a
v�
� I hereby acknowletlga that I have reatl this applieation enE state �
a that tha ebove info�matian is correct and agree to comply with
a all laws regulat(ng building cons[ruction, antl I shell not employ �
,'� any person in violation of the workman's compensation laws of d
W the State of Calitornia. ' -
T. m
3 I hereby certify that I am p�operly licensatl as a contractor unde� SQ. FT, n
the State ot California Business and P�ofessions Cotla, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, antl that such licensas are in full force antl effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: �
am exempt from the provisions of the State ot California Business VALUATION PERMIT FEE a
and ProfassionsCode, Division 3, C apter�9. e $ .D� m
m
Signature of `�� � ,( � PLAN CHECK S i°
0
Perm(ttee $ / U TAX - $ � �
Auffiorizetl A nt Da[e �� —�'��C% � �• V
_ TOTALPAID S _/C��%
, yt � �,t`,
,
,- g�L�,��
EQSTA MESi4 BUILDING-SAFETY DEPARTMENT
P.O: BOX 3f� COSTA MESA. CALIFORNIA
,FOR APPL/CANT TO F/L[ ./N COMPLETE[Y
i TYPE OR PRINT
ADDRESS 295$ Ceylon Drive
�COSTA MESA, C.4LIFORNIA '
E55 1555 Placentia
Newport Beach TN0.6—
ITECT LIC.
LEGAL I LOT `1 I I �7
OESCpIPTION NO. � BLOCK T AC'
A.P. NO.
SIZE^ $OY�OO I NO.OF BLUGS,
USE OF None
EXISTING BLDG.
seiewcw �iNe Fwom C O/ REAR YARD ZY'. � t
CENTER OF STFEET J
SIDE YARD I LEFf �O t I RIGHT J� "
DESCRIPTION OF WORK -�
NEW I A II ALTERATION I II ADDITION I
REPAIR I IIMOVING I IIDEMOLISH I
SIZ�EDING 1HOO SP ROOMS rl. STORIES �
EXTERIOR WALL �ROOF�OCtl
COVERING StUCC COVERING
USE OF BUIL�ING AN� WORK TO 6E PERFORMED
i
an d Attached Garage
1 HEREBY R �GE THAT 1 HAVE READ THIS APPLICATION
AND STAT THA TH ABOVE IS CORFECT ND AGREE TO COM-
PLY WIiRpLL TY RDINAN�PN, LAi � GULqTING
9UILOIN CONST 11C ION.
SIGNATU E OF
■ AUTHORIZED AGENT
�=EE RECr��IEi�
:IAiV 211960 � u
FINAA�CE DEPT.
APPLICAltYOIV FORaF��A�11T
BUILDING
foR officF usF oNcy
Aecciveo
FIRE
DATE
COSTA MESA, CALIFORNIA �
TYPE ✓ GROUP \L� �
ZONING
ZONE 1 NO.OF USE OF NEW (
��1 I PL/NS 2 I BUILOIN6 /�T
1 %/-� /CC/
BYPROVED IOI ��. G� r DATE /�'
YARDS � , � ECs `
ICENTER LINE ST.)
L. SIDE I � F
REAR .TL/• � i
THE AMOUNT SHOWN IINDER VwLIIqTION 19 FOR THE
PURPO6E OF E9TABLISHING A PERMIT FEE ONIY.
VALUATION ,
PERMITFEE' '$ `3�-�
$ I � ��`�I� PLAN CHECK § � y+
TOTAL FEE $ �S `� '�