HomeMy WebLinkAbout2290 WATERMAN WAY - Building Permits • CITY OF COSTA MESA S •
4 ' BUILDING DIVISION
F• ,I 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca,us
rti.IraFOR INSPECTIONS CALL: (714)754-5626
•
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PERMIT NUMBER: B08-00328
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: 42604164 DATE ISSUED: 12/01/2008
ISSUED BY: RMD
JOB ADDRESS: 2290 WATERMAN WY CM - Suite/Unit:
Vicinity: HOUSE AND GARAGE
Squares: 2500 Valuation: $5,000.00
SCOPE OF WORK: TEAR OFF(E)ROOF MATERIALS, INSTALL 1 LAYER OF 304 ON A 4:12 PITCHED ROOF AND REROOF WITH 50
YEAR METAL SHAKE(ICC 5626, 1.3 PPSF)"CLASS A ASSEMBLY",ON AN ATTACHED HOUSE AND GARAGE,
APPROX 2500SF. REPAIR AND REPLACE SHEATHING AS NEEDED.
OWNER: ADLER,JASON A TR Address: 2290 WATERMAN WAY Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: JOHNSON,SCOTT Address: 13672 ONKAYHA CIRCLE Unit: :
PHONE: 714-651-6130 City/State/Zip: IRVINE,CA
CONTRACTOR: POPA ROOFING INC License No. 675902
Address: 13672 ONKAYHAUnit: PHONE: 714-778-6294
City/State/Zip: IRVINE,CA 92720 CELL:
ARCHITECT: License No. PHONE:,
ENGINEER: License No. PHONE:
FEE SUMMARY
Retool Plan Check: $0.00 REEN
Reroof Permit Fee: $111.25
Reinspection Fee: $0.00
TOTAL FEES $111.25
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regutations.(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.
30�r 2. INSPECnON TYPE ee_E INTmALE CODE r INSPECTION TYPE egg IN1U1ALg
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final ��)),,.� 208 Final Plumbing
200 Final Re-Roof //.- (p'I2 8�p 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
WOqRKERS'COMPENSATION DECLARATION• Owner ID verified by drivTT—ense. 0 Yes 0 No w - -+
I 19breby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ 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
performance of the work for which this permit is issued. •
❑ 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:
pemtit is issued. My workers'///111compen ation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feel in depth into width a
number ares-- 1 n— person is required to tlescend•will be made in connection with work authorized
l.-•�q Yom— „f by this permit,and that no building structure,scaffolding,falsework,or demolition
Carrier: / or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(Tits section need not be completed/Jthe pen is valued at one hundred collars(S100)or less.) 2,Art 2,Sec.341,Title B,California Administrative Code).
Policy Number: 06,—(1-5-4 l U
❑ As owner-builder, I will not employ anyone to do work which would
❑ 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 t the workers'compensation provisions of Section 3700 of
Applicant's Signature Date
the Labor Code all forthwith comply with these provisions.
y///G u� Division of Industrial Safety Permit Number:
Iran ngnawre Dal 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? 0 Yes ❑No
($100,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS (Section 25505 of the Califomia 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
ATTORNEYS 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 i in full forceceand effect. a registration form for acutely hazardous materials? 0 Yes ❑No
Lic.# •�� / G a Class# `i (Section 25533 of the California Health and Safety Code, with some
/2-/- 4,- exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
ntractore Si ^� 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).
❑ 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 issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 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 DELARAONS: _ Health and Safety Code been fully complied with? ❑Yes 0 No
I herebaffirm at under penal 751737117 t a .F]s)i EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW f��the following rea on (If. 70311.5, the work which is the subject of this application a permit for such construction
Business and Profess' ns •od�e�.An ci mcoo I req ires a permlt;to or modification from the South Coast Air Quality Management District or from
construct alter improv demobs , or repair a st cure, prior to its any other air pollution control district or agency? ❑Yes ❑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? 0 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 Califomia
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 control officer
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 ' 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 alf state laws and
❑ I, as owner of the properly,am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
UCENSED 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 unti 'l• ins nzy ,4, 1/c5
N`
Signal o1 er(s) Date
Signature pate /e---/_—•�'
3057x6(3/07) — L[�
And/or Authorized Applicant 'Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
C TY OF COSTA MESA CONSTRUCTION PER,MI/� PE ITf� TRACT NO. LOT NO. UNIT NO. '
Project Address 0270 Mtonnsf( WIC• ✓ 7� 10411 3/I7/fl6 11.01E i
Applicants Mailing Address ,i
ORTE ��r TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION U REPAIR - - 4/
Owner's Name /sd/er� Phone 4_4.. .7_4/ ❑ CONVERSION .0 DEMOLISH 0 OTHER A•P.# Zone
DESCRIPTION OF WORK/USE OF BLDG.
Address 5a Yr v. S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMITU GRADING U FOUNDATION STRUCTURAL T Front ZO
Address •
�� 0 TENANT IV ELECTRICAL 0 PLUMBING MECHANICAL B Rear N
Contractor's Name Phone ❑ OTHER A I
PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N
Address(mailing) K G
CONSTRUCTION TYPE VALUATIONS S Left R
City License No. ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION 1 /� •/ - Ping. Ref.`# Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: �J 'y2 w/ A4 CIN/7 �• �4( Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code,and �l �`( l
my license is in full force and effect. I7cP ter q y353 _ S
License Class License No.
Date Signature - PLUMBING FEES
WORKERS'COMPENSATION DECLARATION 1 Bar Sink Showers
I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
100, Lab. C.) Automatic Washer Transformer 0 15-50 KW
Policy No. Company Backflow Irrigation • Sewer Cap - 0 50+ KW
ElCertified copy is hereby Iurnished. Construction Pole Sub.
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection -• Cooking Unit Meter ❑up to 100 amps
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION - - - Clarifiers Solar Collectors Dishwasher - Meter Dover 100 amps --
(Thissection need not be completed if the permit is for one hundred ($100)or - -
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel ' •
I certify that in the performance of the work for which this permit is issued, I '
shalt not employ any person in any mann- so as tor eBl ss bject to the Drinking Fountains Solar TankFan( '
Worke Com ens io yes of Califo /•/ //i0 _ - Motors❑0-1 HP ❑1'h-8
v Date 't //( [T„'ignaturel air - a' ' —Floor Drains Swimming Pool w/Spa / F.A.U.
'NOTICE:If,after raking this declarat'• ou should become subject to the Inc.Solar 09-15 HP ❑16-15+ / ji
Workers' Compensation provisions • e Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply ,with such provisions or s permit shall be deemed revoked. Microwave
CONSTRUCTION' LENDING .AGENCY Gas Service Outlets Water Closet
I hereby affirm that there is a construction lending agency for the performance Device Boxes Pole Light •
of the work for which this permit, Is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets
Lender's Name - ' - Range
Lender's Address Kitchen Sink Water Service Switches Sign '
OWNER BUILDER DECLARATION g
I hereby affirm that I am exempt from the Contractor's License Law for the , LavatoriesGarbageDisposal Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or - Standing Sections _
county which requires a permit to construct,alter,Improve,demolish or repair P—Trap ' ' • Laundry Trays Generator ❑0-5 KW ❑5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions Of Roof Drains.
the Contractor's License Law (Chapter 9(commencing with Section 7000) of /� .-rte /Division 3 of the Business and Professions Code) or that he/she Is exempt - A ri emir' ri
'-d'."">refrom and the basis for the alleged exemption. Any violation of Section' •
'3x631.5 by any applicant for a permit subjects the applicant tO a civil .
Malty of not more than five huntlretl dollars($500).
Yty I, as owner of the property - - -- Reinspection Fee I $15 Issue Fee - $ 3
e nPeuf st will do the work,and the structure is not Intended or offered - Reinspection Fee I $15 Issue Fee $ 3
(.. lfor sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES J
License Law 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 DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler , Hood or Type I 0 '
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By ate •
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground •
prove for the purpose of sale). Building Approved By Date 7'/7
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Ref ' eration System Application Issued By // Date //
tractors to construct the project (Section 7044, Business and Professions Code: .
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 1 0-100,000 BTU 0100,000 BTU /� c SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a con- L r/
tractors) license pursuant•to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
f o// their Worker's Compensation insurance should be provided to me. — PLAN CHECK $ PERMIT
pro lam exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG 4 Fire Dampers ISSUANCE $
// ,,q ��y PLUMBING $ ate
Rat ner - (/.GG rig System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read s application and state that the above 100,000 BTU 0100,000 BTI,-1l/
information is correct. I agree to mply with all city and county ordinances / sq �� •y ay ELECTRICAL $ --lv(� GRADING $
and state laws relating to building construction, and hereby authorize repre-
sentatives • this city to enter u on the above-mentioned property for
ip5pection • es. 7�! 1' •�•� TOTAL FEE $
Signa�'ure near, / 14 `/[4RI !g � MECHANICAL ( --]/_
OrlGers' se or SS Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ .e r C50 its
.
CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Plnk -Accounting; Goldenrod - Assessor
,/CONSTRUCTION AND PLANNING POOL 'A
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
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, O 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 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 O Gas ❑Oil
23. Gas Pipe-Rough & Test • 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑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 Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED -
33. Final Electric ,'J/r,,ft? Notes:
34. Final Heating & Air Conditioning 31/4/ �// L/re /dir
35. Final Gas Pipe-Test •
36. Hood or Canopy •
37. Final Factory Fireplace
38. Final Plumbing
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
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA - PER IT NO. TRACT NO. LOT NO. BLDG.NO. 9486 I0/O4/84 • 5.00 - TL
CONbTRUCT,ION PERMIT rj�j S(n • - _ -
Project Address .2 - i ._ i '-'g at/ _ . _ _ TYPE OF CONSTRUCTION U NEW U ADD LI ALTERATION U REPAIR
Applicant's Mailing ddress , 3 3 41/ /,7lael/,/ ❑ CONVERSION El DEMOLISH .❑ OTHER - A.P.# I Zone ,
Owner's Name D/prC' Phone&Vi 7,6,P DESCRIPTION OF WORK
S Main Building: - Accessory Building: Z
Address - - r'-1O
AMP TYPE OF PERMIT ❑ GRADING `}'�FOUNDATION U STRUCTURAL E Front -- N
-
Arch/Eng. License No. El TENANT ❑ ELECTRICAL L"J PLUMBING ❑ MECHANICAL B Rear • - • I
•
V ) El OTHER A - • N
Address �y // C Right G
Contractors Nam7%e GA/zS /i/r,ALnl77 �phone72ri -2/70 PROJECT DESCRIPTION SQ. FT. OCCUPANCY K r R
93 Address,lmailing)lS 2 W 1-7,1•�z� CONSTRUCTION TYPE VALUATION S Left E
fit ZONE GRADING CU.YDS. ACRES Ping. Ref.# Park.Fees $ O
City License No. - - U
1 LICENSED CONTRACTOR DECLARATION i Remarks: Parking Req./Provided • I
I hereby affirm that I am licensed under provisions of Charter9 (commencingR
O with section 7000) of Division 3 of the Business and Professions Code, and • Use of Building: • E
my license is in full for and effect. • M
Dcen • C ass C- -••••••• Licens: N•- -•/ PLUMBING FEES Planning Notes:
E
Date Signature -0418 , . . at : i- av • Bar Sink Showers •
N
WORKERS'COMPENSATION DECLARATION T
hereby affirm that I have a certificate of consent to self-insure or a certificate Backflow Preventer , Sink S
Workers' Compensation Insurance, or a certified copy thereof (Section --- ' -
4800, Lab. =•r
C-) '/ ''// Backflow irrigation Sewer Cap ELECTRICAL • FEES
Policy No. Qnt 44-; CompanyY'�A✓O-K' �S - -
• „Certified copy is hereby furnished- Bathtubs Sewer Connection Automatic Washer • ,Transformer 0 15-50 KW
Cerilfie copy,I"s f)letl with the city/Qei1d�ng iv Ion
Date `7-�G-054 Applican✓L!!�/(./�G[4 �i�-6 I� Clarifiers Solar Collectors Construction Pole Sub. ❑ 50+KW
EXEMPTION FROM-WORKERS'COMPENSATION DECLARATION- • Dishwasher • - Solar Piping ' •
(This section need not be completed if the permit is for one hundred($100) or P 9 •Cooking Unit- Meter-❑up tb 100 amps
less).
I certify that In the performance of the work for which this permit is issued I • Drinking Fountains ' Solar Tank , Dishwasher Meter Dover 100 amps,
shall not employ any person in any manner so-as to become subject to the - - 1
Workers' Compensation Laws of California. Floor Drains Swimming Pool w/Spa Dryers Deas' ❑Electric Sub Panel '
Date • Signature - •
NOTICE:If,after making this declaration,you should become subject to the Floor Sinks Urinal I Fan Motors❑0-1 HP ❑1%-'B 1
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.Solar 09-15 HP 16.15+
CONSTRUCTION LENDING AGENCY - - -
I hereby affirm that there is a construction lending agency for the performance Interceptors • . Water HeaterFixtures
of the work for which this permit' is'issued (Section 3097. Civ. C.) - rr 0 I l Microwave
Lender's Name - Kitchen Sink _ Water Service Device Boxes Pole Light
Lender's Address- - Lavatories • g
OWNER BUILDER DECLARATION - - Outlets Range
I hereby affirm that I am exempt from the Contractor's License Law for the p-Tra •
following 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 I 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 •
vision,3 of the Business and Professions Code) or that he/she is exempt • Generator 00-5 KW 05-15 KW Trash Compactor •
`Ji refrom and the basis for the alleged exemption. Any violation of Section -
.; $1.5 by any applicant fora permit subjects the applicant to a civil '
'penalty of not more than five hundred dollars($500). .Reinspection Fee $25 Issue Fee $ 3
❑ I, as owner of the property or my employees with wages as their sole - Reinspection Fee $25 Issue Fee i $ 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 - ZoningApproved ByDate
employees, provided that such Improvements are not intended or offered for - Canopy Type II ❑ PP
sale. If, hothe own, the building Improvement f soldhwithin one year of cam- Duct•-Under Ground Application Approved By Oate__^�_
salt.on,the owner t have the burden of provingis he/she did not afcom- e
prove for the purpose of sale). Duct-Structural ' Refrigeration System - Application Issued By aaG=Dat ' l
Ll I, as owner of the property, am exclusively contracting with licensed con- ❑4100,000 BTU ❑100,000 BTU
tractors to construct the project (Section 7044,Business and Professions Code: i Duct-Ventilating SUMMARY OF FEES I• `
The Contractor's-License Law does not apply to an owner of property who
builds or improves thereon,-and who contracts for such projects with a con- Exhaust Sysiem 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP • $
tractor(s) license pursuant to the Contractor's License Law). PLAN CHECK $ PERMIT - --4 tt�
D'1 am exempt under Section B.& P.C.for this reason • Firepl/Fact.Bit. ICBO'# PLUMBING $ .ISSUANCE $ LI
r •
•
Date Owner Heating System&Ducting PLAN CHECK $ • ENERGY P.C. $
I hereby certify that I have read this application and state that the above '❑0.100,000 BTU ❑100,000BTLJ GRADING $
Information is correct- I agree to'comply with all city and county ordinances - ELECTRICAL $
and state laws relating to building cons ruction,and hereby authorize repre- • MICROFILM I $
•
sentatives of this city to enter up the above-mentioned property for - PLAN CHECK $
Inspection Our yges "
Signature 7&/,t,d.Q-,�',44y "'0 Date/ .2-to-Pt - MECHANICAL - $ TOTAL FEE $ -5-
Drivers' License or SS - • Reinspection Fee $25 Issue Fee $ 3 PLAN CHECK $ '
S \
MF 0865-46 rev. 7/83 bite-Building;Canary-Applicant;-Pink''Accounting;Goldenrod-'Assessor - - .- -- -.- •• - - - _ - - - -
CONSTRUCTION AND PLANNING POO( IPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
-' i •
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
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 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 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 El Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank O Gas ❑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 Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: /0/5-ten LEP'r G4/ o- C-ELk
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace '�/
38. Final Plumbing 1611 I�1 LW
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
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
PERMIT O. TRACT NO. LOT NO. UNIT NO.
CIT aF COSTA MESA 1 CO1'�,tl\S�T_�}RUCTION�"PERMIT,
/E�RMI /y� Q �7 A.P.# Zone
Projeyt Address ra`"l� W(.�Gl l't •-cir ,,t,/� �j,/�1l I I0 S Main Building: Accessory Building:
Applicant's Maili g •ddress 7-11)10` Ifb--[,1lc x,11 I i21_4 s TYPE OF CONSTRUCTION 0 NEW Li ADD LLTERATION REPAIR E Z
' , / ""- ❑ CONVERSION ❑ DEMOLISH ❑ O- ER T Front • 0
Owner's Name a� Phone rn
Address ..r����.U�.W a DESCR IPT ION OF WORK/US OF BLDG. ,v� IA Rear N
1 C Right N
Arch/Eng. License No. TYPE OF PER IT S GRADING U FOUNDATION U STRUCTURAL K' G
Address /�� ElTJ.NANT•❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL S Left
R
Contractor's Nam:bir! g7IS IAtPhone /1s ❑ OTHER ` I Ping. Ref.# Parking Req./Provided E
C12-517--
l 517 �� 1 ��y� 1(-V(� PROJECT DESCRIPTION SQ. FT. 1 OCCUPANCY Planning Notes: 0
Address(mailing) 12- { — 'V - • ' mow M
City License No. 73J 4 CONSTRUCTION TVPE_W✓ VALUATION$ col.U/
ZONE GRADING CU.YDS. ACRES T
LICENSED CONTRACTOR DECLARATION (/�� - S.
I hereby affirm tht I am licensed under provisions of Charter 9 (commencing ems
Remarks: fsC - L v /n/�s� /,J,/ f/
with section 7000) of Division 3 of the Business and Professions Code, and gem. 6.0 t�t-�•e�+..y' Aesn.
my license is in full f. • . •fleet. > ter
ELECTRICAL FEES
License Cla s �� Lice,6 ..--.1,e,.. a
c Automatic Washer Transformer 0 15-50 KW
Date ! _��!I Signature �I� .-1� �_ ,�F���� PLUMBING FEES IIIII
OWORKERS'COMPENSATION DELL- ATIONConstruction Pole Sub. • 0 59+ KW
I hereby affirm that I have a certificate of consent to se -insure or a certificate Bar Sink Showers
Workers' Compensation Insurance, or a certified copy thereof (Sectio Cooking Unit Meter Duo to 100 amps
0, Lab. .) Ray- , - 01 Backflow Preventer Service Sink
tic No. ' ompan v • i), Dishwasher Meter Dover 100 amps
y v Backflow Irrigation Sewer Capp
I)I Cert'fie copy is hereby furnished. i—
Date �� Dryers 0Gas ❑Electric Sub Panel - .
yr, .ert/}'}((�le�at co y``z filed with the city 4...;..z1 1 +� �-Ion Bathtubs Sewer Connection
Date l' !J Applicant rl .-.L MIA e_
Clarifiers Solar Collectors Fan Motors 00.1 HP 01 X-8
(T EMP IONoFROM WORKERS'CO TS��SATION D ARATIA
(This section need not be completed if the permit is for on hundred $100)or F.A.U. Inc.Solar ❑9.15 HP 016-15+
less). Dishwasher Solar Piping
Ishall •
certify that in the performancepersonin the work for which this permit a issued, I Fixtures
' employompeanyiperson f any manner so as to become subject to the Drinking Fountains Solar Tank Microwave
Workers' Compensation On Laws California. ,
Date _ Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light
NOTICE: If, makingrov ions declaration, you should becomesubject to ite Outlets Range
comply
Compensation pr provisions of the tr Code, you et forthwith kIIh FIOOr Sinks Urinal g
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCYSwitches Sign
Gas Service Outlets Water Closet 9
I hereby affirmk that there is a permit ue agencyc for the performance
C.)
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections
Lender's Name .
Lender's Address Kitchen Sink Water Service Generator 00.5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATIO —
N
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash -
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry TraVs •
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt Fee Reinspection
-efrom and the basis for the alleged exemption. Any violation of Section P $15 Issue Fee $ 3
1.5 by any applicant for a permit subjects the applicant to a civil
any of not more than five hundred dollars ($500). DEVELOPMENT SERVICES REQUIREMENTS:
U I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 Zoning Approved By Date
compensation, will do the work, and the structure is not intended or offered s �/�
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By / �� 4 //%/ Date
License Law does not apply to an owner of a property who builds or improves _ r
thereon, and who does such work himself/herself or through his or her own Application Issued By .--.... ..-,..... ....-.... .....--.....s...�� // Dat: N s
employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0 _
sale. If. however, the building or improvement Is sold within one year of com- Canopy Type II 0 SUMMAR OF FEES
pletion, the owner will nave the burden of proving he/she did not build or im- Duct-Under Ground
prove for the purpose of sale). BUILDING PERMIT $ 8J. e SMIP $
O I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System
tractors to construct the prosect (Section 7044,Business and Professions Code: PLAN CHECK $ PERMIT
The Contractor's License Law oes not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU
builds or improves thereon. and who contracts for such orolects with a con- PLUMBING $ ISSUANCE $
tractor(s) license pursuant to the contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $
proof of their Worker's Compensation Insurance should be provided to me. ELECTRICAL $ GRADING $
❑ I am exempt under Section B. & P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers
PLAN CHECK 50% $ MICROFILM $
eating Systemp
Date Owner g & Ducting Registers MECHANICAL $ O
I hereby certify that I have read this application and state that the above ❑0.100,000 BTU 0100,000 BT TOTAL FEE $ ,S
information is cor ect. I agree to omply with all city and county ordinances _ PLAN CHECK 25% $
and state laws rel.ting to •• •in• construction,and hereby authorize repre-
sentatives o city r pon the above-mentioned `r per ‘
inspection . rpos- 1l
Signature .��` b• Da ' r• �... -,
. 5�_4;:L:-yr'44!2__
`
' �. p
0865-46,rev. 5/88 White - Building: Canary - Applicant; Pink -Accounting; GOIdeOrOd - Assessor
.- a . '-.
CONSTRUCTION AND PLANNING POOL 'PA
f APPRAVALS 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
5. Steel Reinforcement 7: 56. Rough Plumbing & Pressure Test
6. Electrical UF ER 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, O 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
1.61: 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 1-;+; 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 i-'. 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final(r 80. FOOD CERTIFICATE ISSUED ��tt
33. Final Electric Notes: i,f/90 Ytb �4 ` Qqt
34. Final Heating & Air Conditioning �,�` /lL� _ _ (� .
.04
35. Final Gas Pipe-Test (J� ` C'�-��""�
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final •-1
42. Backflow Preventer 7 r
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation -
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING -48. Special Requirements Completed
ie/15
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co - -
51. CERTIFICATE OF OCCUPANCY .�.
No Date '
ae-le-Z 1_-e--se--a-4' 4 7 W 8//e t" _ ,/ '
07,791i71.v 4--ir r_Qk.a. _ )(OCT 17 198
1801t.
CbSTA MESA BUILDING-SAFETY IIDEPARTMENT r y 7" "
P. O. BOX 5I7 COSTA MESA. CALIFORNIA Cl �. / ,7
For Applicant to Fill In Completely / 9° G` Af E DEPT.
PPP y APPLICATION/ F�OR(PERMIi vknoan TIESA
TYPE OR PRINT
CO, BUILDING
BUILDING Lt/�.ly.,�Q
ADDRESS UU 'Y
''?''j/CCOSA MESA CALIF RNIA For Office Use Only
A ` RECEIPT NO. I IPeRnTI NO.
OWNER / /L�/!C///lI/L/ •
I
MAIL !T3 9 E. /7 RECEIVED Y I DA JIEC[ 6 'DATE I88UED
62
CITY 'r alC JCC G'�� 115
CITY ( rn TN /D y2 BUILDING iJR.ilis...
ADDRESS /
ARCHITECT 7EL. '?'279° COSTA MESA. CALIFORNIA
OR ENGINEER
ZF OI
ADDRESS
CONTRACTOR Hirt., (--titin // do. PE TYPE ATE OUP GK �J
APPROVED [["////
ADDRESS S0C- rn-2 ZONING
ZONE NO.OF .j USE OF NEW -CI JAry/PIy
CITY R_2 IPLANS L BUILDING RI/ �L_�
STATE
TEL ---�"-- at A,,
LIC.NO. CJ11/ D / NO. LEGAL J 7-2 (,/�.87
�C DESCRIPTION CSO 7 /l
SIZE a'2•S8 8�/dJ X NO. Or SLOGS.
OF LOT /-r/+X - D. 3 I NOW ON LOT U A.P.NO. ..---__.
USE OF - YARDS EVES
EXISTING BLDG. APPROVED ALLOWED
SETBACK UNE PROM (7 'S '/ 2-+ (CENTER LINE ST.) 8
CENTER OP STREET O REAR YARD J FRONT a FT. 6 IN.
SIDE YARD I LEFT JD 1 RIGHT /6 R.SIDE / . FT. -.--- IN.
DESCRIPTION OF WORK L.SIDE /0 FT. N.
Th
NEW
IIII
II ALTERATION I II ADDITION I REAR S FT. -- IN. (--\
REPAIR 1 LOVING 1 II DEMOLISH 1 BBYPROVED . /4R n� DATE /%6�4 '.
BU I LDIN Vre)6 NO. OF �f / ''✓A/J' 1
SIZE 90.0 ROOMS / STORIES
EXTERIOR WALL I ROOF /,/ 'O'
COVERING COVERING (f' Jam'/
USE OF BUILDING AND WORK TO BE PERFO MED
/
Ar
1 HEREBY ACKNOWLEDGE THAT I HAVE READ IS APPLICATION THE AMOUNT SOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT A • AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION Sy_SIGNATURE OF PERMIT FEE $ ✓
PERMITTEE 7"" o
$ /4 / b PLAN CHECK $ 2 / — 4
AUTHORIZED AGENT
TOTAL FEE $ / -- G y
OWNER RIVERA, Michael DATE 12-31-63
JOB ADDRESS 2290 Waterman Way BUILDING PERMIT NO. 21267
GENERAL CONTRACTOR Owner-Bldr.
VALUE $ 536.00 Res.
AP No.118=201-6S LOT TRACT FIRE ZONE DESCRIPTION OF WORK Add Pat.Cvr.to/
INSPECTIONS Signature DATE GROUP J TYPE V ZONE R-1
Soil PERMITS ISSUED
SUBCONTRACTOR DATE NUMBER
W.,__r
Rough Corn. Refrig. 0 Air Cond. ❑
Rough Heating
Rough Plumbing
Miscellaneous
Prop. Swr. Line 0 House Con. 0 St. Swr. 0
Sprinkling System
Construction Pole
Underground 0 Power 0
Rough Wiring �^
Trenches 0 Forms 0 Steel Reinf. 0 ! O"'a, /— 7 A 9-
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing —In 0 Out 0
Plaster, brown coat
Refrig. 0 Air Con. 0 Final
134-ung, Final
Ilt,.sing Fixtures, Final
Fit Gas Test
Electric Fixtures, Final =
Building, Final e--- /W/_//G 91
OCCUPANCY
Form BU4–SM-3-63–S-13 P
ni nLv
21267 FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT ntc 31 1963
P.O.BOX 317 COSTA MESA,CALIFORNIA FINANCE DEPT.
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING For Office Use Only
ADDRESS .2 .2 90 W/<reltM4.✓ 01/ 1.1Y�
RECEIPT NO. 2RI 2 7
COSTA MESA, CALIFORNIA L L/
'/ RHC61y[D BY yO =HC 60,�' p E 1q/
OWNER MIC/F/K'� ��iY L IZF{ l�/C/ .3•) '�r//� /
BUILDING
MAIL A ^ Y -n n�� / /, y ADDRESS
ADDRESS 2 2 90 !.✓,4re'g'l,M (✓/�/'
FIRE
CITY C - M. NoLS• e.23 i3 ZONE TYP" GROUP
APPROVED //
ARCHITECT TEL --- BY Of
A A' DATE AU! '/
-OR ENGINEER _ _ NO. I �,')
ZONING /1/ AP
ADDRESS /�4
H I NO.OF vl USE OF NEW Ir
/� PLANS BUILDING V //��
CONTRACTOR U L I A/C 2 LkG L (
^U I / 7 /D / /
ADDRESS
DESCRIPTION
V ^^ '' V\ `'J /
CITY A.P.NO. / / 3 - 4o.3— 6, 7
NOTE: NO SAVE OVERHANG SHALL BE LESS THAN
STATE _ TEL. 30'TO SIDE ft REAR P.L.
LIC.NO. NO.
I
a',2-5` 4'.b'F.e,g' X EAVES
SIZE No.OF BLEEDS. I ALLOWED (U.B.C.REQUIREMENT)
OF LOT /,(/ A' 41-c.1/4S-' NOW ON LOT
YARDS APPROVED YARDS APPROVED
USE OFMAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. Re-.rl U&/PCG
(FROM C/L STREET) /
SETBACK LINE FROM `` ✓ / r q
CENTER OF 6TREET ZP S REAR YARD cr FRONT j IV ` j'T FT.
SIDE YARD I LEFT /U ' RIGHT /6 ' R.SIDS 1 GFT,/J}� FI'•
DESCRIPTION OF WORK L.SIDE lCO N>// " of Fr.
NEW ,` ALTERATION ADDITION REAR
DISTANCE BET. BET.MAIN 9
REPAIR I MOVING DEMOLISH MAIN SLOGS. ACCESS.BLDGS.
S ILDING As-/ I NO.OF VAR.# DATE
X/IROOMS STORIES — C.V.P.# ' APPROVED
EXTERIOR WALL ROOF Olt[-7V ,r 4,4T APPROVE / opt 2
COVERING �_ I COVERING BY $C^ /I//,OAITE 1 a-3/-H/
USE OF BUILDING AND WORK TO BE PERFORMED �f//
O PriV 7')924-7- Pnp o coon -0'40i- (ca-40 ,M4 i n_o✓t4
/ �L / n N
/ l'/KNY7J TO a Ff i U F7V(.%
VA-
/95 s4_ad .F•r. /V71 > CPS
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 VALUATION S------
-LA
— m
BUILDING CONSTRUCTION. ,e.,s— // J N
SIGNATURE OF2� / Ce.., $J 3X/ PLAMICHET E CO
H
PERMITTEE �/
0
AUTHORIZED AGENT
TOTAL FEE $C� !