HomeMy WebLinkAbout2995 CEYLON DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.���LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 29JS CEYLON DR
Suite:
� Vicinity: HOUSE AND GARAGE ROOF
Primary Occ: R3
Parcel Number: 13923212
npplicant: MCCARTHY, STEVEN
Address: � 9781 EASTWOOD CI
VILLA PARK, CA ,
Owner: JONES, THOMAS E�
Address 2995 CEYCON DR ; ,
COSTA MESA, CA � �
., �
Coniraotoc�- THE ROOF�GUY--^ �' �
Address:' 9781 EAS7WOOD CI�-
- - - VILLA PARK, CA
, � Zip: 92881� ,; .'
Arch .
Address:
• � - Phone:�
Type of Conslruction: V-N
Zoning: R1
Phone: 714-921-1500
� Zip: - 92861
� i
Phone:
- = . ..Zip: .92626 '
Phone: 714-921-1500
License: 638593
Eng:
, . .Address:
Status: ISSUED
Applied: 02/13/2006
Issued: 02/132006
ISSUED BY:
Phone:
. Zip: - - _" "License: � - - -.. License:
SCOPE OF PERMIT
, TEAR OFF (E).ROOF MATERIALS, INSTALL 1 LAYER 30# FELT AND 40 YEAR COMP SHINGLES ON ATTACHED HOUSE AND GARAGE, APPROX
� 4700SF. REPAIR AND REPLACE SHEATHING AS NEEDED. ` " - � '
� . � i � ' • _ � ' FFF SI IMMARV �.- .
Plan Check: $0.00
� � � Permit: $279.25 `
SMIP Res: $170
SMIP Com: $0.00
' ` Other $0.00
Inspection: $0.00
�
Total: ' $280.95 '
, �<^, _, � ..
Calc Valuation:
` Claim Valuation
• ,' PLANNING R20NING
SETBACKS
MAINSTRUCTURE Pront � 0-0� ���-, _�-Rear�� 0-0 - - Le8 0-0 �-��
ACCESSORY , -Fronl 0-0� �� -Rear 0-0 � Left 0-0 �
� ..i i
: ��
��� ,. j •
PARKING ' Exlstina: � 0�, �Reauired: , �0 ' � Pr000sed: 0
� � �.`
. -;� � � " �� - � -
� � �
_
., ��- . .� ..
�n,000.00
sn,000.00
" ;
>
--Right ,0-0 _
Right ' 0- 0 � '
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis 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 inapeetions 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) 7545fi26
zaae�ne (a�oo�
WORKERS' COMPENSATION DECLARATON: � . ��
1 here6y eHirm under penelry of peRury o�e ot Ne tollowing tleclaralions: �
❑ I heve end will maintein e certiticate oi consent to self-Insure tor workers' compensation ;as provitled for Dy section 3700 of the Labor Cotle, tor the paAormance of the
work br which t�is pertnit is issued. � �
Q�;���gM�will maimain workers' compensetion insurance, as required by section 3700 oi the Labor Code, for Ihe pedortnance of the work for which Ihis pertnit is issued.
C-My rkers' compensation Insurance carrier end policy number ere:
airiep� %t � c ��^. u�.. c� � P�c� y,Nu�2 -�y� 4 v'I — a(.
(This'Section need nof be completed il lhe permif is valuetl af one huntlred tlollers (5100) or less.) �1s>��
❑ I certily that in the pedormance of ihe wo�k for which this permit is issuetl, I shall not employ any person in any manner so es to become subject ro tha workere'
compen5ati0n laws of Califomia, end egree that if I should become subject to the workers' compensetion provisions ot Section 3700 oi ihe Labor Cade, I shall forihwith
comply with thes� �r visions. /
A4 , iw�l $igna -!a: � � f1 �1 Cf� '� pa � 2.— I'� — p�i.
�AHNIN(ir'FA1�E TO SECU E WORKERS' COMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SIIBJECT AN EMPLOVER TO CFIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED
THOUSAND OplAfiE (5100.000�. IN ADOITIIXJ TO THE COST OF COMPENSATION, �AMNGES AS PROVIDED FOR IN SECTION 3]O6 OF THE LABOR CADE, IMEREST, AND FTTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
of Chapter 9(commencing with Section 7000) of Division 3 o'f,(he.Business and Professions Code, and my license is in full
c��� i 4
— o� �— l3 -,��
CONSTRUCTION LENDING AGENCY: �.
❑ I hereby aHirm that there is a constmction lending agency for Ihe pedormance of ihe work for which ihis permit is issued. (Sec. 3097, Civil Code). '
Lentlefs Name: Lentleis Adtlress:
Signawre: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirm that under penalry of perjury ihat I em E%EMPT FROM THE CONTflACTORS LICENSE LAW tor ihe tollowing reason (Sec. 7031.5, Business antl Professions
Ca1e: Any ciry or counry which requires a pertnit to consimct, alter, impmve, demolish, or repair any stmcture, prior to its issuance, also requires the applicant for such pertnit
to file a signed statement ihet he or she Is licensetl pursuant to ihe pmvisions ot �he Contrectors License Lew (Chapter 9(commencing with Section 7000) of Division 3 of the
Business end Protessions Code) or that he or sha is exampt therefrom end the basis (or the alleged ezemption. Any violetbn of Section 7�31.5 by any epplicant fw a pertnit
supjecis ihe applicant to a civil penalty of not more than five huntlred dollars ($500).):
❑ I, as owner of ihe propeny, or my employees with wages as their sole compensation, WILL DO TXE WORK, and the structure is not intendetl or oflered tor sale (Sec.
7044, Business and Protessions Code: The Coniractors License Law tloes not epply to an owner of property who builds or improves thereon, antl who does such work
himself or he�self or through his or har own employees, pmvided that such improvements are not intentled or otteretl tor sale. It, however, ihe builtling or improvement is
soltl within one year of completion, tha owner-builder will �ave the burtlen oi proving that he or she tlid not build or impmve tor purpose ot sale.). '
❑ I, as owner o� lhe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct ihe project (Sac. 7044, Business and Professions
Cotle: The con�racbrs License Law tloes not apply to an owner ol propeAy who builtls or Improves ihereon, and who contrects tor such projad with a contrector(s)
license pursuant to the Contrectors License Laws.). .
❑ .I am exempt untler sec.
Signawre:
p�yner ID verifiad by tlnver5license. ❑ Ves ❑ No
Business and Protessions Code for this reason:
Ve�iication of Ownership by (type oi document, i.e. - property tax bill or deetl):
Driver's License No.
Date:
E:pires:
DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION:
❑ I hereby cenity that no exca�ation tive (5) or mora tee� in tlepth Inio which a person is required to descend, will be made in connec0on wi�h work authorized by Ihis
permit, and ihat no builtling slmcWre, scaHoldinq, falsework, or demoli�ion or dismantling Ihereof, will 6e more ihan Ihirry-si: (36) teet high. (Chap. 32, Gry 2, Ar12. Sec.
341, Title B, Calitornia Adminisirative Cotle).
❑ As owner-builder, I will not employ anyone to tlo work which woultl require a permi� from ihe Division of Intlustriel Safery, as noted ebove, unless such pereon hes a
permit to do such work from the division.
Signature: Date:
Div�sion of Industnal Satery Pertnit Number.
CEFnFlCATE OF COMPLIANCE AND AUTHORIZATON OF ENTRV: I certify under penalty ot perjury ihat I have read ihis application and s�ate that Ihe iniormation given is
wrrect. I agree to comply with all state laws and city ortlinances relating to building construc�ion, and authorize representatives of ihe City ot Costa Mesa to enter upon the
ebo�e-described property for inspection purposes. I agree noi to occupy or allow xcupancy of any building authonzed by this permit until final inspection.
� INSPECP�NTYPE
7676 Fixetl System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Foot
201 Final Block/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
Zpq Final �emolidon
0
� �G (�✓
�
COpE� INSPECTIONTYPE
206 � Final Mechanical '
20B Final Plumbing
210 �Final Elecirical
272 Final Flre Prevention
220 . Final Planning Approval
222 Final Site
250 Final Building/Occupency
DRTE �M
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Tract .i� � ` I Block
Builtlin9 ^ ^� � `��
Atldl¢55 �'}� �
area
Owner
AdCress
City �
Architecl/
Designer
Atltlres5
/
ICATION FOR A BUILDING PERM
Lot I � T
cross
Street
o N� �'
�c�Lo�v �
�f%7 Zip Phone
Lic¢nse No.
City 2ip Phone
r En9inee� Ucense No.
c
p, Atltlress
m CItY Zip Phone
y LICENSED CONTRACTOR'S DECLARATION
U
N
m 1 hereby affirm that I am licensed under provisions of Chapter 9
y (commencing with Section 7000 of Oivision 3 of tha BuOs�iness_z�
Protossions Cod and my licensa is in full force and effec ^��1
� lican a Clas LicenSe Number �
} Date @onttactor
E Atldress _
jy Ciry antl 2ip Phone ��.�� ��.�
� NSTRUC N LENOING AGENCY
� I hereby eftirm that there is a conshuction lending agency tor the
d performenca of the iyork tor whi h this permit is issuetl (Sec. 3097,
Civ. C.1.
aj Lendar's Name �_8.__/� /�-�
C Lantler's Address \ �V ��
'� OWNER-BUILDER DECLARATION
� 1 hereby atfirm thai I am exempt frorp the Contractor's License Law
� for tha following renwn:
� ❑ I, as owner of [he property, or my employees N•ith wages as their
� sole compensation, will do the work, and the sttucture is not
r intended or otteretl forsaln.
«
� ❑ I, as owner ot the O�oparty, am ezclusively contracting with
licensed canttac[oroto tonSVuct t�e project,
�d„ ❑ I am exemo� untler Sec. . B&PC for this reason
m
a Data Owner
E WORKERS' COMPENSATION DECLARATION
� I hereby afiirm that I have a certifiCate of mnsent to ulf-insure,
« or e certiticate of Workars' CompensaUon Insurance, or a certifietl
C copy thereof.
j� Policy No.— �ompany
�d ❑ Cartifietl copy is hereby turnishetl.
Q❑ Ce ified cOpy is filed with Oren Ount�{ E
Dat��pn��cant `I ��Q�
CERTIFICATE OF EXEMPTION
FROM WORKERS'COMPENSqTIONINSURANCE
(This section need no[ be completed if permit is tor $100 or less).
I tertify that in the perfbrmance of [he work for which this permii is
issued, I shall not employ any person ih any manner so as to become
sublect to the Workers' Compenution Ldws of California.
Data Applicant
NOTICE TO APPLICANT: If, aRer making this Certiticate of
Exemption, you shoultl become subjec[ io the Workeri Compensation
prOvislOns of tha LsbOr Cotle, you must tarthwith comply with such
provisions or thb parmit shall be deemed rewked.
I CERTIFY THAT I HAVE READ THI$ qpPLICATION AND STATE
THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO
COMPLY WITN ALL COUNTY ORDINANCES AND STATE LAWS
REIATING TO BUILDING CONSTRUCTION, AND HEREBY AUTH-
ORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON
THE ABO�E M�1V=1Qf�{�D/PP.j]�EF7V FOR INSPECTION' P%R-
POSES: alY //a/I � ( O
Signature of pplicun or gent � p¢ D
� wt err��������
Print Qo t' /� t' Nama
All spaces within this hox must be completed to process
CMF 0335-46 (BUQB) rev. 6/80
BUILDING PERMiT NO
� ��
Type of Project: ❑ New
❑ Repair ❑ Convert
A.P.
Zone
Setbacks
Struct
Height
Park FeeS Ves
Requiretl No
Zoning Approvetl BY:
Misc.
Proposetl Use
o( Structure
Occ.
CId55
Front
No, of
Storles
C.
Electrical
Permit No.
Plumbing ,
Permit No.
Mechanical
Permlt No.
❑ Alter �AtlOition
Demo lJ Occupancy Pmt.
Su0• Dist./
Insp. Area
SPI. Pmt. No.
C/L SL Street Wi
USE/OCCUPANCV \
1. \
2.
3.
4.
Total Valuation
Encroachment Permif ReqWretl ❑ Ves
Gratling Pmt. Grac
Requiretl ❑ Ves ❑ No Pmt.
Rou9M1 Gratling
App�ov¢tl by:
PERMIT FEES
5[ructural S
Electrical E
Plumbing $
Mechanical 8
Pre-Gratle $
Inspectian
Pre-Gratle $
Re[. No.
Plan
Check By:
Plan Chatk
$PeGial
Issue
Approvetl:
No. ot
Family
Receipt
Date
Year
SIZE SQ. FT.
No
$
$
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OWNER 1 g
JOB ADDRES$ Ceylon I
GENERAL CONTRACTOR Earl I
AP No. - LOT
INSPECTIONS
SOIL
GAS
WRTER
FOUGH PLUMBING
PROP. SWR. LINE � NOUSE CON. �
SPRINKLING SVSTEM
MISCELLANEOUS
ROUGH HEATING ANO AIR CONDITIONING
TEMPORnRV SERVICE Qq ppLE
UNDERGROUNO � POWER �
ROUGN WIRING
TRENCMES FORM$ STEEI REINF.
FLOOR SYSTEM
BONO BEAM � ST�EL REINFORCE ❑
SXEATMING
FflFME ANO FLRSNING
11TMING — IN � lllR �
STRUCTUFaL FIN
NEATING, VENT.,
PLUMBING.fINAL
ELECTRIC, FINAL
BUIL�IN0. FINAL
F
DATE 12-1�76
6UILDING PERMIT 1
RIPTION of WORK Remodel Gar.
ZONE VALUE E 4,0OO.Oi
PE V - GROUP J
SUBCONTRACTOR
" � a�iio
• , COSTA MESA BUILpING-SAFETY DEPARTMENT
. P.O. BOX 1200 COSTA MESA, CALIFOHNIA 92626
For Applicant to Fill in Completely — Use Ink Only
N. . . . . ,s �� •
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OWNER � � �(,Q/J
MAI� �
ADDRE55
� /f�/ TEL
GTY /�/ NO.
BRANCH �.L7`J - 1 G�']�/�
ADDRESS �� � � 1�� 1
ARCHITECT TEL.
ADD
ADDRESS ���0/ '/.�JdC/J//j��y/ "
J �fEL.
CITV _L� NO. B 7 &�
STA7E CITY
LIC. NO. Z ^� � LIC. NO.
SIZE NO.OF BLIX'aS.
OF LOT � NOW ON LOT
VSE OF � p �J . _� �7/�� ✓�
EXISTING BLDG. �C/ Y� ��crii.
Separate permits are reqwred for
electric, plumbing and heating work.
USE OF BUILDING AND W�RK TO BE PERFORMED
/,./.� ,//%..,. .Od ili..,.�,1 aSx 2�
A.P. NO.
BUILDING
AODRES:
�a��
��er. —i-�F_,-�,�0 0��°�^� �����42.5�1
ON COR STRUCTURAL PERMIT
� h R���� DATE ISSUEC
r
� ��2 �/� PERMITNO.
� /l i-. �
OWNER � � �
�SE c�42 G
FIflE
ZONE T'
APPROVEO ��
ZONE �/ N
PI
YARDS APPF
MAIN BVIL
(FROM GL STR
DISTANCE BET
MAIN B�OGS.
VAfi. #
6
��
OF USE OF NEW y/uw! �JG�
� Z BUILDING p��p'7�J���' -�
VED VARDSAPPROVED
NG ACCESSOFV BUILDING
cT) //
FT.G `
FY P�
�z ' . ��
%n FT. ��
6ET. MAIN FL
ACCESS. BLDGS.
DATE
APPROVED ��
� P�• ne�r� f.� %/ /h
I haraby acknowledpe that � have read Mis apPlication entl state '^
that the abova information is correct and aBree to comply with �
�
all laws regulatinp bulltling construction, entl I shall not employ �
any person in violation o£ Me workman's compensetion lews of d
the State of Calitornia.
m
I hereby ce�tify ihat I am p�ope�ly licensed as e contracior under SQ. �T. �v
fhe State of Calif rnia Busi�ess antl Professions Code, Division 3, THE AMOUNTSHOWN UNDER VALVATION IS FOR m
Chapcer 9, antl th t such lioenses are in full force end effect, o� I THE PUFPpSE OF ESTABLISHING A PERMIT FEE ONLV: �
am ezampt tro e provislons of ihe State f California B�siness VALUATION Q
end Protessio o e, Division 3, Chapter 9. ' PERMIT FEE $ (� N
!Y!/ m
j P�AN CHECK 5 0
Signature ot ._.s��n
Permittee $ � v </ /"41 LL
TAX $ ' V �
U
Authorizad TOTALPAID y a
1
� OWNER JONES, T. E.
�JOB ADDRESS 2995 Ceylon i
�GENERAL CONTRACTOR Earl E
�AP No. 139-232-12 LOT
�INSPECTIONS
� soi�
� GAS
�' WATER
ROUGH PLUMBING
PROP. SWR. LIHE Q HOU6E COH. �
SPRINKLING SYSTEM
�\ MISCELL4NEOU5
ROU6H HE�TING AN� �IP CONDITIONING
TEMPORARV SERVICE OR bOLE
UNDERGROUN� � POWER �
ROUGH WIRING
TRENCMES FORMS STEEL REINF
FLOOR SVSTEM
BONO BEAM � STEEL pEINFORCE ❑
SXEATMING
FRAME ANO FlqSHING
LATHING - IN �J OU7 n
PLASTER, BROWN COr1T
STRUCTUR4L, FINAL
NEATING, VENT., REFRIG. ANO �.C., FINAL
PLUMBING. FIN4L ANO GAS TEST �
' ELECTRIC. FINAL
BUILDING. FINAL �Q L I• L�
DATE 12_1_
BUILDING P
VALUE 51,200':
SUBCONTRACTOR
.; , � 4 � 1 I ,l
COSTA MESA BU�LDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUIIDING �J p� � �
ADDRESS U (
OWNEfl
MAIL
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CITY �� C�%I.LAG N�L�
CqNSTRUCTION �9 � ' .
BRANCH L"„(�'i�I2 Lf((„(i�[�j ,
ADDRESS 3,�_� r /Pl/�
ARCHITECT TEL.
ADOfiESS /
CONTRACTOR �Qj,�"��/��„y���""- �
i-� T�-
[� �'
ADDRESS � � ('J r ���j��,���' •
r / TEL.
CITV / .UfiLa�l.. 6���qI NO. �?
LI O Z �� - q� LICVNO.
SI2E - NO.OF BLDGS.
OF lOT - NOW ON LOT
VSE OF
EX75�ING BLDG.
Separate permits are required for
electric, plumbing and heating work.
1 hereby acknowledge thet I have reatl this application antl ztate
that tha abova intormation is correct and agfee to comply wiih
all laws re8ulettng b�ildinB construction, entl I shall not employ
any person in violation of the workman's compenution laws of
the Stata ot Celifornla.
I hereby certify that I am properly Ilcensed as a conttactor under
ihe State ot California Businecs antl Protessions Cotla, Division 3,
Chapter 9, antl that such licansas ara in full force and effect, or I
am exempt frOm the provisions of tha $taie of California Businass
�antl Professions Co���tl///JJJe, Division 3, Chapte� 9.
Signature pf � ������� �_
Permlttee XC
Auffiorizetl Agent , -
A.P. NO.
BUILDING
ADDRESS
���t��
';F,C'�-1-7:r,;,s;Q!1 Q1�,. �;r;*::18.`��
FORSTRUCTURALPERMIT
�/19�L�
� ��A���
FIRE
ZONE T
APPROVED �
Bv
20NE /� NO.OF
!1, Pu+�
VARDS APPFOV ED
MAIN BUILDING
(FROM C/L STREET
ROM
n %
DISTANCE BET.
MAIN BLDGS.
VAR. #
0
DAT E �/. � �'�
USE OF NEW
BUILDING
DATE
APPROVED
APPpOVED
FT
&
THE AMOUNTSHOWN�UNDER VALUATION IS
THE PUflPOSE OF ESiABLISHING A PERMIT FEE OI
VALUATION PERMIT FEE $
/� PLAN CHECK $
$ / Q�OD � TAX $ �
TOTALPAI� § , L
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OWNER
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WATER
7RESS CyyS �eyion
,L CONTRACTOR orcier
139-232-1 L07 134
fIONS
UMBING
R. LINE � HOUSE CON. �
VG SYSTEM
NEOUS
ATING ANO AIR CON�ITIONING
UNDERGROUND � I POWER U
ROUGM WIRING p a�
TflENCMES FORMS STE L REI
FLOOR SVSTEM
�BONO BEAM STEEL REINFORCE
SHEATMING �—. ,
,FRAME nND FLASHING py�l4OtNsJ 14AdAa
�_� �
LATHING — IN n OUT �
PLASTER,BROwN COAT �
STAUCTURAL FINRI
ING. VENT._ FEFRIG. ANO A.C.,
r-PLUMBING, FINAL ANO
dELECTRIC, FINAL
6UILOING, FINAL
DATE 5/20/80
BUILDING PERMIT N0.
FIRE ZONE
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
For Applicant to Filf in Completely — Use Ink Only
BUILDING `] � � / ��
ADDRESS ( L_.
OWNER OR � \��
TENANT N
ADDRE 5 �9 �� � 'p �
CITY COS I/� GS � NOL.
CONSTFUCTION � _ n . .
BRANCM
ADORESS
ARCHITECT�_,ti�� �% _.,,.._.__ TEL.
CONTRACTOR 'r'�C7 I��j t/� v���� j L}
ADDRESS�IQ J �!; ��u^'�U\��
CITV � (��G c NOLt1iI J��
STATE 2� a > �, ,� CITV
U0. NO. 4C. NO.
SIZE i NO.OF eLDGS.
OF LOT NOW ON LOT
USE OF
EXISTING BLDG.
Separate permits are required for
electric, plumbing and heating work:
USE OF BVI�OING AND WORK TO BE PERFORMED
(
APPLICATION F
RECEIVED V P
A.P. NO. /�/�g
BUILDING ��
ADDRE55
VNIT OR
SPACE NO.
TR.NO LOT
NEw ADD TI
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OWNER � �
USE u,�
�nn��
�.�I'RlI���PERI�
ERMIT 7�7p 505
1V
-. Z -- L
APPROVEDSETBACKS
(FROM C/l STREET)
FFOM
1 �
L. SIDE FT.
' y,
REAR FT. C
PLANNING ACTION
DATE
APPROVED
:?;`^:���^"�
C�1;51h2 TU
EMOLI
I hereby acknowlatlge that I have reatl this applicetion and state �
that the above information is correct antl agrea to comply with �
all �aws regulating builtling construction, and I shall not employ �
any person in violation of the workman's compensation laws of :
the State of Californla. / �
I hereby certify that I am properly licensetl as a contractor untler � SQ. FT. /� Q�� �__ ��`+
the State of California Businesa entl Professions Cotle, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
ChapSer 9, and that such licenus are in full force entl effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: e
am exempt trom tha provisians of the Stata ot Callfornia Business VALUATION PERMIT FEE $
and Grofessions Cotle, Division 3, Chapter 9. -�� �
n
PLAN CHECK S Q "�
v �
SiBnatura ot - ' � / OQO-/ LL
Permittee $ (% TAX $ f
or ' � u
Authorizetl Agent Date TOTAL PAID $�� � ��j
,R
� ������
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 377 GOSTA MESA. CALIFORNIA
fOR APPUCANT TO F/[L /N COMPLfTELY
TYPE OR PRINT
ADORE55 2995 Ceylon Drive
COSTA MESA, CALIFORNIA ,
1 C•Y.'1.`I�i
Placentia
LEGAL , ILOT
DESCRIPTION NO.
A.P. NO.
;=EE R�.C�i�Et�
CLL� �- �- �o
fINA(�:CE DEPT. �
CITY 0� cosT.1 h4ESA
APPLICATION FOR PERMIT
BUILDING
fOR OFF/CE USf ONLY
I PECEIPT NO. I PERMIT NO.
�� �11 C �nl
FECEIVEG BY � DATE NECEIVED. CRT �E I68UEC
� � � -/ -GoI F€B 3 ��
COSTA MESA, CALIFORNIA .
FIRE '/ _A1,/ �
[ ZONE TYPE Y GROUP v�
9J APPROVED
BY DATE
SIZE � NO.OF BLOGB.
OF LOT 95x98 irre �ow�o� �o, 0
USE OF None �
EXISTING BLOG.
SET9ACK LINE FFOM nOQ � '
CENTER OF STFEET � REAR YARD
SIDE YARD ILEFT � IRIGHT 1 �'
DESCRIPT.ION OF WORK „
�SZIEDING IpOQ $f` ROOMS p STORIES y
lU
� EXTERIOR WN.I. � RooF WOOd Sh111�165
KQS
ara
1 MEREBT ACKNOWLEDGE THAT 1 HpVE READ THIS APP4CATION
AND ST�TE THAT THE P90VE IS CORFECT ANO AGFEE TO COM-
PLY WITH ALL Y FDIN� ANO STRT LAWS REGOLATING
BUILOING CO STR ION.
SIGNATURE OF
PERMII"fEE
AUTHORIZED AGENT
ZONING
NO.OF USE
PLANB � Bllll
APPROVED //�` `7 `
BY N �'
YARDS
REOUIRED
ICENTER LINE ST4
FRONT �
R. SIDE � I �
ftEAR
:W ✓li'�� /—
T�
IN.
IN.
IN.
IN.
THE AMOUNT SHOWN LINDER VALUATION IS FOR THE
PUPPOSE OF ESTqBLISHING A PERMIT FEE ONLY.
VALUATION
(7 PERMIT FEE S � ��
! VJ ��3 pLAN CHECK $ �'��
�
TOTAL FEE $ —4� J'—'
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F
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0.
Q
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
�OWNEq
MAIL
A-DDRyE:
CITV \
BRANCH
ADDRESS
ADDRE55
TEL
NO.
L.
ADDRESS
TEL.
CITV NO.
STATE ' . CITV
LIC. NO. UC. NO.
SI2E ' NO.OF BLDGS.
OF LOT NOW ON LOT
USE'OF �('��S'A_-.C� '
EXIS'fING BLDG. �1 L_��A
SeFarate permits are required for
electric, plumbing and heating work.
USE OF BUIIDING AND WONK TO BE PERFORMED
I hereby acknowlatlee that I have reetl this application anC stata
Mat the above informat(on is correct and agtee to comply wiM
ell laws repulatinp buildlnp constructlon, antl I shall� not employ
any person in violation of Me workman's compensetion laws of
Me State of California. �
I hereby certify thai I am properly Iicensetl as a contrector untlar
the Sute of Califor a Businea entl Profealons Cotle, Divislon 3,
Chapter 9, antl tha ch Iicenses are in full force and effect, or I
am exempt from xh rovisions of the State of California Business
anC Professlons C�( ivisfon 3, Chaqter 9�
Permittee �
Auffiorfzad AOent
�
7656 6/30%78 ` '`"54.50� LU
APPLICATION FOR STRUCfURAL PERMIT
� �k
�c
OWNER ` L.�
FIRE
VALUE
DATE
�_7b .r
YAFlDS'APPROVED I YARDSAPPROVED
VAR. �
C.U.P.;
�
FT. �
BET. MAIN &
AOCE§ BI_IX'S.
h
n
m
��
m
m
SQ. FT. w
THE AMOUNTSHOWN UNDEF VALUATION IS FOR m
THE PURPo6E OF ESTABLISHING A PERMIT FEE ONLV: �
VA�UATION PERMIT FEE S a
�1.� � m
� PLANCHECK� $ "�
O
$ � LL�
TAX E �
� u
TOTALPAID S