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Home My WebLink About2797 WAXWING CT - Building Permits - '« CITY OF COSTA MESA 4 BUILDING DIVISION It/Friar DEVELOPMENT SERVICES DEPARTMENT PER NUMBER fl • PERMITI 05-01157 4kborPo.mcc (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ristLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2797 WAXWING CI Status: ISSUED Suite: Applied: 07/12/2005 Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 07/12/2005 Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number: 13962128 Zoning: R1 • Applicant KENNETH D MCCLURG / Address: 9661 CAITHNESS ISSUED BY: Allorr Phone: (714)964-1762 HUNTINGTON BEACH,CA , - Zip: 92660 Owner: JANCARIK, JERRY TR • Address 2797 WAXWING CIR Phone: COSTA MESA,CA Zip: 92626 Contractor: KENNETH D MCCLURG Address: 9661 CAITHNESS CA - Phone: (714)964-1762 HUNTINGTON BEACH Zip: 92660. License: 356431 • Arch : Eng: Address: Address: Phone: Phone: Zip: License: Licenser SCOPE OF PERMIT REROOF RESIDENCE AND ATTACHED GARAGE:T/O EXISTING WOOD SHAKE;7/16"OSB, 1,LAYER 30#FELT,APPLY"50-YEAR ELK COMP SHINGLES."2900 SQ FT FEE SUMMARY Plan Check: $0.00 - - Calc Valuation: $8,115.00 Permit: $16725 Claim Valuation: $8,115.00 SMIP Res: $0.81 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $168.06 PLANNING &ZONING • SETBACKS MAIN STRUCTURE Front 0-0- - Rear 0-0 - Left. 0-0 Right 0-0 ' ACCESSORY Front ' 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned fora period of 180 days. 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. FOR INSPECTIONS CALL: (714)754-5626 2446-46(NW) DECLARATIONS ,I I (, WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O 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 work for which this permit is issued. 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 permit Is issued. `' My workers'com nation lasurance Mer and policy number are: ^7 �+ Carrier:_ - p44' �/�-/ Policy Number: 4 C-/nc,. 1(TMssec(fon e notplated if the permit is valued at one hundred dollars($100)or less.) -----a O I certify that in the performance of the work for which this permit Ls Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. ApplicanLSignatore, Date:- - -71 -01 WARNING'FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO'iiiIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADORION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm 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.Licva % 3Y64¶1— rOlass -2 S ' Contractor's Signature: 3,/ Date:- 7- /c-d x / 1 I _ CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097.Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or 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 to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code)or that he or 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 t0 a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for 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 did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. _ Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire 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 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code.with some exceptions,requires registration with the Costa Mesa Flre Department by each business which at any one time has on hand a quantity of acutely 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 temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare en RMPP(Risk Management end Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing withlne Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Cade been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ppermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If yes*,the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of 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 until final inspection. Signature Legal Owner(s) Date. / z'✓And/Or Applicant Date CODE I INSPECTIONTYPE PATE ROMA pODE1 INSPECTIONTYPE PATE IILULS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final n /t 208 Final Plumbing 200 Final Re-Roof 7'"2-L7 c9C /E$G" 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 ,5all F CITY OF COSTA MESA C , a '@@ AA BUILDING DIVISION Y :, `.,• ..sr DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER hI ... . l TPERMIT y "'r>o os4. M02-00545 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2797 WAXWING CI Status: ISSUED Suite No Applied: 12/13/2002 Issued: 12/13/2002 Vicinity: Parcel Number: 13962128 ISSUED BY: Applicant: HERNANDEZ, GEORGE Address: 9911 LARSON AVE Phone: 714-530-2440 GARDEN GROVE,CA Zip: 92644 Owner: JANCARIK, JERRY TR Address: 2797 WAXWING CIR Phone: COSTA MESA,CA Zip: 92626 Contractor A AMES PLUMBING, HEAT, AC Address: 9911 LARSON AVE • Phone: 714-530-2440 GARDEN GROVE,CA Zip: 92644 License:250307 SCOPE OF PERMIT REPLACE FAU. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall HV $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 • 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 . 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 - Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp , $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $38.30 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. 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. FOR INSPECTIONS CALL: (714)754-5626 2446.46(6/00) DECLARATIONS I WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty 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 work for which this permit s Issued. have and will maintain ers' m n Insuran as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compe 'o e card r and poll umber are: 7 Carrier: i2 a Policy Number: JO 74"0/ (This section need not be cam feted if the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for w ich this permit is Issued,I shall not employ any person in any manner so a to become subject to the workers' compensation laws of Calif•rnia,and agree t f I should becomebject to the workers'compensation provisions of Sect n 3700 f the Labor Code,I shall forthwith comply with these •rov'-i• . // '�///s/s/rid i t7 Applicant Signature: ,_ _� t' / 1/L iDate: 1 !/ L 1 WARNING:FAILURE T. ECURE Wey R5'COMPE SATION COVERAGE2 I UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),I IIMDITION TO THE COST OF COMPENS ION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed undererPrerroyi'd,) 9( mmencin ith Section 7000)of Division 3 of the Business end Professior.0 a and my license Is in full farce and effect.iia•a��F ✓ Class a n C Contractor's Signature: .�/�� Date: { -/ ( I ��01 ..- CONSTRUCTION CONSTRUCTION LENDING AG Y: 111 v 1 C1 ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or 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 to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors 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 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($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for 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 did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled with the Costa Mesa Fire 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 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely 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 temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Cale provides that the 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. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which'Is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 8 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (if'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of 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 until final inspection. / / Sign: up: • Legal Owner /`Pale Al _ _ /!� 1�� l� ` •.•Or •uthorized App' ant Date ;ODE I INSPECTION TYPE PAIS $I®94$ 900E1 INSPECRON TYPE DAIL 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1 a•AL._od 1266 Pod Spa Final 208 Final Plumbing 200 Final Re-Roof 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 OWNER T.lst LOS Angeles Corp. DATE 8-7-72 JOB ADDRESS - 2797 Waxwing Circle BUILDING PERMIT NO. 35045 k..,,,, ' ERAL CONTRACTOR The Burro's Co. DESCRIPTION of WORK Res.w/att.garage �Ar No. LOT 26 TRACT 6758 FIRE ZONE VALUE $ 26,500.00 INSPECTIONS • Si nature Date GROUP J&J TYPE 1 ZONE R-1 SOIL /[ 5 rY 119Y I PERMITS ISSUED GAS SUBCONTRACTOR WATER t I Date Number Signature _Y'1-e�� Pluy� •i n• PROP. SWR.ROUGH PLUMBING OUSE CON. �.Z SYIl o 6 ��/]/C, �� JO r9R7d4/it:1 — SPRINKLING SYSTEM MISCELLANEOUI, 0.0 -9 - >' • ROUGH HEATING AND AIR CON TIONMING in_C/0 '147y TEMPORARY SERVICE OR POLE UNDERGROUND El POWER ❑ ROUGH WIRING �y/�,w' _ ///S�5 Heating and YVen t. TRENCHES 0 FORMS ❑ STEEL REINF. e s r �/� (/Ji.,ui . CpL//, Pi 74J-- (7-1-21( Y— FLOOR SYSTEM v/JY�-'� // o• esr" BOND BEAM n STEEL REINFORCE n SHEATHING Ana- -S-7'✓ FRAME AND FLASHING /e-7+ - '7't- 1 ;NG — IN n OUT f ///[[[��- 1 /ER, BROWN COATC/,-X1--. STRUCTURAL, FINAL 9 HEATING, VENT., REFRIG. AND A.C., FINAL fI�Ae / 2.-fl iL Lint / iii / . /- 1,,-A. O - PLUMBING, FINAL AND GAS TEST n .77--9 4 2-c 7 // ELECTRIC, FINAL //ijj ) /4. .2.Q 'L- Fun mut: F Iuel M 2'1 /i✓).'r25 L • 'ALAti 7,4 WC -7-7?-AS 00 436* *** 142.b,„ Lor 2 C 35045 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 P IC TION FOR BUILDING PERMIT For Applicant to Fill in Completely �•�p R �iEI ED Y �${QTE C ED D Ey V D BUILDING 797 /!/Ara ac VGccE �✓ ` ' � � ADDRESS 7 /� / �j,)�� I PERMIT 50 OWNER 7/ .1/49./- ECE✓- f0/P.1� A.P.NO. JV 4 MAIL BUILDING �J�J/� /�J /,, ,'/� ea Z . ADDRESS 7 1.2/4.1-41. � . a ..Jv ADDRESSG / %� //4k'14' �i `-'�F LU / fJ //' TRACT 6zs8 LOT 26. BLOCK o- U CITV Lol'1��G'E«,/ NOL67�79TJ Z Q CONSTRUCTION 4"1,47 C � NEW ADD ALTER REPAIR MOVING DFMOI ISH O CO LENDER 717. � �'� tL CO W 0 BRANCH �• ,p. / �y�/� mJ SX/ Ge--dy %'/4'. r "**csO OWNER /�T L-� A- -r'�/� n5 LLI-COADDRESS cca�rr /� �! VALUE J Q OR ENGINEERG��L Ca. �K 'CL NO�•> 8� '' S FLf LU J�J� at"' $ 26/S�Q U Q �� FIRE W IL ADDRESS72 L.3 G 7> ----IP.; deole Ag(-14 ZONE VPE ROU /..• UiZ BPPROVE• :J W Z CONTRACTORT�E BIIGCCE'9 co. BV /- i/ ...,/ti 'ATF '- co O /// l m Z // JCC ADDRESS TeV 5 ', a' c//.Ulu' pa, O= CITV �f�l^/r NOL /��V/ ZON[1 i PLANS y BUILDING NEWNO.OF USE OF � /Ane 0 STATE CITY �7YARDS APPROVED YARDS APPROVE N CL LIC. NO. /-7c • *7-7 LIC. NO. 2740.9- D� MAIN BUILDING ACCESSORY BUILDING D O (FROM C/L STREET/ SIZE �Ox /fid INOW ON LONO.OF BLS OF LOT FRONT /-5-FT. PSL. FT. USE OF EXISTING BLDG. R.SIDE EFT. FT. I- SIZE OF /�/ /� NO.OF �j Z NEW BLDG.�47�CK//FTROOMS / STORIES / L.SIDE C-FT. FT. U EXTERIOR WALL ROOF ./Y.'r' —±. • , _ COVERING ICOV EKING V/�MCC REAR y� FT. FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& a. MAIN BLOCS. ACCESS.BLOCS. a CA '� (�� VAR.# DATE 0 fLfL/fc W c % V r C.U.P.# APPROVED I— qq E� ��//1 `15-- �/7 I— V) RY7lrt`O 1 U'- t` z DATE '7 t� tt.� 'T O I hereby acknowledge that I have read this application and state �70� /� D that the above information is correct and agree to comply with POR CC all laws regulating building construction, and I shall not employ 4 Sit I— any person in violation of the workman's compensation laws of CT' L w N the State of California. /�C/f� rt� co J(/ ��.., to z I hereby certify that I am properly licensed as a contractor under SO. FT. i o the State of California Business and Professions Code, Division 3. THE AMOUNT SHOWN UNDER VALUATIO-f�1IVFOR 5 Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERM IT FEE FEE ONLY: I[ am exempt from the provisions of the State of California Business VALUATION and Professions CCCode, i n Chapter 9. 0° � %! /f��G'." /. PERMIT FEE $ roSignature of / /��ty_/Permittee $�/pJ(� , PLAN CHECK $ E !4 o Authorized Agent // u. [ TOTAL FEE $ /