HomeMy WebLinkAbout340 VILLANOVA RD - Building Permits.
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CITY OF COSTA MESA
BUILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
P�RMIT TYPE: B COMBO
Sub Type: RES_ALT
Joa q��ReSS: 340 VILLANOVA
APN: 14147106 .';
Vicinity: BEDROOMS
Const Type: V-B
SCOPE OF WORK: 350SF
CONVERSION OF A BEDF
BATH. i;
1 SHOWER . 1 HOSE BIB'
1 ALT DUCT SYSTEM :;ys
4 LIGHTS 7 OUTLETS 4`S1
OWNER: JUAN,
Phone:
APpUCANT: JUSI, SIN
Phone: 8181126•1
CONTRACTOR:
Phone:
Cell:
ARCHITECT:
ENGINEER: AGRIPINO B
FOR INSPEC710NS CALL: (714) 754-5626
PERMIT NUMBER: BC08-00152
STATUS: ISSUED
DATE ISSUED: 05I13I2008
=';:�1-: :��`,'.; ISSUED BY:
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`EXISTING ONE-STORY SFD. WORK INC
Y ROOM. ELEC & MECN. 4 BEDROOM, 2
$32,340.00
OF 2 BEDROOM,
TO 5 BEDROOM, 2
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.' Address 340 VILLANOVA RD, ., �; � } i Unit
' �,����City/State2ip �-�.�COSTA MESA, CA�. � , � � r q •'`� �., p:',
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U - ,� , Address: Unit: - �i�+�
City/State: -- - � �`.��ZipCode
,,_ � , LicenseNo: , , PHONE:
MENOR �=� License�No.C28539 „ - . � - PHONE:323-255-3934
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:RMIT'F.EE SUMMARY � - •
BuildingPlanCheck: ,�'�$30716=��s' _ _ �� ' ���*-
Building Fees: ' �$472.'S5 , �
Electrical Fees: � �; $44-75=":�, - '
Mechanical Fees: �>;$44.45 ` �- '� . -;;r,::.�� .
Plumbing Fees: $43 10"�.� ,_ �, � ;
SMIP Residential: $3.23
._..,._. _
SMIP Commercial: $0.00
TOTAL FEES: $915.24
"Refer to fee receipts for all fees paid for project �
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPEC710NS: 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 oblained. Failure to obtain inspections and f nal approval will result in the expiration of this permit.
GO E E INSPEG110NTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final .
200 Final Re-Roof
207 Final Block/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
ORTE IXTI71AL5
cooef ixsvecnoxrne
206 Final Mechanical
208 Final Plumbing
210 Final Electncal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy P/�l
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WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the foiiowing declarations:
❑ I have antl vrill maintain a certificate of wnsent to self-Insure for workers'
wmpensation, as provitleC for by section 3700 0( the Labor Cotle, for the
peAortnance of Ihe xvrk for which this pertnit is issued.
❑ I have and will maintain workers' wmpensation insu2nce, as required by
secl'an 3700 of the Labor Code, (a lhe pedortnance of the wnrk for which this
permit is issued. My vrorkers' wmpensation Insurance carrier and policy
number are:
Carrie[
(iltis seUun neetl rof Ee mmplelM d Ine pemW a valuetl ai me nuntlrtd tldlars (Ef001 aleuJ
Policy Number:
� I certify Nat in the pertormance ot lhe vrork tor which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the vrorkers' compensalion laws of Califomia, and agree [hat if I should
become subject to the vrorkers' compensation provisions of Section 3700 of
the Labor Code, I shall forthwith comply with these provisions.
Appli�anl's SipnaWre Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDRION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 37W OF THE LABOR COOE, INTEREST, AND
ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencing
vrith Section 7000) of Division 3 ot the Business and Protessions Code, and
my license is in (ull force antl effect.
Lic. # Class #
COnV3Glor's $ignaWre Da�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrm that there is a construction lending agency fw the
peAortnance of the v.ork ftt wfiich this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Signature Date
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty of perjury ihat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Cotle: Any city or counry which requires a permi[ to
coretruct, alter, improve, demolish, or repair any sWcture, prior to its
issuance, also requires the app�icant tor such permit to file a si9ned statement
that he or she is licensed pursuaM to the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
BuSinesS and Pfo(essiOnS Cotle) Or thal he or she is exempt �herefrom and
Ihe basis for [he alleged exemption. Any violation of Section 7037.5 by any
applicant !or a pertnit subjects the applicant to a civil penalty of not more than
five hundred dollars ($500).):
❑ I, as ovmer of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and ihe structure is not inlendeC or
offered tor sale (Sec. 7044, Business and Pro(essions Cotle: T�e Contractors
License Law dces not appy to an ovmer of property who Duilds or improves
thereon, antl who tloes such vrork himself or herself or throuqh his or her own
employees, provided that such improvements are not intended or offeretl 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
d�id Jrrot build or improve for purpose of sale.). � �
❑� I, as ovmer o1 the property, am EXCLUSIVELY CON7RAC71NG WITH
LJCENSED CONTRACTORS to consiruct the project (Sec. 7044, Business and
Professbns Code: rne contractors License Law dces rrot appty to an wmer of
property who builds or improves thereon, and v.ho contracts tor such project with
a contractor(s) license pursuant to the Contractors License Lavrs.�.
❑ I am exempt under sec. �
Business a rofe iorWrCode for lhis reason:
�
Owner ID veri(etl by dnv z�'" {���Yes ❑ No /� �� �
Oriv� er.'s.License�No. �' Expires: v^�y�t% '��
Verification of Ownership by (rype of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: �
❑ I hereby ced'rfy Ihat no excavation frve (5) or more feet in tlepih into which a
person is requiretl to descend, will be matle in connection with work authonzed
by this pertnit, and that no building st�ucture, scaffdding, falsework, or demolition
or disman0ing thereof, will be more than thiAy-six (36) feet high. (Chap. 3.2, Grp
2, AR 2, Sec. 341, TUe 8, Califwnia Administ2Me Cotle).
❑ As ovmer-builder, I vnll not employ anyone to do vrork which woultl
require a permit from lhe Division of Industrial Safety, as noled above, unless
such person has a permit to do such work from the division.
Appli W nl's Signalure Date
Division of Industrial Safery Permit Number:
HAZHRDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will Ihe applicant or present or future building occupant need to file and
certify a Business Plan for emergency response to release or threalened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 ot the Califomia Health and Safery Code requires, with some
ezceptions, that a Business Plan be filed vnth the Costa Mesa Fire
Department by every business which has at any one time dunng a reportetl
year a quantiry of hazartlous 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 anC pressure).
2. Does or will the appliwnt or present or fuW re building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of Ihe Califomia Health antl Safery Code, with some
exceptions, requires registration with [he Cos[a Mesa Fire DepaAment by
each business vTich at any one time has on hand a quantiry of acutely
hazardous matenals equal to or grea[er than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed qas at stantlard
tempera[ure and pressure).
3. Does or will the applicant or present or fulure building occupanl need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safery Cotle provides that the
Costa Mesa Fire Department may require the preparation, certifcation and
filing with Ihe Fire Department o( an RMPP by businesses which are requiretl
to register acutely hazardous matedals vrith lhe Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Healt� antl Safery Code been fully complied with? ❑ Ves ❑ No
5. Dces or will the applicanl or present or (uture building occupant require for
the work which is Ne subject of Ihis application a permit for such construction
or modification from the South Coast Air Qualiry Management DisMct or (rom
any other air polWlion control tlislrict or agency? ❑ Ves ❑ No
(Section 65850.2 of [he Califomia Govemment Code requires [hat ihe 2quested
infortnatbn be fumishetl on applications fv rron-resitlential builtling 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? ❑ Ves ❑ No
Qf 'j�es", �he facility must meet Ihe requirement of Seclions 25534 antl 42303
of the Califomia Heal[h antl Safety Code).
7. If a permit fmm the South Coast Air �ualiy Management District or other
air pollution wntrol disMcl or aqency is requiretl for the vrork which is the
subject of this application, hava all of t�e disclosures prescribed by Califomia
Health and Safery Code Section 42303 been made? ❑ Yes � No
8. Qf yes", attach certificate of compliance from the appropriate air pollution
contmloKceq.
CERTIFICATE OF COMPLIANCE: I certify that under penalty oLperjury the
information given above is correcL I agree to comply with all state lav'rs and
ciry ortlinances regartlinq Hazardous Materials and Emissions. ''
Signawre
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury that I have read this application and state Ihat
the information given is corre . I aqree to comply with all state laws and city
ordinances relating to buildi construclion, and authonze representatives of
the City of Co� t6Yqesa enter upon lhe above-descnbetl pmperty for
inspection p rposes. agr e not to occupy or allow occupancy o( ny building
authonze y this mit ntil fin inspection.
4' � � .��"'
SignaWreM galOrmer(s) T ��'— le
_l_ ' — _
305]�A6 (3/0]) �.�/�� �
qnElw
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.c�ILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 340 VILLANOVARD Status: ISSUED
Suite: Applied: 08/11/2003
Vicinity: Issued: 08/11/2003
Parcel Number: 14147106
Applicant: SMITH, KEN
Address: 11691LUZON
CYPRESS,CA
Owner: JUAN,-ALFREDO L JR TR
Address 340VILLANOVARD
\ �
- - � COSTA MESA, CA �
Contractor. A OK REOVATION & ROOFING
Address: 11691 LUZON- �
" CYPRESS,CA
2ip: 92630
Arch :
Address:
Zip:
Phone:
License:
Zoning:
Phane: (774)391-3754
Zip: 92630
Phone: - �� �
Zip: 92626-6334
Phone: (714)391-3754
License: ; 639447
. Eng:
' Address:
SCC
TEAR OFF EXISTING COMP AND ROCK ROOF, COVER WITH 30
FEESUMMARY
ISSUED BY:
Phone:
License:
un��
SHINGLES INCLUDES ATTACHED GARAGE.
Plan Check: $0.00
Permit: $111.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $111.75
SETBACKS'
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existinq: 0
NOTES:
Rear 0- 0
Rear 0- 0
Re uired; 0
PLANNING & ZONING
Left 0- 0
Left 0- 0 `
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
Sa,sss.00
sa,sss.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, § t, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 1B0 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In ordar for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspactlons 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
2446-461fi/00) '
WORKERS'COMPENSAnON OECLARAnON: — ' �
I hereby aHirtn under penalty of perjury one of the following tledarations: �. �' . �
❑ I have antl will maintain e cenificate of consent to self-Insure for workers' compensetion, as provitletl for by section 3700 of the Labor Code, tor the pertormance of Ihe
wo for which this permit is issuatl.
ave and will maintain workero' compensation insuranca, as required by section 3700 oi the Lebor Cotle, for the petlortnance of the work for which this pertnit is issued.
M workers' com e/ry��tio/n� I�ns,u,r�anc�e carriar and li number are:
Carrier:Y� P/U–V �`l� T� r PolicyNumber. '' '
(This section need not b completed i/ the permif is va/ued et one huntlretl tlollars (5100) or less.)
I'1
❑ I certify that in the peAortnance of e work for w�ich this pertnit i issued, I shell not employ�ny person in any manner so as to become subject to Ihe workers' '
compensation laws ot Califomia, ntl agrea ih tT�hould co subjact to t�e workers' compensation pmvisions of Sectibn 3 � 0 0l ttie La�Code, I shall forihwith
comply with these e�iea ��1 � � J
AO�licant Signetur . .+ Dale: /1 � L
WARNING: FAILUR TO SECURE ERS' COMPENSATION COVEPAGE IS UNUWFUL AND SHALL SU6IECT AN EMPLOYEfi TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO IXJE HUNpRED
TFiqJ$AND E100 , N AODITION TO THE COST OF CAMPENSATION, DPA41GE5 AS PROVIDED WR IN SECTION 31W OF THE LABOR COOE, INTEREST, M!D AiiORNE1^S FEES.
LICENSED CONTRACTORS DECLARATION:
I herehy ettirm Ihat I am licensetl nder provisions of Chapter 9(co mencing wiN Section 7000) of Division 3 ot the Business and Profassions Code, entl my license is in tull
force entl eflecL Lic. p Class k
Comrectors Si ture: � Date:
CONSTRUCTI DING AGENCV: � �
❑ I hereby affirtn that there is a consWction lending agency for t�e performanca ot the work for which this permit is issued. (Sea 3097, Civil Cotle).
Lentlers Name:
SignaWre: _
OWNER-BUILDER DECLARATIONS:
Lendefs Aadress:
Data:
I hereby affirtn Ihat under penalry of perjury Ihat I am EXEMPT FROM THE CON7RACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Protessions
Code: Any ciry or wunry which requires a permit �o constmct, alter, improva, tlemolish, or repair any stmcture, prior to its issuance, elso requires the applicant tor such pertnit
to file a signetl stetement Ihet he or she is licensetl pursuant to the provisions ol lhe Contrectors License Law (Chapter 9(commencing with Section 7000) ot DiWsion 3 of the
Business and Professions Code) or Ihat he or she is exempt thereimm entl the basis tor the allegetl azemption. Any Woletion of Section 7031.5 by any applicant for a permit
subjecis the applicam ro a civil penalry of not more than fiva hunared dollere (5500)J:
❑ I, as owner ot the pmperty, or my employees with wages as their sole wmpensation, WILL DO THE WORK, and Ihe simc�ure Is not intended or otte�ed tor sale (Sec.
7044, Business ana Professions Code: 7he Contractors license Law tloes not apply to an owner of property who builds or improves ihereon, end who tloes such work
himsetl or hersetl or through his or her own employees, D�ovitled that such improvements ere not intended or oHered tor sale. tl, however, Ihe building or improvement is
sold wit�in one year of completioq the owner-builder will have the burAen oi pmving that he or she did not build or improve for purpose of seleJ. �
❑ I, as owner ot the properry, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (SeC. 7044, Business and Protessions
Cotle: The coniractors lJcensa Law does not eppty to en owner oi pmpeny who builtls or Improves Ihereon, entl who comracts lor such project with e comractor(s)
license Oursuant to the Contrectors License Laws.).
❑ I am eaempt untler sec. Business and Protessions Code tor Ihis reason:
Signature: Date:
Owner ID venfied by tlnver's license. ❑ Yes ❑ No Drivels License No. Ezpires:
Veritiwtion oi Ownerehip by (type ol documeN, i.e. - pmperty t� Dill or tleetl):
DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICA710N:
❑ I hereby cenify thet no excavation Five (5) or more teet in depth into which a person is required to descend, wlll be mada in connection with work euthorized by this
pertnit, and ihat no builtling siructure, scaHolding, falsework, or demolition or dismantling thereoi, will be more than ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Califomia Administretive Code).
❑ As owner-builder, I will not employ enyone to do work which would require a permit trom the Division of Intlustnel Sefety, as noted ebove, unless such parson has e
pertnii �o do such work Irom �he tlivision.
Signawre: Date:
Division of Intlustrial Safary Permit Number:
CERTIFlCATE OF COMPUANCE AND AUTHORIZATON OF EMRY: I cenity under penalry ot perjury that I have reatl ihis application end state that the information given is
wrrect. I egree to compty with all state laws and ciry ordinances relating to building construction, antl authonze representatives of the Ciry of Costa Mesa to enter upon the
ebove-descnbed property for inspection purposes. I agree not to occupy or allow occupency ot any building authorized by this permil unlil linal inspection.
COQE6 INSPECTIONTYVE � ' -
1616 Fixetl System Final Fire Prevention
1266 Pool SOe Final
200 Final Re-Roof �
201 Final BIocWRetaining Wall
202 Final Factory Fire Place ,
2D3 Final Sign
204 Final Demolition
QeIF ' ' INTRIALS
�
i �
• �
0
� '�'
♦ /�
�- .
COOE 1 INSPECTION TYVE ' � '
206 �FinalMechanical
20B Final Plumbing
210 Final Electncal
212 Final Fire Prevention
220 -' Final Planning Approval
222 Final Site
250 Final Building/Occupancy �
Q� ��
�
OWNER PRINCETON
DATE
JOB ADDRESS 3Lt0 4111anova Road BUILDING PERMIT NO. 598j.{
GENERAL CONTRACTOR Dike & CO�.BQTOVB VALUE $ �(y,�.(�6,0� �
AP. No. LOT 2% zaacT 2953 FIRE ZONE DESCRIPTION OF WORK Residence x/att aar.
GROUP I& J TYPE 0 ZONE PLAN NO. FiOlS
INSPECTIONS
House
Stcel
DATE � gUBCONTRACTOR
�PERMITS ISSU—ED
I NUMBER
6�15
COSTA MESA BUILDING DEPARTMENT
P. O. 80X 31 �
COSTA MESA, CALIFORNIA
FOR APPLICANT TO FILL IN
BUILDING
AODqE55 ']l.11 Tli l l �..r...� DnnA
IOWNER
I ARi
OR
i c.i �u�:a.cac.a�
COSTA MESA. CA�IFORNIA
� FEE RECEIUED �
i/ - � 3 -S'�
Y� �
FINANCE DEPT.
CITY OF COSTA PdESA
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
PECEIVED 9Y LIATE HECEIVEO OATE
✓ //- ��'CS N�V
�o:r.i. 8-1159 ADDRE55
��c. COSTA MESA. CALIFORNIA
NO.
CITY LIC.
�lIVP NO.
APPROVEO
BY
LEGAL
oescrxivrior+
A.P. NO.
NO.OF BLDGS.
�IOW ON LOT
USE OF
E%ISTING BLDG. n�np
SETBICN LINE FROM � ^
cervrER or srR[[r % �[ 'Q� REAR VARD
SIDE YAR� RIGHT I �EFT' �
DESCRIPTION OF WORK
NEW ALTERATION ADDITION
REPAIR � MOVING DEMOlISH
BUILDING NO.OF
SIZE ROOMS STORIES
EXTER�OR WALL ROOF _
DATE
CORRECTIONS
I XEREBY FCI(NOWLEOGE THAT 1 HAVE PERD TXIS APPIICATION FNp
STATE THAT THE FBOVE IS CORRECT ANp PGREE TO COMPLV WITH 4LL
crtv OROirvaNCES BND 5 E LaWS NEGV TING BUILOING ONSTRUP
norv. /� � VALUATION �
\
SIGNATURE OF � ��
PERMITTEE_�
$ 14,11+6.00
�r�u_ca�u�
�
PERM�T FEE B
PLAN CHECK S
TOTAL FEE $
���
�eMr
\
:"�' 99�5
,y; -
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA. CALIFORNIA,
fOR APPUCANT TO F/LL /N COMPLETELY
TYPE OR PRINT
BUILDING ' (�/w
ADDRE55 7 v O
COSTA MESA. CALIFORNIA ,
C� �(/6N.0 ��j.L,E�p 6l ,NO.
A JT LIC.
OL .NEER NO.
ADORE55 �/ O
A/�/ I/I/ i STATE
7
� LEGAL
� � I ruow�o
� SETBACK LINE FfiOM ' �
DESCRIPTION OF WORK
I II ALTERATION I II ADOITION
.DING NO.OF
ROOMS
'.RIOR WALL I ROOF
SRING GOVERI
OF BUILDING AND WORK�TO E
1 XEiiEBY ACKNOWLEDGE THAT 1 HAVE REAO THIS APPLICATION
r1NO STATE THAT THE PBOVE IS CORREGT AND AGREE TO COM�
PLY WITH ALL CITY OROINANCES AND STATE LAWS IiEGOLATIN6
BUILOING CONSTRU ION.
SIGNATURE OF�
PERMITTEE
AUTHORIZED AGENT
r�E RECEI�l�U
��^�' JUl 151968
FINANCE DEPT,
CITY OF COSiA MESA
� APPLICATION FOR PERMIT
BUILDING
FOR OfF/CE USE ONCY
I RECEIPT NO. I �MI)�N__Oi�
JM1.Ii,
RECEIVF.p BY DATE RECEIVED DATE ISSUED
� /J ' % �%._ �L- o—G ` � �— .
COSTA MESA, CALIFORNIA
ZONING
NO.OF I USE OF NEW
PLANS BUILDING
�A/MYV1iOATE /+�5�
(CENTER
L.SIDE .�J FT.
REAR �S/ FT.
THE AmOUNT SHOWN IINOER VALUATION 19'FOR THE
PURP08E OF E6TABLISHING A PERMIT FEE ONIY.
VALUATION / � CY1
Q !� � PERMIT FEE S �
/ (J �
$ PLAN CHECK $
TOTAL FEE $ ,� /,
OWNER �R$, F DATE 7'i5�59
JOB ADDRESS �6l1 Si;l l�nnvn StrePi; BUILDING PERMIT NO. 99�
FIRE ZONE DESCRIPTION OF WORK
INSPECTIONS DATE I GROUP J TYPE ZONE
Underground Soil U.G. Water _I I PERMITS ISSU
SUBCONTRACTOR
210-3M-4.59 �- . - - �� 9905