HomeMy WebLinkAbout1075 VISALIA DR - Building Permits CITY OF COSTA MESA
e, : BUILDING DIVISION
F
( ' : -i I, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
4bb onnrw'� PERMIT
`lo.mw B05-00781
l /
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa,0a.yjg DING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1075 VISALIA DR CULL Status: ISSUED
Suite: Applied: 05/16/2005
Vicinity: Issued: 05/16/2005
Primary Occ: R3 Type of Construction: V-N
Parcel Number: 41210434 Zoning: R1
Applicant: SPECIALTY ROOFING CONTRACTORS_ - r
___6.71
• 'clic- ISSUED BY:
Address: 6152 SIERRA PALOS.----,,,Li;��� �-_... - --� -` --- - _ ,-
- f- r' ":-- _ - Phone: 1949;725-0500 �'._ '`
IRVINE,CA l �"
r —D t
d-! --1( /i , 'Zip: , 92612/ / "�.
, �--�.: 1\. `- ' ,.. . 1 /11 [' - \�.;'N'..
Owner COLBY,-MICHAEL"0'TR ; -/I •
_ �--- ,� ����.�-
Address -1075 VISALIA DR- \ C%"�/---�`--- - ":::-..:L„,c \J / i ',N
/ „-�+/ . N
a.a.2'1„/ - .,' 1 - ,.�r� Phone: ,_� ,w' r- .
i;,COSTA MESA,CAr-1 = Zip: 92626 V -1/4:-,...- // r� \AA y
f7/w i,>:..' /11)t(-7%,:-/r - ' 'A
Contractor: SPEC LT ROOFING CONTRACTORS \` \* > / \\\,„:,
\ `,
'Add• ress:- 6152 SIERRA PALOS i\", '`✓/
/ }�; ( 6'� i�f"/ Phone: 949-725-0500 A\\ .
• -N,,__ /IRVINE;CA ,` _ ��
r Zip: 92612 I ;License:- 449292
Arch: / r/Jr.-r . ..1, f�. , I Eng_
Address: -'1/-1-1 ,rl ° / .v'" -;r>` rf' <' -- r :Address:= \1/4 ,
1 , r / Vit.., 1-Phone:
yrs �1
•t ;Zip:- f i:./ , -
' " License: N. License:.
,4,44/ ' ;' , ,t, fir, rte,/,Syr , SCOPE;OF PERMIT' +� �
; . , 1.� i !
• TEAR OFF INSTALL 15/32 PLYWOOD WITH/1-30LB FELT-AND 30 YR COMP :SHINGLES. - -1,:,,I i '
�' FEE SUMMARY r
Plan Check $0.00 n r �=" t 3% `'� 'v\ rft` Calc Valuation ;r, $7,000:00;
t `1 Permit', ''', $139.25 .. __ 771;7 7 'f -'Claim Valuation ,;#`` -$:7-006 obi
$0.70 / '� "�
$MIP Com: $0.00 .. 4,, _; `i' it — ;4,
Other V
Z, $0.00 _ 1/7 f;' ' ;-, / /,
In$pection: N.:\$‘000 .a,; - / ri ( / /r+ /
-� -r i/'? / i.'i
'Total: �,4$13995- 'i> , o° r:%
'• v 7/////' PLANNINGr&ZONING ''c`-V/ , N ' r
., >/� mow`!!", / //
SETBACKS , / ��:'`�.,,. a ` o j_ _l'r`,.• ' '/
MAIN STRUCTURE-Front 0 0 5.,-- Rear `0 0 - -- Left 0 0_..4-'_�' RightSlo-0// �j ./
ACCESSORY Front N: -0----'0-
V 7/ Rear 0i i0 1_ Left _0-0a--3C\\\, Righ-C;y 0-0---4"
: >
PARKING Existing: --0-11,-.--- Required: 0, ) ,1 , / Proposed:,, C-01.-� � j
NOTES: - - - ------', �=2
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=21492)
-EXPIRATION: This:permit-shall automatically.expire-andbecome-void-if work is-not commenced:within 180.days,-or If work iasuspended or abandoned
'for a-period of 180-days.
•
INSPECTIONS: Iln.order;forthe work authorized.under,this permit,to-be considered legal, such work-must comply-with all applicable codes, and all
regtdred:InspectIoneand,finabapproval:mustbe obtained.1Failure-to obtain,inspections:andfinabapprovahwill•result inthe-expiration of this permit.
'FOR:INSPECTIONS-CALL: 1/4(714)754-5828
.244646(6/00)
DECLARATIONS \
WORKERS'COMPENSATION DECLARATION: A. •;
I hereby affirm undena ty of perjury one of the following declarations: • •
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the,performance of the
• ork for which this permit is issued. •
dopc I . - .-•will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for th- :
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO. 4;12 4 Ste_ DATE 7"/� 7 ')
LOT NO. a 9 /
ADDRESS „OO 7 C ',.csc ,I✓t
The developer of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that (he-she-they)
(was or were) _,A,, 44 advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa
Mesa as having complied with the conditions of approval which were imposed by
the city at the time the final tract map was approved.
The city assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the city harmless from any claim
resulting in damage or personal injury to the undersigned by reason of the
aforementioned uncompleted condition.
/
BY Af 1 • Ar �i�
R E C E I V E D Purchaser
CITY of COST,\ MESA Purchaser
�i,iG�—,Tit- L
Developer anit/or authcitijid
3 i973
'.
!U!_
representative
.
AM
718191i01iiii211,2e314i516 BY
Lender
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•
•
PROJECT ADDRESS; 1075 VISALIA DR UNIT: 0 • CITY OF COSTA MESA — BUILDING PERMIT PERM NO; P 04S&45
OWNER'S NAME: COLBY _
•
ADDRESS; SAME AS ABOVE PERMIT NO: P 049645PLAN CHECK NO: N GOVP: N SLTPP : N
- CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH
.714/5567979
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : WATER HEATER REPLACEMENT I SQ FT:
ADDRESS: UNIT: •
CLAIM VALUE: • CALL—VALUE: ' ' 'GROUP OCC :
PERMITTEE:'NOCK PLUMBING ( 714 ) 895--1246
ADDRESS: 11610 SEABOARD CIRCOMMENTS : NO STRUCTURAL WORK BEING DONE •
4 •STANTON CA 90680 ******-kk*3t*******RP*k**-k**"k -vE**Tt-kvE*-kkaERE*krt*****-k-k**-k*******k***aL-k** -*-k* -*k*x- k-k*
LICENSED CONTRACTOR DECLARATION: I hereby affirm That I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS '
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. S E T B A C K S
otYuc..:/ v 050386 •HmEuc.511971 cosi 36 •
Dale'.—(Y — 30- 4Signature: - _ MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-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
• POLICY N0.:11679929EXP. DATE 0S/01 /91 - '
•
coMPANY:STATE PARKING REQ: • PROV: PARCEL : 13919219 ZNE: . ' REF NO:
a Certified copy is hereby furnished. Ki Certified copy is filed with the city Building Division. PLANNING NOTES>
�
/J .� // >
Date- t0 ,30— . ' Applicant: —e--^^ V4)I ***************************************************iE*************)44+)41*)4.M****•k***
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: This section need not be completed if the permit is for one hundred(51001 or less). D EV EL OPMEN T SERV ICES REQUIREMENTS
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ' ZONING APPROVED .BY . . DATE:
Daie:• - signature: - BUILDING APPROVED BY DATE:
NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. / `) t /j� C�
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: DATE: L V / d
which this permit is issued(Section 3097.Civ.C). ********************************************* HHHkIk"'777rittt*k****.***k********;e)e- •k*kkk3f* ***
LENDER: *********************************************k*******************)Fkk*Xbe Y*k******
ADDRESS; LEGALIZATION:N F E EIS U M"M A R Y STRUCTURALSEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC 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 P ERM I T -2 . 00
• repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed - 5%- SNIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN ' '
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE 3 . 00 '
• 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 TOTAL S ----> 2 . 00 3. 00 _ 0 . 00 5 . 00 5 . 00 . 00 •
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/hersell or through i f '
his or her own employees,provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED:'' 5 . 00 OVER/SHORT: 00
• forptherpurpose sold one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC ' FIRE SMIP/TOT GRADING PLAN—CHECK
• 5 . 00 - —
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 1
❑ and Professions Code: The Contractors'SlatLicenseLawtlens t apply tan owner of property whbuilds improves theree
and woo contracts fr such projects with a contraserLaidoese pursuant totoe Contractors'State License Law).l em aware
********************************************34**04********** 4)434********3404****k***
that proof of their Worker's Compensation insurance should be provided to me. • INDIVIDUALF •E E BREAKD 'OWN
•
❑ I am exempt under Section: - B.&P.C. .
for this reason: TYPE QTY DESCRIPTIO N• UNIT COST TOTAL COST
. Date: ' Owner: PLU 1 WATER HEATER AND/OA VENT . 2 . 00 2 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF 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. ,
Dale: • Applicant; 01 D0073225-00073225 TOT 5.00
I herebycertifythat I have read this application and state that the above information is correct.I agree to complywith all cityand county [ a
pp gDATE: 10/31/90 TIME: 12:11
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter up the above-mentioned -
property for inspection purposes. V^ _i :�
•
Date: O —C11'0 signature: 7•
•
Driver's License or Social Security ' •
•
164t-46 While—Building;Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor 1
11111
CONSTRUCTION AND PLANNING PO._- & SPA
APPROVALS Permit # Date Inspector APPROVALS Permit# Date Inspector
' 1. Temporary Electrical Service or Pole • 52. Pool & Equipment Location '
2. ,Soil Pipe-Undrgrnd. I 53. Steel Reinforcement -
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd:-, 55. Electrical Bonding
5. 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
1
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 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air ConditioningFIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace "� _ t 4 , 'APPROVALS.;'[ .Permit # `
21. Ducts, in Structure •• - • =' ' + a. 70. Underground'Hydro
22. Ducts, Ventilating • , ; _ ; , , -71. Product-Piping 0 Gas OOil
21'Gas Pipe,Rough & Test rr ; r , • • r ' 72. Underground Flush •
t 24. Roof Framing • . . , , `73.-4Undergrnd.Storage Tank O Gas O Oil -
•
25. Roof Sheathing �- ; - 74. Overhead Hydro ' + -
26.'T-Ba'r Ceiling (Structural) & Monocoat _ :; - 1 ; ; 75: Dry Chemical ,1, '
27. :Frame and Flashing ;•,•• t. l i '�
76. Dry Standpipe ' .
• 28. Lathing & Siding • • , - ', ".; ' 77. FIXED SY.SIEM FINAL
29. Insulation •• 78.`:FIRE PREV. FINAL '
'30. Drywall Nailing . ; ' •4 -: .;HEALTH DEPT,. REQUIREMENT
31. Plaster Brown Coat - : t •79. FINAL INSPECTION + r,
'-32'Electrical Power Meter-Final. Er ' 80:100D CERTIFICATE ISSUED
33. Final Electric - .; r .-' tr t Notes:lZ'Ze ll°„Noo'h 14°ThCJ t ..icra'Qo 1...p
",34, Final Heating & Air Conditioning 1i .r -41' 4( f-tWoi � f4 €- .. '
"i �
35. Final Gas Pipe-Test •: ; , • i I `
' 'ZM-R( ^ eFe2-W»7' esi-P+ercAS ArS Pltz Zab
'36. Hood or Canopy ? t • • U.f'.G. : (.TG+7
• ,
37.7Final Factory Fireplace l , • ,
38. Final Plumbing ' ..j{ - , •
39. Water Service-Final ' '" ' „ '
40. Gas Service-Final t.�r'•• ' • ' `r I -
, •I I •
- 41. Solar Domestic-Final -
42. Backflow Preventer I, ,
43. Backflow Irrigation ,. I ,
•'44. Landscape Irrigation System 't . l -' ' '�
45. Sound Attenuation +`• ..
r
`• , 46. Handicap Regulations s - - i -
47. FINAL STRUCTURE&BUILDING I ` ' - •
48. FINAL PLANNING ;
.49. Electric Release to Edison 'J!•• '
50. Gas Release to Southern California Gas Co • ' 4 • I • •
•
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER HELTZER ENTERPRISES DATE 8_28=72
JOB ADDRESS 1075 Visalia Drive BUILDING PERMIT NO. 35283
GENERAL CONTRACTOR Heltzer DESCRIPTION of WORK Res. w/ att. gar. _
AP No. LOT 49 TRACT 6245 FIRE ZONE VALUE $ 35,000.00 _
INSPECTIONS Signature Date GROUP T Re ,T TYPE ,5 ZONE Rl
SOIL 5/0-0--72d _ PERMITS ISSUED
GAS SUBCONTRACTOR
Date Number � Signature
WATERfl_�faio .�/�Z /` Plumbin.
ROUG
PROP.SWR.PLUMBING
HOUSE CON. art , - .� ./ J r 1u�i - //3q
SPRINKLING SYSTEM
Mi SC ELLAN EOUS , � /
ROUGH HEATING AND AIR CONDITIONING � _/4L 7/#<7
TEMPORARY SERVICE OR POLE
UNDERGROUND D POWER LI I
ROUGH WIRING �✓ -T//7j' Heating and V nt.
TRENCHES 1---FORMS STEEL REINF. 0'( 7r/ /{'��/^n��1 J///�/Jj�/'��y} l� a
FLOOR SYSTEM / O JL-7 v if;it 1.0 ��� tel'-/[7-%J /9�r�
BOND BEAM n STEEL REINFORCE n {{{///���
SHEATHING r' i.5.-.-__/9
FRAME AND FLASHING .� ') 3
LATHING — IN OUT 3
PLASTER, BROWN COAT �' 5' /13
HEATING, VE, RLE ` E{aa� - /�J .75-3.5-7/9
HEATING, VENT., REF RIG. AND A.C., FINAL MA-0 �i/7 T> 1/!1 fat-
�j Lr' 50�/
PLUMBING, FINAL AND GAS TEST al /" /(7-.j /
ELECTRIC. FINAL (:::U -(('it _
RIM niNG LINA] 1/177^i 1 a `4)
•
,ut _ PAIU
� _ 35293 AUG 3o-7zP;, „OOzosf, ***-1-/-:,..._
COSTA MESA BUILDING-SAFETY DEPARTMENT - \
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
• For Applicant to Fill in Completely
RECEIV D BY DATE RECEIVED
BUILDIN Y / AT 7 DATE ISSUED?
ADDRESS O /[, a Ka '1A �•_7z O �I �/ .
_ PERMIT NO,-
OWNER Heltzer Enterprises-Costa Mesa A.P. NO. - J72 .-
MAIL BUILDING -
. ADDRESS 740 N. La Brea Avenue ADDRESS 0 _ - Dim
z (213)
0 0 CITY Los Angeles, CA 90038 NO. 937-2771 TRACT 6245 LOT 49 BLOCK
1- ZCONSTRUCTION NEW ADD ALTER REPAIR MOVING DFMOI ISH
O N LENDER United California Bank
n. m
_J 0 BRANCH Main Office - ! -
J to - OWNER -__- 4111_,...a.,,
Q W ADDRESS 600 S. Spring St. , Los Ang- - OF VALUE
CO •
- Q OR ENGINEER David Freedman.00 ARCHITECT NO. L.3 -3852 . USE QIX� t $
0 Q FIRE r�1y '
WCC ADDRESS 113 N. San Vicente, Beverly Hill-. ZONE TYPE GROUP4•
a_1-1r1 APPROVED /
J ZO ' CONTRACTOR George J. Heltzer BY DATE
Ca Z .
J ¢ ADDRESS 740 N. La Brea Avenue
W W TEL. (213) ZONE NO.OF 1 BUILDINGuj
• NEW (./Z CITY .Los Angeles, CA 90038 No. �
937-2171 � PLANS 1
0 . STATE CITY YARDS APPROVED YARDS APPROVED
oo CC LIC.NO. 3144 LIC.NO. 1900 MAIN BUILDING ACCESSORY
70 i (FROM C/L STREET)
' SI2E NO.OF SLOGS. •
OF LOT I NOW ON LOT ' FRONT 50.c FT.
USE OF
EXISTING BLDG. a.SIDE S FT.
F- SIZE OF NO.OF
Z NEW BLDG. ROOMS STORIES 2 L.SIDE 5 FT.
ta.1 EXTERIOR WALL ROOF
- COVERING COVERING . REAR .5 7 FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET.CL
a MAIN BLOC'S. ACCESS.BLDGS
•
a0
Single
�RyeJss�idence 407 E Rev. .C.U.P. PPRO •
2cn• - lie C� tr APPROVED 11A-Ari (3
IPS
/
O C STAMO, a FO. D
P. - ` 'Oil REMENTS /
U I hereby acknowledge that I have read this application and ath
that the' above information is correct and agree to comply with
D all laws regulating building construction, and I shall not employ
F any person in violation of the workman's.compensation laws of
CO the State of California. .^ �� •z (� /
I hereby certifyproperlylicensed as a contractor under
d
z that I am SQ. FT.{�/9- dipD�O Cjyc
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VAL ATION IS FOR
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the •rovisions of the State of California Business VALUATION
and Professions Code 1•vision 3,Chapt- 9. PERMIT FEE $ //60---
�I
/ A\ Signature of ,/ �� �d
permittee �� �� $.�SODO PLAN CHECK $
I J _ rXl/
11111 Authorized Agent TOTAL FEE $ / /
OWNER COLEY, Mike DATE 10-25-76
JOB ADDRESS 1075 Visalia Drive BUILDING PERMIT NO. 42917
GENERAL CONTRACTOR Owner/Bldr. DESCRIPTION of WORK 2 Patio Covers _
P No. 412-104-34 LOT TRACT FIRE ZONE VALUES 500.00
INSPECTIONS Signature Date TV PE V GROUP
SUBCONTRACTOR J ZONE R-1
oIL • PERMITS ISSMED
CAS
Date Number Sianawre
MATER Plumbing
ROUGH PLUMBING
4...
PROP. SWR. LINE Q HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING •
TEMPORARY SERVICE^ OR POLE LJ
UNDERGROUND POWER ❑
ROUGH WIRING Heating and Vent.
TRENCHES FORMS STEEL REINF. (, /6-7-6-.Z.
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING — IN fl OUT n PLASTER, BROWN COAT _
STRUCTURAL, FINAL Electric
HEATING. VENT., REFRIG. AND A.C.,.FINAL
PLUMBING. FINAL AND GAS TEST f
' ELECTRIC, FINAL -6
BUILDING, FINAL RL \V +'1U
42917 = :`
h CT 25-7(,;,;<;C@i3Bfl r' 55C
~ y COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
/ APPLICATION FOR STRUCTURAL PERMIT
! ,/ For Applicant to Fill in Completely —Use Ink Only
;;�� PEC BV /O DATE Ra:r•clyFp /01 �
ADDRESS BU I L DI NG /075 �.r IJ°1i_tn pa. 'y✓_�LVe l q
OWNER MI1'�r Cr t-l'JY A.P.NO. —7697 ye./
MAIL BUILDING ////
ADDRESS i'41UI1_ //__�� n ADDRESS /6 5 l5aih—.
CITY C,ob1t•, (—k't4 TNO`ie(thI / TRACT �(Ust LOT g 9 BLOCK
CONSTRUCTION NEW ADD ALTER REPAIR (MOVING DFMOLISH
LENDER afgelifir ARCHCH 01 rOWNER1ADDRESS VALUEORCNITECT NEL. USE $
OR ENGINEER NO.
FIRE
ADDRESS ZONE TYPET, GROUP
// APPROVED f'� /O ZC- 9/
CONTRACTOR Ow mE BY ,G j 54/e"
_iJ{IpL DATE i
ADDRESS — ZONE NO.OF 1�" USE OF NEW fear
TEL. R/ IPLANS� BUILDING
CITY NO.
F STATE CITY YARDS APPROVED YARDS PPROVED
LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE INO.OFBLDGS. (FROM C/LSTRE ET)
6. OF LOT tJ +� NOW ON LOT FRONT b FT. FT.
"E USE OFus EXISTING BLDG, h1±..li �t`rti_ R,$IpF / rFTtp ,/ FT.
FSeparate permits are required for L.SIDE {q /FT. FT.
electric,plumbing and heating work. /
WREAR /, FT. FT.
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN&
Q< MAIN BLOC'S. c ACCESS.BLDGS--
j VA
C r rs VAR.# DATE
.et
AN%U lJ SQ.-:.-V'—. C.U.P.#p+ ..j��J APPROVED
/J
(2 5?Me3&arE Ea s) �eV ROVE/ /iI/L �� DATE /V �I��6
Q I hereby acknowledge that I have read this application and state
N
N
• a that the above information is correct and agree to comply with
m
n. all laws regulating building construction, and I shall not employ
Z
any person in violation of the workman's compensation laws of m
x the State of California.
3 I hereby certify that I am properly licensed as a contractor under SQ. FT. a
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: —
am exempt from the provisions of the State of California Business to
VALUATIONe
and Professions Cod Division 3�Chapter 9� PERMIT FEE $ 6;67 O a
m
�/� ��7y/] PLAN CHECK S ro
C
Signature o // 1 412( I n/�i/ o
Permittee _ f L/ c ``� $ 500 TAX $ f61 t
U
Authorized Agent TOTAL PAID $
6;50