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Home My WebLink About3269 WASHINGTON AVE - Building Permits• CITY OF COSTA MESA � svao�N� �►v�s►oN 77 FAIR DRIVE, COSTA MESA, CA 92626 •(774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us � � FOR INSPECTIONS CALL: (714� 754•5626 PERMIT TYPE B_ROOF2 APN: 13905609 JOB ADDRESS: vicini[y: Squares: 2800 PERMIT NUMBER: 610-00021 STATUS: DATE ISSUED: ISSUED BY: 3269 WASHINGTON AV CM Suite/Unit: Valuation: ISSUED 0112912010 KJB $7,500.00 SCOPE OF WORK: TEAR OFF EXISTING COMP ROOF. RESHEATH AND COVER WITH 30 YR COMP SHINGLES. ROOF PITCH IS 5:12. OWNER: COATS, ROBERT BENJAMIN TR PHONE: APPLICANT: JAYS ROOFING PHONE: 714�23•2120 CONTRACTOR: JAYS ROOFING Address: 7717 COUNTRY CLUB LNUniI: City/State2ip: CORONA, CA 92880 ARCHITECT: ENGINEER: FEE SUMMARY Reroof Plan Check: Reroof Permit Fee: Reinspection Fee: Bldg Std Admin Fund TOTALFEES $0.00 $153.25 $0.00 $1.00 5154.25 Address: 3269 WASHINGTON AVE City/Stale/Zip: COSTA MESA, CA Address: '1117 COUNTRY CLUB LN City/Stale/Zip: CORONA, CA License No. License No. PHONE: License No. 512051 714-423-2120 CELL: 951 •280•9668 PHONE: PHONE: Unit: Unit: : NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenls under Cali(omia sta[utes and related regulalions. (Ord. No. 9248, § 1, 12-21-92) � EXPIRATION; PERMIT EXPIRES 780 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPEC710N5: In order (or 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 vrill result in the expiration o( this pertnit. CODE/, INSPECTONTYPE U�1 Nlil TIRLS �0� INSPECTIONME � INTITIRLS 1818 Fixed SyStem Pinal Fire Prevention 206 Final Mechanical 12fi6 Pool Spa Final 208 Final PlumOing 200 Pinal Re-Roof �_�_ fjr �� 210 Final Electncal 201 Final BIceiJRetaining Wall 272 Final Fire Prevention 202 Final F�ctory Fire Place 220 Final Planning Approval 203 FinalSign 222 FinalSite 204 Final Demolition 250 Final Building/Occupancy � WORKERS' COMPENSATION DECLARATION: I hereby atfirm under penalry of perjury one of lhe following declarations: ❑ I have and will maintain a certificate of wnsent to sel4lnsure �or workers' co�lion, a� proo"tletl (or by section 3700 0l the Labor Code, for the eAo nCe of lhe work for vRiith lhi5 pertnit is issued. I have and will maintain wnrkers' compensation insurance, as required by sec n 3700 of Ihe Labor Code, (w Ihe per(ormance of the vrork for which this pertni[ is issued. My kers' compensation Insurance carrier and policy number are: � �""Garcier. ( � (TnrssectanneMrrof�ee �m\de��Afhep��em,/�,¢,raNeoalonenuntlrcdtlaaars(S�Oo)aless) Rbf`'I�umber: V `�' � � `" � � � ❑ I certity Ihat in the peAormance ot �he work (or which this permi� is issued, I shall no� employ any person in any manner so as to become subject b the workers' compensation laws of California, and agree thal if I should become subject ro the workers' compensatiDn prOvisions o( Section 3700 of the Labor e. I shall t hwitl comply vnth these provisions. � 9 /.� pl 'e�SigrPdWre Daie WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. �,�,� �a o s- �u� G3 9 / e2 S- /O x"'s.,TiAtetvre �aia� CONS7RUCTION LENDING AGENCY: ❑ I hereby aKrtn that there is a consWction lending agency tor the pedortnance o! Ihe aork fa which Ws pertnit is issued. (Sec. 3097,�Civil Code�. Lender's Name: Lender's Address: SiB^ature OWNER-BUILDER DECLARATIONS: I hereby aKrm that under penalty of perjury that I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW (or the following reason (Sec. 7031.5, Business and Professions Code: Any city or counry which requires a permit ro construct, alter, improve, demolish, or repair any stmcNre, prior lo its issuance, also requires the applicant (or such permit to file a signed statement that he or she is licensetl pursuant to Ihe provisions of the Contractors License Law (Chapter 9(commencing wilh Section 7000) of Division 3 0( the Business and Professions Code) or that he or she is exempt therelrom and ihe basis (or lhe alleged exemption. Any violation of Seclion 7031.5 by any applicant for a permit subjects the applicanl to a civil penalry of not more lhan fve huntlretl Oollars ($500).): ❑ I, as owner of the property, or my employees vnth v2ges as their sole compensation, WILL DO 7HE WORK, and the sWcture is not intended or oftered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of pmperty who builds or improves thereon, and who tloes such work himself or herself or through his or her ovm employees, provided that such improvements are not intended or ofiered for 5ale. I(, however, the builtling or imprOvement is sold wilhin one year o( completion, the ovmer-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as ovmer of the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS lo construct the project (Sec. 7044, Business and Professions Code: 7he contractors License Law dces not apply to an ovmer of property who builds or impmves thereon, and who contraas (or such proiecl with a contractor(s) license pursuant to the Cont2ctors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: 305]46 (]/OJ� Owner ID verifed by driver s license. ❑ Ves ❑ No Driver's License No. Expires: _�_._ Venfcation of Ownership by (type of document, i.e. - property tax bill or tleetl�: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cehify that no excavation frve (5) or more feet in depth into which a person is required to descend, vrill be matle in connectbn with v.ork authorized by Ihis permit, and [hat no building sWCWre, scaffdding, (alsework, or tlemolition or tlismantlinq thereof, wiil be more �han Ihitly-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 347, TUe 8, Cali(ornia Administrative Cotle). ❑ As ownerbuilder, I will not employ anyone to tlo work which would require a permit Irom the Division of Intlustrial Safety, as noted above, unless such person has a permit to do such work fmm the division. Applicanfs Slgwwre Division of Industrial Safety Permit Number. _ HAZARDOUS MATERIALS AND EMISSIONS CER7IFICATION: 1. Will the applicant or present or fuNre building ocwpanl need to file antl certify a Business Plan for emergency response to release or Ihreatened release ot a hazardous matenal? ❑ Yes ❑ No (Section 25505 of the Calitomia Health and Safety Code requires, with some exceplions, that a Business Plan be filed with the Costa Mesa Fire DepaAment by every business which has at any one time dunng a reported year a quantiry ot hazardous matenals equal to or greater than a weight ot 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at slantlard temperaNre and pressure). 2. Does or will the applicam or present or /uture building occupant need to file a registration /orm for awtely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Heal[h antl Safety Code, with some exceptions, requires registration with Ne Costa Mesa Fire Department by each business which at any one [ime has on hantl a quantity of acu�ely hazardous matenals equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic fee[ of compressed gas at sWndard temperature and pressure). 3. Does or will the applican[ or present or future building occupant need [o prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of Ihe Califomia Health antl Safely Code provides tha[ the Costa Mesa Fire Depatlment may require the preparation, certification antl fling with the Fire Departmenl o( an RMPP by businesses which are required to register acutely hazardous materials vrith Ihe Fire Department. 4. I/ an RMPP is presently required, has Section 25534 of the Califomia Health and Satety Code been fully complied with7 ❑ Yes ❑ No 5. Does or will ihe applicant or present or future building occupan[ require for Ihe work wF�ich is the subject of this application a permit for such construction or motlification from the Soulh Coast Air �ualiry Management Dislrict or from any other air pollution control disMct or agency? ❑ Yes ❑ No (Sectbn 658502 of the Califomia Govemmem Code requires �nat the requested information be turnished on applicalions fa non-resitlential building pertnits). 6. Will any parl of the faciliry to be consWcted under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No Qf "yes", Ihe facility must meet the requirement of Seclions 25534 antl 42303 of Ihe California Health and Salety Code). 7. If a pefmll (rom lhe SoUth COaSI Air �Uali�y Management Dis�rict or olher air polWlion control district or agency is required for the work which i5 lhe subject of this application, have all of Ihe disGosures prescribetl by Calitomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If "yes", attach certiticate of compliance from ihe appropriate air polWtion control oKcer�. CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the information given above is correcL I agree to comply with all state lav5 and city ordinances regarding Hazardous Matenals and Emissions. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the informalion given is correcL I agree to comply with all state laws antl city ordinances relating to building construction, and authorize representatives of the Ciry ot Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy o( any building authorized by this permit until (nal inspection. Si a re o1 Legai e F Da�e %-e2 9 -/C� f n orAu onie0'Ap`pticanl �� CONSTRUCTION PERMIT Applicant to fill in all spaces ezceo� ihose within heavy DorOer lines ana sign all appropriate aeclarations. PERMIT NO. TRACT NO. LOT NO. UNIT NO Project Address d 1 O Applicant's Maili Ad2dress � � �1 E � �� Owner's Name �� `-� � �� 5 Ph �� Address � W�1 IN&' O Arch/Eng. �G ✓�IZ ,n, �G LicenseNo. �,u�� Address , ��3b 1lOSE S� • C�'R�1�OS . Contractor'sName C. � NE12 COrtC(Z�TC. phon�—�%-3��(� Address (maiiingl '� �f �X -�13 (�R�-'�� a0� City Licenre No. �� 2 LICENSED CONTRACTOR DE�LARATION I hereby aitirm tnaP,l'am licensetl under provisions of Charter 9(commencing with section ]000) of Diyision 3 of tM1e.Business antl Professions Cotle, antl my license is in f II fO�ce�antl eitect. License Class — �� Licens � �3 Date ��_��+-� . Signatura '� WORKERS' COMPENSATION PE RATION ' M1ereby aHirm that GHave a cert�ficate of mnsent to self-insure or a certilicate Workers' Compensation InsUrance, or a certifietl copy thereot (Section J0, Lab. C. . Polic o. 4�� Comp y ��E uN ertitietl copy is hereby furnishetl. Certifietl wgy is tiletl witM1 tbe city i Divi ' Date��'j-k, 'qpp�jcant �KEMPTION FROM WORKERS' COMP SATION DECLARATION M1issection neetl not be Completetl it tne permit i5 for one huntlretl ($300) or �less). I tertify that in the per/ormance oi the duork for which this perm�t is issuetl, I snall not employ any..person in any manner so as to become subject to the YJorkers' Compensation Lawi of Califomia. i �u[e ' Signa[ure � NOTICE: If, aiter making.this tleclaration, you shoultl become subject to the Workers' Compensa[ion provisiJns of the Labor Cotle, you mus[ forthwith tomply with such p�ovi5ion5 0� this permit shall be tleemed �evoketl. GONSTRUCTION LENDING AGENCV I her¢by affi�m ihat there iz a coe�st�uction lentling agency for the pe�fo�mance of the work for whicM1 this Permit is issuetl (Section 309] Civ. CJ Lentler's Name Lentler's Atltlress OWNER BUILDER �ECLARAYION I hereby affirm that I am exemPt fram the Contractor'S License Law for the followinq reason (Section ]031,5 Business antl Professional Cotle: Any tlry or county which iequires a pe�mit to const�uct, alte�, improve, tlemolish o� �e0ai� any 5[ru[[ure, prior to it5 i55uaqce, al5o requireSlhe appli[ant for Such permit to tile a signetl statement that f�e/she is licensetl putsuant to the provisions ot the Contractor4 License Law (Chapter 9(commencing witM1 Section ]000) o( Division 3 ot the Business antl P/otessions Cotle) o� tM1at he/sne is exemp[ erefrom antl lhe basis fo� thF allegetl exemption. Any violation ot $ection 31.5 by any applicant tor a permit subject5 Me applicant to a civil .ndlty ot not mor¢ than five h�ntlretl tlollars ($500). ❑ I, as owne� o( the propertY or my emDloyees with wages as tM1ei� sole Wmpensation, will do the work, antl the structure is not intentletl or offeretl for sale (Section 7044, BusinBss antl Professional Cotle: The Contractor's Litense Law tloes not apply to 2n owner oi a property who builds or improves thereon, antl who does such work himself/herseli or through his or her own emO�oYeeS, provitletl that suth improvements are not intentletl o� otfefetl for sale. it, however, the builtling o� improvement is soltl within one year o� com- pletion, the owner will have thF burtlen of provin9 he/she tlitl not builtl or im- prove for the purpose of sale). ❑ I, a5 owner of the property, am exclusively cont�acting with licens¢tl con- tractors to construct the project (Section ]044, Business antl Professions Cotle: The ConVactor's License Law does mt appty to an owner of propertY wha builtls or improve5 thereon, and wbo contract5 for such Orojects with a con- Iractor(sl I¢ense pursuant to tM1e Con[rattor's LirenSe Law). 1 am aware that proof of tbeir Wo�ker'S CompEnsation insu�ance shoultl be provitletl to me. ❑ I am exempt untler Section B. & P. C. for thi5 reason Date OwnF� I hereby certify that I ave reatl this appliwtion antl state that the above info�mation is mr e t, gree tJ comply with all city antl [ounty ortlinances antl state laws r n o builtling construction, antl hereby authorize repre- sentatives of th s i to entEr upon the above-mentianetl property for in5pection pu�p I, Signdture - Date �' ��% Drivers' License or 5 — z�7 s7 036 7� /7 E CONSTRUCTION NEW �A�D ALTERATION REPAIR CONVERSION ❑ DEMOLISH ❑ OTHER �ESCRIPTION OF WORK/USE OF BLDG=-N�Wu" (a` F'F�G'h COPX- • r�.... _ � TYPE OF PERMIT LJ GRADING LJ FOVNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 5a. FT. oCCUvarvcv CONSTRUCTION TVPE ��y� - VALUATION S iC1 ZONE GRADINGGU.VDS. ACRES_ Remarks: Sink Preventer tubs Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Intercepmrs Kimhen Sink lavatories Roof Reinspection Fea Boiler Du Under Ground Duct-Stru al Duct � Ventilating Exhaust System ❑ MWti Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ 0-7 00,000 BTU � 1�;( Fee CMF 0865-46, rev. 10/84 White�- Building; Canary - Applicant Pink - Accounting; Goltlenrotl - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collecmrs Solar Piping Solar Ta Swi r(ing Pool w/Spa r I _ Water et Water Heater Water Service Auto-Wash Laundry Trays $75 Issue Fee MECHANICAL Hood or Typel � Canopy Type I I ❑ Refrigeration Syste � ❑0-100,000 ❑100,000 Syste epair/Alteration � ire Dampers $15 � � ' Issue Fee FEES A.P. � S Main I E T Front B Rear A C Righ K _ Ping. Ref. # Planning Notes: ic Washer tion PoleS Unit . 4126 3/17/87 Zone Parking Req./Provided Z O N I N G R E Q M T S ELECTRICAL Transformer ❑ 15-50 KW � ❑ 50+KW Dryers LJGa LJElectric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garba9e Disposal Generator �0- W 05-15 KW Y 3 ` Rainspection Fee $75 FEE DEVELOPMENT SERVICES REQUI .2oning App�oved By Building Approved By Aooliotion Issued Bv $ 3 Meter LJ Me[er ❑ Su6 Panel Motors C IOC. 2f icrowav Pole Ligh to 100 r 100 z 0-'i HP O 1'/: - 8 ❑9-15 HP �16-15+ Standing Se2ti�n Trash Compactor Issue Fee SUMMARV OF FEES - BUILDING PERMIT $ /6 . �O SMIP PLAN CHECK $ /�-' • 4C0 pERM1T PLUMBING $ �SSUANCE PLAN CHECK 25% $ ENERGV P.C. ELECTRICAL $ GRADING PLANCHECK � 50% g MICROFILM MECHANICAL $ TOTALFEE PLAN CHECK 25% $ FEES $ 3 $ 6•$O CONSTRUCTION AND P.LANNING� POOL & SPA APPROVA�S Permit # Date Inspector p�ppROVALS 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. ElectricaiConduit-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 77. 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 O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling.lStructural) & Monocoat 75. Dry Chemical 27. Frame anq Flashing 76. Dry Standpipe . 28. Lathing & Siding . � 77. FIXED SYSTEM FINAL 29. Insulation 78, FIRE PREV. FINAL 30. DrY`Nall 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 a 36. Hood or Canopy 37�^ Final Factory Fireplace � 38.� Final Plumbing , � 39. Water Seruice-Final ' y: 40. Gas Service-Final � � 41. Solar pomestioFinal � � , 42.� Backflow Preventer . 43: Backflow Irrigation t� � o � 44; Landscape Irrigation System � . � 45� Sound Attenuation � � 46: Handicap Regulations � 47: FINALS7RUCTURE&BUILDING --- `'� �'S �B � 48. Special Requirements Completed - 49. Electrie Release to Edison � 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - No. Date '�'. l� � : •j7T,�y*�^r�i�ifc�d: �a�ia.� 1H7S A(�2EEt+��STP, made ar�d entered into this f.� ,�,(�%� d� day of , 1�{, bY ard between �E1��t'-'.�� /.� , ��}'� herninafter referred to as "I,AND �ddER", and ,{%�'' %� L7EXX.� hereinafter referred to as "AATA(T�STf PRdPER1Y Q�iNER". It is hereby agreed that a party Yrall will be constructed on the prc�erty line be�ueen ��9 � 3273 ,��J�f/i(/G'jQ/C� � (Address o Adjoining Properties) , �0�� .,GI�-�,A� �',� 9�6�b in the City of Costa Mesa, Coimty of Orange, State of CaliSornia, as per a►�p recocded in Bodc , Page of Miscellaneais Maps, in the office of the Coimty Eaecrorder of said Co�ty. 7tie party wall shall be permitted to encroad� IN WI2NFSS t4iEREOF, the parties ha�e entered into this Agreement the day arr3 year fizst aba�e written. a. � �.u.� .; �C��, � (Signature) ?�o G3rR i �, CoR �s Name ('Iyped or Printed) ��Cf �ASN1NGroNr-tU (Adc}ress) �l � S ifi `"1 �= S fF �� r q� �a� . • �� .'.�.• o •� • a�• / � �_� / __ - _ �' �- � � � .-. . _. /S�dIO ��'G-�� I�l% (Address)��c�,da,�, �� 4��G (NpTE; Please see revetse side fvr notary's statement) FEE REC�IVED " 1`�� — SEP 161�?0 COSTA MESA BUILDING•SAFETY DEPARTMENT � � � P, O. BO% 917 C06TA MEBA. GALIFORNIA Cj'� �� For Applicanf fio Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING ADDRE68 32 9 Washington Avenue COSTA MESA CALIFORNIA For Offlte Use Only oWNER �erst Develo ment Co, aece�rr NO. P8(H,MIT fo. ADDRESS 1533 Baker Street aBCervsD ev , I oA REGerveD AT 189 G�f/ -/3'� ° e a ? � 1960 cirr Costa Mesa NEo. K19�S�- AooRe�se ARCHITHC�' CaT'ZSOn Bc re�. COSTA MESA, CALIFORNIA ' OR ENGINEER NO. i / ADDRES& PIRE ^y� y 20NE TYPE � GROUPk-/ ,V CONTRAG'1'OR Dike PY (�i0�.6 rove YRC • APPROVED / BY DATH ADDRESS 1533 Baker Street ZONING v c�.n, C.OStB Mesa, C31].f . ZON R-1 I p�e 2 I eun.nino� ucTNo. 167293 No: KI 9-u51 g�p��o� Lot 1?, Tr. 3875 81ZE [ I No, o> et�a OP LOT V� X 1�� Now oN LOT�ORe A. P. NO. TIORe USE OF None YARD6 EVES E%ISTING BLDG APPROVED ALLOWED 6CTBACK LINe PPOM [ ��TeA ��NB aT•� �> ceNTeH OP eTrt[ei 7�� REAR YARD ZS FRONT V FT. IN. SIOE YARp I LEFT � I RIGHT 7� R. 61DE F7. IN. DESCRIPTION OF WORK L. SIDE FT. IN. NEW I� II ALTERATION I II ADDITION I RHAR Fi. IN. � REPAIR I IIMOVING I IIDEMOIISH I BYPROVED w L• D. DATE 9-15-60 e zE°'"G 1465 SQ.ft�00M5 V STORIES 1 EXTERIOR WALL ROOF COVERING StillCCO COYERING Wood 9I11I1 �.B ( U8E OP BU�LDING AND WORK TO BE PERFORMED �, b Single family residence t,rith attached ara?e. Plan 11B � 1 HBPBBY ACKNOWLBDOH TXAT I HAVE RCAD TH19 APPLIGTION TH8 AMOUNT BHO�'/N UNDEH VALUATION �8 POR TNH AND 8TAT6 TXAT THE ABOVB IB COPRER AND AORBH T COM- pUM098 OF 88T�9LI6HIN� • PEHMIT PeE ONLY. PLV WITM �LL GITY O INANC89 AND lAWB Re TN6 Bu1LDIN0 CON6iAu VALUATION [ BIGNATURE OP PERMIT FEE S 3J�QQ ' � i7.5o " PERMIITE [ o $ 17,139• PLAN CFiECK $ K AU7NORIZED AGENT Dike let C+Ole rove IRC• TOTAL FEE � 4