HomeMy WebLinkAbout2879 VELASCO LN - Building Permits ' ADDRESS OFe LCOM: 2879 VELASCO LN 0NT' CITY OF COSTA MESA — BUILDING PERMIT
• OWNERS NAME IFKNOT: BOGDAN, ANITA TR /PERM NO: B 075092
ABOREss' 70 TIDEWIND
• r • IRVINE,CA 92715 PERMIT NO: B 075092 PLAN CHECK NO: N GOVT: N SUPP: N
854-1719
s APPL.MAILING ADORES& CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: 0TH
3 ARCHITECT OR ENGINEER; LK.NO.: JOB DESCRIPTION : T/OFF SHEATH 6 REROOF W/COMP SHINGLES SQ FT: 5, 000
ARCH.OR ENG.'S ADDRESS: SPIT:
CLAIM VALUE: 5, 000 . 00 CALL—VALUE: 5, 000 . 00 GROUP OCC: R-3 /M-1
CallBACTM Miff PEACE ROOFING ( 909 ) 736-1430
CONTRACTOR'S MAILING 888 COTTONWOOD ST COMMENTS: REROOF 3400SF RESIDENCE, SMOKE DETECTORS REQUIREED PER 91UBC
ADDRESS CORONA CA uKo: 712823 **+ *****+ * F****** FEF*iEs *SSS ******iFSuFFF*** FF* F*** FSFF+ tttUKEeFp
91719 EMT: Z ONING R EQU IR EMENT M
LICENSED CONTRACTORS DECLARATION:I hereby Nim under penalty of perjury that I em licensed under provisions of Chapter 9 SETBACKS c A l ,(^Et)
(commencing with Sargon 7000)al Division 3 d the Business and Professions Code.and my license S in full force end ekes. (Qx`iy, +K,
CITY UC.NO.: UC.CLASS; C_39 UC.NO.: 71282 EXP : MAIN BUILDING ACCESSORY B I
Dae: //e /9r _ Contractor:_7( .//�� vr/�� (i �� FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
1 // �t LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty el perjury I em exempt from ihA Contreraoe License Law for the
following reason[Semon 7o31s Bntleas and Professions Cade:Any cryo county which requires a peri to cenethxd,mer,improve, PARKING REQ: - P RO V: PARCEL: 14154621 Z N E: REF NO:
'modish.. 'modish.or repel any structure,per tom
Xs uwne,also requires the applicant la such permit to file a signed statement Mel he or she Q
licensed pursuant ant to the provisions of the Contractors License Law[Chapter 9(commencing with Sedon 7000)of Division 3 d the PLANNING NOTES>
nosiness end Profession Code]or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation a Section > '
7031.5 by any applicant for epermit subjects the applicant toecivil Pendry of not more than fore hundred dollen($500D. ******fE*******iE************!E**************************************************iE
❑ I."owner of the popery or my employees with wages as their sole compensation,will do the work,end the structure S not intended
or offered for sale(Section 7044,Business and ProfessSno
sCade:The Contractors Leense Law donot to en owner of property E V E ' L OPMENT SERVICES REQUIREMENTS
or Iowan.'who bolds Iowan.'thereon.end who does such work bmedeor herself or Sough he or her own employees.provided that such
improvements are too intended or offered forflltt however.the butdinig or inprovemetto S soil within one year Of riiplefoni.the ZONING APPROVED BY DATE:
owrorLmlder wit have the burden d proving he or she did nor build a purposeimprove/or the of sale).
❑ I.as haver a Ihe property.am exclusively cortradig with licensed contractors to construct the projed(Section 7044,Business and
professions Code:The contrarian License Law does not apply lean owner a property who builds or improves thereon and who BUILDING APPROVED BY : DATE:
contracts for such pajeds with a mntrador(e)licensed pursuant to the Contractors License Law). �^
❑ Iamexsmplc4derSection: B.AP.C..forthisreason: APPLICATION ISSUED BY: � DATE : 11 t (I
_ **
Dae: Owner ********************************************* *********************** ** *
eb .tywlamaware aend md«sandthe egaiemerdeacdaodaNwnendLEGALIZATION: N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
I eone
Safety Code Sed en 25505.25533.and
25534,and that I or any Mum building occupant will/we not(circle one)need to comply with said state codes and the requirements for
a permit for construction or modification from the Ak u ty enagement District.Residential a
entconmdonappicetbn are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 72 . 00 . 50
Date: Applicant: SM I P/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm d
m under penalty perjury one d the following dedentons: PLAN
o Ihave and wit maintain acertificate of consent tosetinsure for workers'comperneance.nprovbedfor bySedan3700el the Labor ISSUE FEE
Code,for the performancedkgworkforwhichthispermiSissued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
o Ihave and wilmaintainworkers'compensatoninsurance,as required bySecton3700of the Labor Code.for the Performance ofthe TOTALS > 72 . 50 0 . 00 0 . 00 72 . 50 72 . 50 . 00
work for which this permit S issued.My workers'compensation insurance carver and policy number are:
Cartier REVENUE DIVISION TOTALS--> COLLECTED : 72 . 50 OVER/SHORT: . 00
Policy Number BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
.This section need not be completed I the pemia is for one hundred dollars jsloo)or len) 72 . 00 . 50
❑ howdy that in the performance of the work for which the permit is Sued,I mall net employ any person in any manner so as to
become Subject to the workers'compensation laws d California.and agree out a m
I should become euMed to the workers' ********************************,***********************************************
cornea provsn of Section 3]00 of the Labor Code.I mall forthwith comply with those Dae: // e/Q S Applicant: /4-2 -4-4 2 ei I I U D I V I D U A L F E E BR EAKDOWN
4.
Warning:Failure to secure workers'compensation coverage la unlawful,s shell subject an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines up to one hundred thousand dollars($104000),In addition to the coat of compensation,damages Si provided for In
Section 3706 of:he Labor Cob,IMenaL and eWomey'•los. SFR 5000 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 5, 000 . 00
CONSTRUCTIONofthe LENDING fa AGENCY:p hereby issued under penalty . perjury that there e a construction lending agency for the END OF FEES
performance d INs work IN which NC perms is eauad ,(Section 3097. ci C). /////
LENDER'S NAME:
LENDER'S ADDRESS;
I certify that I have read this application end sae that the above information is coned.I agree to comply with all city end county ordinances
and state laws relating to building construction and hereby authorize representatives of the city to enter upon the ebove'mentbned popery
for inspection purposes.
WAYNE CAMPBELLril
runt Name (j� c -
�0 [WT.; dT . lr. �•✓ ,las
. /vim _—.� Date l� /s'1 C w;
Signature of ownenlApe f pefaant/Contratlp
(515146.WP) White-Building A Safety:Ctreen-File:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor
I ••
CONSTRUCTION AND PLANNING POO. SPA
Date Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit #
1. Temporary Electrical Service or Pole .f • 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
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVE R-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
ii
13. Roof Drains - 64. Plumbing System - Final 1
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-1 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE.DEPT. REQUIREMENT
•
20. Rough Factory Fireplace APPROVALS Permit# -
21. Ducts, in Structure • , 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas OOil
23. Gas Pipe-Rough & Test • 72. Underground Flush -
24. Roof Framing / 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing U- 6-Rs b 74. Overhead Hydro
•
26. T-Bar Ceiling (Structural) & Monocoat '. , 75. Dry Chemical -
27. Frame and Flashing - 76. Dry Standpipe -
28. Lathing&Siding . , - . - • , 77.• FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL '
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat . • ' 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80-. FOOD CERTIFICATE ISSUED
33. Final Electric _ Notes: -
34. Final Heating & Air Conditioning
•
35. Final Gas Pipe-Test
«
36. Hood or Canopy ' - - , ' , •
37. Final Factory Fireplace - -
38. Final Plumbing . ,
39. Water Service-Final t
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer - ' '
43. Backflow Irrigation - -.
44. Landscape Irrigation System - --
45. Sound Attenuation -'i- .
46. Handicap Regulations •-1re- - f -
47. FINAL STRUCTURE& RaOING n Zt��, �� •
48. FINAL PLANNING, - -
49. Electric Release to Edison . ;
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. "Date
Applicant to fill in al;spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. BLDG.NO. -
CONSTRUCTION PERMIT a (�
� j � 7175 3/26/84 5.00 TL
Project Address o2S<7 9 ✓l= -R.SCO/ CO$TR H�SA�/�,267� TYPE OF CONSTRUCTION ❑ NEW H ADD H ALTERATION H REPAIR
Applicant's Mailing Address. CI CONVERSION DEMOLISH CIOTHER A.P.# Zone
Owner's Name Pf1N/E1-• BnGAA-N Phone_.53-046 DESCRIPTION OF WORK
S Main Building: Accessory Building: Z
Address 01,079 I/EI-ASCO Ln! Cow HE'S/r,Q2 2- E O
/ TYPE OF PERMIT U GRADING 1E-PLUMBING
U STRUCTURAL T Front N
Arch/Eng. License No. ❑ TENANT CI ELECTRICAL I PLUMBING ElMECHANICAL B -
Rear •
N
Address ❑ OTHER A
Contractor's Name H- C• "-I wry Phone 5447-521P PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right G
CONSTRUCTION TYPE VALUATION$ q� -670 g Left R
Address(mailing) /70/ S. �?nADWh?'y ,$.q/I/Tiq AA)/1, 9207E
City License No. s7.0X5"Z ZONE GRADING CU.YDS. ACRES Ping. Ref.# Park.Fees $ - 0
U
LICENSED CONTRACTOR DECLARATION Remarks: Parking Req./Provided 1
• I hereby affirm that I an, licensed under provisions of Charter 9(commencing R
with section 7000) of Division 3 of the Business and Professions Code,and Use of Building: - E
my license is In full force and effect.
License Class C - -ice 7�s—License No. 2i 1100 PLUMBING I FEES Planning Notes: E
Date Signature 'vr t--� N
;,, ORK�C MPENSATION DECLARATION T _ Bar Sink Showers
C..,aereby affirm that I have a certificate of consent to self-insure or a certificate T
°„-:i Workers' Compensation Insurance, or a certified copyBackflow Preventer - Service Sink S
p thereof (Section
"3800, Lab. C.) Backflow Irrigation Sewer Cap ELECTRICAL FEES
Policy No. Company
8 Certified copy Is hereby furnished. Bathtubs Sewer Connection Automatic Washer. Transformer 0 15-50 KW
Certified copy Is filed with the city Building Division. 0 50+KW
Date Applicant Clarifiers Solar Collectors • Construction Pole Sub.
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Dishwasher Solar Piping -
(This section need not be completed if the permit is for one hundred ($100) or Ot P 9 �- ��� Cooking Unit Meter Dup to 100 amps
less).
I certify that in the performance of the work for which this permit is issued, I Drinking Fountains Solar Tank Dishwashers Meter Dover 100 amps'
shall not employ any person in any manner so as to become subject to the -
Workers' Co pensation Laws of California. JL Floor Drains Swimming Pool w/Spa Dryers OGas ❑Electric Sub Panel
Date •.3 --,7//?� Signature /T ie - - .-
NOTICE: If,after making this declaration,you should bec me ject to the Floor Sinks Urinal Fan Motors❑0-1 HP 01%-8
Workers' Compensation provisions of the Labor Code, you must forthwith - - -
comply with such provisions or this permit shall be deemed revoked. Gas Service Outlets Water Closet F.A.U. Inc. olar ❑9.15 HP 016-15+
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance Interceptors Water Heater Fixtures 'Microwave
of the work for which this permit is issued -(Section 3097 Civ. C.)
Lender's Name Kitchen Sink Water Service Device Boxes Pole Light
Lender's Address -
OWNER BUILDER DECLARATION Lavatories Outlets Range •
1 hereby affirm that I am exempt from the Contractor's License Law for the P-Trap reason (Section 7031.5 Business and Professional Code: Any city or p Switches Sign
county which requires a permit to construct,alter improve,demolish or repair
any structure, prior to its issuance, also requires the applicant for such permit Roof Drains ' - Garbage Disposal ' Standing Sections '
to file a signed statement that he/she Is licensed pursuant to the provisions of "
,.the Contractor's License Law(Chapter 9 (commencing with Section 7000)of
ia- Generator 00-5 KW 05-15 KW Trash Compactor
vision 3 of the Business and Professions Code) or that he/she Is exempt
•% erefrom and the basis for the alleged exemption. Any violation of Section
!,:031.5 by any applicant for a permit subjects the applicant to a civil
LJenalty of not more than five hundred dollars($500). Reinspection Fee $25 Issue Fee • - $ 3
I, as owner of the property or my employees with wager as their sole - - Reinspection Fee $25 Issue Fee • $ 3
compensation, will do the work,and the structure is not intended or offered MECHANICAL FEES
for sale (Secion 7044, Business and Professional Code: The Contractor's PUBLIC SERVICES REQUIREMENTS:
License Law does not apply to an owner of a property who builds or improves ' Boiler Hood or Type I 0 - -
thereon, and who does such work himself/herself or through his or her own
employees, Zoning Approved By nate
provided that such or improv eves are not intendedhor yearrCf com- Canopy Type II ❑
sale. If, however,hewnthe willhave building theburdendof pro i g he/she within one rim- Duct-Under Ground _ Application Approved By Date
pletion,n, the owner of proving did not build or im- p
eLove for the purpose of sale). Duct-Structural Refrigeration System Application Issued By____7M..." - Date 01'7fir
LJ I, as owner of the property, am exclusively contracting with licensed con- 00-100,000 BTU ❑100,000 BTU
tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating SUMMARY OF FEES
The Contractor's License-Law does not apply to an owner of property who , ' •
builds or improves thereon, who contracts for such projects with a con- Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
the
tractor(s) license pursuant to the Contractor's License Law). PLAN CHECK $ PERMIT
0 I am exempt under Section B.& P.C.for this reason ' Firepl/Fact.Blt. ICBG# 00 ISSUANCE $ C3-0 o
PLUMBING - $
Date Owner Heating System& Ducting PLAN CHECK $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above 1:10.100,000 BTU 0100,000BTL GRADING $
information is correct. I agree to comply with all city and county ordinances _ - ELECTRICAL $
and state laws relating to building construction,and hereby authorize repro- PLAN CHECK $ MICROFILM $
sentatives of this city to enter upon the above-mentioned property for
inspection purposes. ,0
Signature ..._y//..�1.�� Date °-U 2 - MECHANICAL $ TOTAL FEE $ �"
Drivers' License or.SS �� - Reinspection Fee $25 Issue Fee $ 3 1 PLAN CHECK $
CMF 086546 rev. 7/83 White-Building:Canary--Applicant;Pink-Accounting;Goldenrod -Assessor - - - • - '- - - • -- - - •
CONSTRUCTION AND PLANNING POO SPA
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. Electridai: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, O 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',Oen 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 68. 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 . APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts;Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough &Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coate 79. FINAL INSPECTION
32. Electrical Power Meter-Final • 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing ..00/r/ (,Eo
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. ,Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING -
• 48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY •
No. Date
OWNER MESA DEL MSR DEVELOPMENT COMPANY DATE 3-12-62
JOB ADDRESS 2879 Velasco Lane BUILDING PERMIT NO. 167211.
GENERAL CONTRACTOR Macco Corp. VALUE $ 18:11.67.00
AP No. LOT 126 TRACT11260 FIRE ZONE DESCRIPTION OF WORK res watt gar
INSPECTIONS Signature DATE GROUP rfral TYPE V ZONE R1
g
-±frer � -'7'�---�rJ-- q�SUBCONI'RACTOR PERMITS ISSUED
DATE NUMBER
Water 0 !/i /'rrJ __rem_ //O
Rough jr-A3
Rcfrig. El Air Cond. 0
Rough Heating (/-!�[/-PCZ-. _ i 7_7-. :-,227=6.;-:- -7.// h,
Rough Plumbing _ � ) /�.'� Ji/ ✓•. ✓•, �i . , ti-i2- '(o. .a �"
Miscellaneous IAM '/ a iii- xx �� .r /bt�_i3_3
Prop.Swr.Line p. ouse Conte St.Swr. 0 ��U Z—�yb2 / to(L/G t 3 I/'_jj__ hY(-_
Sprinkling System ,?/(77r � !a-r3-b hr
-'1�" u ' • /O-/S i- 767w - tb
Construction Pole _�.�
Underground 0 Power 5
I
Rough Wiring 7/-Si4,gfL/ e z10-e._i/e /—
Trenches lEicr Forms Fr Steel Reinf. 0 _ /4 `sem
Floor System /5.
Bond Beam 0 Steel Reinforce 0
Sheathing Df'05:: L= •CLZ
Frame and Flashing •_-7,V17 J '
1
Lathing — In 0/Out p- / 4/.?i/-7
Plaster, brown coat . / A'.)-q-6 2 •
Refrig. 0 Air Cond. 0 Final d,�S G2
' 'njl-
g, Final I la-Q-en--
h....nbing Fixtures, Final
Final Gas Test /,r /1/1749
Electric Fixtures, Final ! �.C�Q^ ' L
/Z / /1
Building, Final ( FX.
OCCUPANCY
i4vvh.
6724p
F�r RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT 4AR 7 1962 lot 126 - (Tract 11260
P. O. BOX 817 COSTA MESA. CALIFORNIA .FINANCE DEPT, Plan 400-B
For Applicant to Fill In Completely TTY OF uC0APPL11CAtTION FOR PERMIT
TYPE OR PRINT
BUILDING
BUILDING
ADDRESS 4_79 Velasco lane
COSTA MESA. CALIFORNIA For Office Use Only
RECEIPT NO. I 1`5724
OWNER Mepsa p��e++l Mar Develoonent Co„ V 'L
AMAIL DDRESS 18nn y;L- Coast Hi hw RECEIVED BY DATE RECEI ED DATE ISSUED
MM62
g ay �i(r �' MAR 1
CITY Corona Del I$ar,Calif. No�R3-11220 ADDRESS
ARCHITECT Cliff Olsten & TEL CALIFORNIA COSTA MESA.
OR ENGINEER Assoc. NO.NIA3-1221 CA //��
ADDRESS 90251 E. Florerce A .,Dowmeys ZONE TYPE /V' GROUP 1/ l,/'
Calif.
CONTRACTOR Macc° C orn oration APPROVED
BY DATE
ADDRESS 18no E. Coast Highway ZONING _
T� i.,(, (� T ZON NO.OF USE OF NEW Si./ goo.AB
CITY CoronarpDcel Mar,Cali . —/ I/PLANS C. I BUILDING� �kit/G�--9a
LIC.NO. 98808-SB-1 ND. OR 3220 LDESCRIPTION `e.f / Z 6 T'• / 2 6 0
SIZENO. OF BLOCS.
OF LOT 7000+ S.F. NOW ON LOT LVOn A.P.NO. ._...._____ —
USE OFYARDS EVES
EXISTING BLDG No TE APPROVED ALLOWED
SETBACK LINE PROM I (CENTER LINE BT.) p
CENTER OF STREET 1181 REAR YARD 22 10 FRONT 11 O FT. IN.
SIDE YARD I LEFT 71 I RIGHT 51 R.SIDE -5--
FT. IN.
DESCRIPTION OF WORK
L.SIDE 7 FT. IN.
NEW I X II ALTERATION I II ADDITION I REAR Z a FT. /D IN.
REPAIR I LOVING I D DEMOLISH I APPROVED �.,/�1/M®
SIZDATE z-/Z �✓
i� Z-
E DI hi 1611)611 1211 RMS OO6 STORIES 1 ��A N'
EXTERIORhhWALL StuC COI ROOF
COVERING +,. COVERING 1.T....A
USE OF BUILbIN AND WORK TO BE PERFORMED
Single fanily dwelling Livin- area 1702 S.F.
w/attached garage
Garage 11 1163 S.F.
Covered Porch 63 S.F.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION �-
SIGNATURE OF PERMIT FEE $d[/• (tet J
PERMITTEE T' /_ >]aTzpl PT1meY1tCOA p e
By $ 18,1167.QQ PLAN CHECK $ /�. � F
AUTHORIZED AG E
TOTAL FEE S 57.00 2