HomeMy WebLinkAbout2866 VELASCO LN - Building Permits CITY OF COSTA MESA
O "ft BUILDING DIVISION
F(�. 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
tptcli FOR INSPECTIONS CALL:(714)754-5626
PERMIT NUMBER: B10-00130
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: 14154219 DATE ISSUED: 05/11/2010
ISSUED BY: BE
JOB ADDRESS: 2866 VELASCO LN CM Suite/Unit:
Vicinity:
Squares: 0 Valuation: $8,800.00
SCOPE OF WORK: TEAR OFF EXISTING ROOF RE-SHEATH WITH 7/16TH OSB,15LB FELT,AND 30YR COMP APPROX 28 SQUARES.
COOL ROOF NOT REQUIRED.
OWNER: STEWART, KENNETH D Address: 2866 VELASCO LN Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: ADAMS ROOFING Address: 3435 S SILVER SPUR Unit: :
PHONE: 714-965-0245 City/State/Zip: SANTA ANA,CA
CONTRACTOR: ADAMS ROOFING License No. 524341
Address: 3435 S SILVER SPURUnit: PHONE: 714-965-0245
City/State/Zip: SANTA ANA,CA 92701 CELL: 562-961-9299
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $167.25
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00
TOTAL FEES S168.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010-PER CMMC Soc. 13-279
Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibitied all hours-Sundays and the following Federal holidays
New Years Day, Memorial Day,Independence Day. Labor Day,Thanksgiving Day and Christmas Day
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE S. INSPECTION TYPE DATE INTMAI4 CODE P INSPECTION TYPE DATE INTmALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof ® a 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
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivb,0 license. 0 Yes 0 No o' r
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
ye ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document.i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
y performance_foof the work for which this permit is issued.
, p 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend, will be made in connection with work authorized
Carrier:
519 to T y r� by this permit,and that no building structure,scaffolding.falsework,or demolition
or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp
(Tilts setton need not be completed J the pmM u valued art one hundred dot ars(S10D)or ksi.) 2 Art 2.Sec.341,Title B,California Administrative Code).
Policy Number: /Z oO 2-1-/(7
0 As owner-builder, I will not employ anyone to do work which would
K. El I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above.unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the ers'compensation provisions of Section 3700 of
Applicant's Signature Date
the Labor de,I shall f hwith comply with these ,provisio s. J
S 0y Division of Industrial Safety Permit Number:
`Apo coot's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions. that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force2/l .k
and e ect.
C- a registration form for acutely hazardous materials? ❑Yes 0 No
3c- Lic.# �J7/ Class# (Section 25533 of the California Health and Safety Code, with some
C-- exceptions, requires registration with the Costa Mesa Fire Department by
-'3C _ ` -1/4- J each business which at any one time has on hand a quantity of acutely
Contractor's Signature Date 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
U I hereby affum that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
- performance of the work for which this permit is'' sued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes',the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No
thereon,and who does such work himself or herself or through his or her own
8. (If'yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
Sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the properly, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit i1 final inspection.
gnatme IOwner(s) to
Sgnature Date x ( "� A 7 /0
-0
aDs] e(w]) And/or Authorized Applicant Date
bWNE
JECT ADDRESS: 2866 VELASCO LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 049542
A'SNAME: MERRIMAN EDWARD C
ADDRESS: 2866 VELASCO LN PERMIT NO: B 049592 PLAN CHECK NO: N GOVT: N SUPP : N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: V N PERMIT TYPE; STR PURPOSE: ALT
549 -5926
ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : T/OFF REROOF W/CLASS A SHAKE SQ FT: 4 , 800
ADDRESS: UNIT:
CLAIM VALUE: 4 , 800 . 00 CALC—VALUE: 4 , 800 . 00 GROUP OCC: R-3 /
- PERMITTEE: ADAMS ROOFING ( 714 ) 965-0245
ADDRESS: 1925 ANAHEIM AV B-2 COMMENTS : T/OFF REROOF W/ CLASS A SHAKES
COSTA MESA CA 92627 *************************>E* *** +E************ *******************ar********u***>F
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 Ol the Business and Professions Code.and my license is in full force and aMpgt. SETBACKS
CITY LIC.:04 6 2 STATELIC.:524341 C SS' C-3)l lf,/l
Date: e 0 Signature: /—.,�/%."_ �Gc� _ MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
`OLICY NO.: EXP.DATE:
COMPANY: PARKING REQ: PROV: PARCEL : 14154219 ZNE: REF NO:
El Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES>
>
Date: Applicant: ********************************************************************:***********
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES R EQUIREMENSS
I certify that in the performance of the work for which this permit is issued.I shall not employ ny person in any manner so as to become 'r
Dat ,subject to thejNl kke/ryq'Compensation Laws of California. ZONING APPROVED BY DATE :
Date: /0/( 70 Signature: L
NOTICE:If.alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction tending agency for the performance of the work for APPLICATION ISSUED BY: a -I _� N. DATE: U /9 90
which this permit is issued(Section 3O97,Civ.C). .**********************• • • *** .<�'' ' :=�-- -•� - ***.7E***{p{e.X.*******.**{F* *}E ******
LENDER: ************************************** ' ***************************************
ADDRESS: LEGALIZATION:N F E E UMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason .BLDG PMT PLUMBING ELEC '' IC , MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 7 2 . 0 0 . 5 0
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed SM I P/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing With Section 7000)of Division 3 of the Business •
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN '
any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars(5500). ISSUE FEE
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 72 . 50 0 . 00 .0 . 00 72 . 50 72 . 50 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or DIVISION —_
forptheepurpose of sale). one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE
PMTPLUMBINGELECTRICOMECHANDIC FIRE2 SMIP/TOT/SHORT: . 00
GRADING PLAN—CHECK
I.as owner of the properly.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 72 . 00 1 . 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F 'E E BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTION — UNIT COST TOTAL COST
Date: Owner: SFR 4800 REROOF BY VALUE RESIDENIAL NOZONE 1 . 00 4 , 800 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and ENDOF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a •
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant: -_
I hereby certify that I have read this application and state that the above information is correct.1 agree to comply with all city and county SMOKES ETECTOR O1 00072348-000 r 399
ordinances and state laws relating to building construction and hereby outngr¢e representatives f this
dry to enter upon the above-mentioned �� 72
Properly f��nsppctiory�rppses. / - DATE: TOT ;7.5
/� �� REQUIRED ;.I � 10/19/90 TIME: 13:00
.�—Date'. Signature: �} ,(-
Driver's License or Social Security a: -L
Driver's
1641-46 White-Building;Green-Code Enforcement:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING t__ L & SPA t
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
' 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2: Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3: Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
15. Steel Reinforcement 56. Rough Plumbing & Pressure Test
•• 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe•Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 66. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
•
20. Rough Factory Fireplace u:l 1, ' ' - ' 'APPROVALS. ;, Per'niit # - ' '
21. Ducts,in Structure , r 70. Underground1Hydro '
22. Ducts, Ventilating • . .71. Product Piping 0Gas ❑'Oil
23. Gas Pipe:Rough & Test ,,1 . i 72. Underground Flush,- •
24. 'Roof-Framing' , -: '-7 3.'.Undergrnd�:Storage Tank OGas 0 Oil -
25. Roof Sheathing :i . - . • • ' 74: Overhead Hydro , .
26. T-Bar Ceiling (Structural) &•Monocoat : 75., Dry Chemical ' • '
27. Frame and Flashing - 1: : 76. Dry Standpipe .1 - �
28. Lathing & Siding t • '•,t . , 77.' FIXED SYSTEM,F.INAL; ' •
•
29. Insulation , ' .1 • 78:"FIRE PREV. FINAL 1 ^'
30. Drywall Nailing • ^ 4 HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat, , . .i, ft ..79.-FINAL INSPECTION : . - .
32. Electrical Power Meter-Final ^80. 'FOOD CERTIFICATE ISSUED
,
33. Final Electric 1 ',, ^ Notes: .1 r-; • ' •
34. Final Heating-& Air Conditioning• 11 1 ,{ 1',• , "' 1 . " _ ,
.1' 4
35. Final Gas Pipe-Test i I 1 .5"--t6 --qr-- • ,4A-1,0-/-- .
" 2I- del.,[ m�
36. Hood or Canopy - '1 , ! I I . (�C,GL _'14
t -I W
37. Final Factory Fireplace , „ •1, .' j. I l - C.
38. Final Plumbing i I , • ll .. . -
- , i
39. Water Service-Final '' ,t t I •
.i .t : w •
40. Gas Service-Final •r. ° -; 1 '4: , 1
41. Solar Domestic-Final I 4 + ,
, , •
42. Backflow Preventer ^ ' I;• -, .
43. Backflow Irrigation ' ' '• '
44. Landscape Irrigation System '. • • • • '-
45. Sound Attenuation
46. Handicap Regulations • •
47. FINAL STRUCTURE & BUILDING cl�/ &Wr ' - • _ •
-48. FINAL PLANNING - 1 .1: 1,
49. Electric Release to Edison '•1 .
50. Gas Release to Southern California Gas Co ' " .
51. CERTIFICATE OF OCCUPANCY
No Date i
OWNER MESA—DEL MAR DEVELOPMENT COMPANY DATE 3-12-62
JOB ADDRESS 2866 Velasco lane BUILDING PERMIT NO. 16681
GENERAL CONTRACTOR Macco Corp. VALUE S 18,960.00
AP No. LOT 83 TRACT 4260 FIRE ZONE DESCRIPTION OF WORK res w/att gar
I'" .?ECTIONS Signature DATE GROUP 1W TYPE V ZONE R1
S. £,(` 3-V-3 0� PERMITS ISSUED
GSUBCONTRACTOR DATE NUMBER
as
Watcr . , ^%/i �thE /7Z
Rough m. Refrig. ❑ Air Cond. ❑ _ /
Rough Heating _ . '. - .� a
Rough Plumbing = _ _ -- C _ �_ I. _ �02�(,�- 3 1` _//
Miscellaneous I .. err y _ f. a-r- y l � slid_�� _ / Q ✓ I i
Prop.Swr.Line R-House Con.'Q-St.Swr. 0 ' ni aL '�j..?- - —.011�//i 2- "_ f — 4
Sprinkling System S/r7al ic,rs-s,y / _ 4(, 7l b
Construction Pole Zu' tt"" '�'� d- /T-G: /.._.
11161 I 1
Underground 0 Power 0 1
Rough Wiring C/ _ �Py�i� gC/ 7"/0 -(a.? �9
Trenches g----Forms [Steel Reinf. 0
='%� / _.
Floor System __ V .
Bond Beam 0 Steel Reinforce 0
Sheathing k.��r!i 7-3-6z
Frame and Flashing
— In 0 Out 0 4 %Y'S 1--3a-4L
Plater, brown coat F1' ' C .9,7/9- (2
Ixt=,g. 0 Air Cond. 0 Final
lacing,ting, Final /14+S /d-Q-42
Plumbing Fixtures, Final -9 fO i'
Final Gas Test/3— '�"!
Electric Fixtures, Final r �f t,J /2/C
-C
Building, Final Jl_ C�UW 1 tri �6
OCCUPANCY
FORM BU4•5M — 7-61 1 AAFti
• •
16681 r E ' mak��,s�siv D •
83 n Tract 4260
COSTA MESA BUILDING-SAFETY DEPARTMENT FIN'\NCE DtYl Plan LS -0
P. O. BOX 917 COSTA MESA. CALIFORNIA CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINTI BUILDING
BUILDING
ADDRESS 2866 Velasco ?ane
COSTA MESA. CALIFORNIA For Office Use Only,{1.7�
OWNER Mesa Del Mar Development Co. I RECEIPT NO. I min
MAIL RECEIVED BY DATE RECEIVE DATE ISSUED
ADDRESS 3800 E. Coast Highway
fir %�/t —A SD 1 Y 114%
city Corona Del Mar,Calif. ND;'R 3-1220 AD-LS
ARCHITECT Cliff Olsten TEL_li COSTA MESA. CALIFORNIA
OR ENGINEER `�C C C 3 y NO.LA3-1221 /C
ADDRESS 9025•' E. Florence Ave. ,Downey, ZONE TYPE Vj GROUP-8:_P%
Calif.
CONTRACTOR Ma o Comoratinn APPROVED
BY DATE
ADDRESS 3800 E. Coast Highway ZONING
CITY Corona Del Mar, Calif. ZONENO.OP Z BULDINOuse OF EW•
/r~, TWIN/�+..
- I FLANS I u/ aV. Ot-I .
STA
NO. 98808-S)3-1 TEL
OR 141220 LEGAL L6'- 5)3 7/P X12 6 o
DESCRIPTION
SIZE ..pp I NO. or NOW ON LLOOGS,�Tone
OF Lot 717 y S.F. A.P.NO.
USE OF YARDS EVES
EXISTING BLDG_ NOnep _ APPROVED ALLOWED
SETBACK LINE FROM 1 O, REAR YARD ZV1ZII (CENTER LINE STA i."
D
CENTER OF STREET FRONT ��/V FT. - IN.
SIDE YARD I LEFT 71 I RIGHT 7 t R.SIDE ! FT. IN.
DESCRIPTION OF WORKL.SIDE 7 FT. IN.
NEW IX II ALTERATION I II ADDITION I REAR Z 8 FT. a IN. '
REPAIR I II MOVING I II DEMOLISH I BYPROVED eez) DATE i i t i 76 L.
coo
BUILDING L^ NO. OF
SIZE oIx5o f loll ROOMS 7l
6STORIES 1
EXTERIOR COVERING WALL�t11CCOI COVERINGROVF
World
USE OF BUILDING AND WORK TO BE PERFORMED
Si r6Tla family dwlling L1y1rE area 17 9 5•F•
w/attached garage Garage II 460 S.F.
•
Covered Porch 108. S.F.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS POR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CAM• PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION g
SIGNATURE OF,. T,q., PERMIT FEE S . (]• 4 e
PERMITTEE ea Del. r Development Co,
AW
By 10, / lora i/ $ 18,960.00 PLAN CHECK $ /t Or
AUTHORIZED f N � ' E
TOTAL FEE $ 57.00 y