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Home My WebLink About3375 WISTERIA CIR - Building PermitsA CI1Y OF COSTA MESA BiIILDZNG SAFETY DEPART"IE.1T CERTIFICATION � the �dersigned, I am fully aware of tY.e responsibilities a.: owner builder. I hereby certify that the personnel li�ted belw, vt�o are preseatly performing work at are employed by me. I vill wiihhold Social Security deductions, State and Federal income taxes. They are also covered 'oy Workmen's Compensation Insurance as prescribed by the State laws of California. NAME 5 lu7DRESS OCCUPATIOY ] ,��.�,(�i��,�f��n,�_Y �c��,�'L.e�r� E,l2eP��vr�ir_ DBte ti � �- 7'�' Signed: _. Address CITY OF COSTA MESA REQUEST FOR OCCUPANCY TRACT N0. �/ � 0 � /� / IAT N0. � f�S � , � npDxEss ,,' 3 %',�' � ` The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the CiCy of Coata Mesa. The undersigned, by executing this agreement, acknowledges that l�.—s=:rthey) (nna—at were)_�G/�'�_ advised that this tzact has not been given final spection nor has it been accepted by the City of Costa Mesa ae having complied with the conditiona of approval which were imposed by the City at the time the final tract map was approved. The City ass�es no liability for the enforcement of the conditions neceasary for approval other than those conditions protected by surety bond. The undersigned agreea to indemnify and hold the City harmlesa from any claim result3ng in damage or personal injury to the undersigned by reaeon of the aforementioned uncompleted condition. BY C� Pure ser BY /J� %� �d2'��/�� Developex and/or authorized zepresentative sx .,�'�� ,.. ender ADP��ant to fill in all spaces excepl those wit�in �eavy bortler lines antl sign all appropriate Geela�alionz. CiTY OF COSTA MESA ONSTRI;CTIOtd PERMIT Project Address � 2 e �ApplicanYsMa'I' Addreu L �_ Owner'sName�NNl1= � oil�L. Phone� Address Arch/Eng. License No, Address n Contracmr's Nam ' , '�` m/ r� Pho 2e��a-3y Addresslmailing) �53� p1/.(/��n%C�LA�O�A�/I. i�o�// City License No. � 3 p ' LICENSED CONTRACTOR DECLA0.ATION � 1 hereby atfirm that 1 am IlcenseU untler provi5lOn5 of Charter 9(commencin9 A_ with section 7000) o( DivislOn 3 of [he Busine55 antl Professions Code, antl �� my license is in full i ce e/tect. a License Ia55�5 (_ ��4 CeCn2e No'/� /��S � � Oale ��a'Q c'enat��r_ l//1(�YU !Ll/�[NLQJ C WORKERS' COMPENSATION DECLARATION 1 hereby affirm thal I have a certifitate ot consent to self-insure or a cerUficate � it Workers' Compensation Insurdnce, o� a ce�tni(ietl copy the�eo� (Section 3800, Lab. C.1nUhyD .CKav�2 ��+ Policy No. Company eCer[itietl coOY i5 her¢by lurnishetl. Cer ie o filetl with the ciry iltling iyisit� Da[e �� Applitant / !J (A�.f/K�ii EXEMPTION FqOM WORKERS' COMPENSATION DECLARATION (This section neetl not be completetl if the permi[ is for one huntlretl (E100) or IessJ. I certify that in the performanCe of the work Por which this perml( i5 issuetl, I shall not employ any person in any manner so as to become subject [o [he workers' Compensation Laws of California. Date Si9nature NOTICE: If, after making this tletlaration, you shoultl become subject to the Worke�s' Compensalion provi5ion5 ot the LabOr Cotle, y0u must forthwith mmply with Such provislons or tM1ls pe�mit shall be tleem¢tl revoketl. CONSTRVCTION LENDING AGENCV I hereby aifirm that there is a construction IenOinq a9ency for the pertormance of the work for whicn tnis Oermit is issuetl (Section 3097 Civ. C.) LenUer's Name Lentlet's ACtlress OWNER BUILDER OECLARATION� I hereby affirm that I am exemOt from the ConVacfoCz License Law tor tne following rea5on (SecHon 7031.5 Business antl Grofessional Cotle: Any city or counly which requires a oermit to construct, alter, improve, tlemolish or repair any structure, prlor to Its issuance, also requires the appli<ant for such permit to file a signetl Statemenl lhat ne/she is IicenSetl pursuant to the provisions ot the Conlractor's Llcense Law (Chapter 9(rommencing witn Section ]000) ot Oivision 3 of IhC Business antl Prote55ion5 COtl¢) o� thal ne/sbe Is exemp[ herefrom antl the basis for the allegetl exemption. Any vlolation oi Section 031.5 by any ap0licant for a pe�mit subjects the appliCan[ t0 a civll eendlty of mt more Ihan live huntlretl tlollars ($500). LJ I, as owner of the p�o0erty o� my emplOye¢5 with wages as tM1eb sole com0ensation, will tlo tne work, antl the structu�e is not Intentletl o� oHeretl for sale (Section 7044, Business antl Professional Cotle: Tne Contractor's License Law tloes no[ apply to an owner ot a property who builtl5 or improve5 thereon, antl who tloes such work himself/herself or through his or har own employees, provitletl thal such improvoments are not intentletl o� offeretl fo� Sale. If, however, (he bulltlinq c� improvemen[ i5 soltl wlthin one yoa� of com- pletlon, the owner wlll nave the burtlen of proving he/she tlIG not builtl or im- p�ove tor the purpose o1 sale). ❑ I, as owner of the proper[y, am excWsivety contractln9 with Ilcensetl con- tractors to construc[ t�e project (Section ]044, Husiness antl Professions Cotle: The Contractor's License Law tloes not appty to an owner of property who builtls or improves the�eon, antl wb0 COnt�dC[5 to� SOCh O�Oj¢Ct5 wllh a con- tractor(sl license Dursuant�to [he Contractor'i License Law). I am aware that proot o( their WOrker'S Compensation insurance shoultl be provitletl to me. ❑ I am exempt untler Section B. 6 P. G. �or this reason TYPE OF CONSTRUCTION LI NEW IJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p # DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TVPEOFPERMIT GRApING�� FOUNDATION ❑$TRVCTVRAL T F�Ont ❑ TENANT ❑ ELECT0.ICAL L'SPLVM6ING ❑ MEGHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION 54. F7. oCCUaANCV C Right K Left CONSTRVCTIONTVPE VA�VATION$ $ ZONE GRADING CU. VDS. ACRES Ping. Ref. # Remarks: Planning Notes: Preventer Irrigation Dishwasher Drinking Foi Floor Drains Floor Sinks Gas Service I ntercepmrs Kitchen Sink Lavatories P—Trap fioof Drains Reinspection Fea Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Outlets Water Closet � Water Heater Water Service $15 Boiler Duct- UnderGround Duct - Structural Duct - Ventilating. Exhaust SyStem ❑ Mul[iple Firepl/Fact. Blt. ICBO � Oate Owner Hea[ing System & Ducting I herlby Certity lhat I-have reatl this applicatiOn antl itate that the dbove 06100,000 BTU 0100,000 information is correci. I a9ree to comply with all <ity antl county ortlinances antl State IawS r¢lating t0 builtling ConStruclion, antl h¢�eby au[hOrize �ep�e- sentatives of tnis city to e er upon the above-mentionetl�,Proper(y for inspection pyr ses. � (}_/� C7� -a Si9nature A __ Date � Reinspec[ion Fee Drivars' Li o 5 � CMF 0865-46, re �y'B4 White - Builtling; Canary - Applicant: Pink -Atcounting; Goltlenrotl -Assessor $15 laue Fee Hoodor, Typel ❑ Canopy Type I I ❑ Fefrigeration Sysrem ❑0-100,OOOBTU ❑100,000 System Repair/Alteration laue Fee Automatic Washer Construction Pole Sub. Cooking Uni[ . Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets 9391 9391 II/12/87 Zone Accessory Buildin9: Parking Req./Provid ' lJRlf - ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over100amps Garbage Dispoul Generator �65 KW 0615 KW Sub Panel Momrs � 0� t H P O 1 h- 8 Inc.Solar �9-75 HP �16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor i} $ 3 . Reinspection Fee $15 luue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approvad By Building Approved By Aooiiption laued Bv $ 3 �,p,i i L ' FEES $ 3 SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT � PLUMBING $ T� �SSUANCE $ � PIAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM 5 MECHANICP.L $ TOTALFEE $ �� . PLAN CHECK 25% $ Z O N I N G R E � M T $. , .. CONSTRUCTION ANDPLANNING APPROVALS Permit # 4 1. Temporary Electrical Service or Pole 2. Soil�Pipe-Undrgrnd. � 3. Electrical Conduit UtilitY-Undrgrnd. 4. Electrical Conduit-Undrgrnd. 5. Steel Reinforcement . 6. Electrical UFER Grnd. ' 7. Footings � 48. Foundation 9. �Water Pipa,-Undrgrnd. 10. Structural Floor System i1. Property Sewer Line & House Connection 12. Sewer Cap . • 13. Roof Drains 14. Rough�Plumbing 15. Rough Electrical-Conduit 76. RoughEl�ctricWiring 1�7. Rough Wiring Sign 18:� Rough Electrical-T Bar Ceiling' 19. Rough Heating & Air Conditioning 20.; Rough Factory Fireplace � 21. DuCts, in Structure , 22. Ducts, Ventilating 23. Gas Pipe-fiough & Test 24. Roof Framing 25. Root Sheathing 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing 28. Lathing & Siding 29. Insulation 30. Drywall Nailing" 31. Plaster Brown Coat 32.'Electrical Power Meter-Final ' 33. Final Electric 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 ;� 40. Gas Servire-Final ?j r-. 41 . Solar pomestic-Final f•^i 42. Backflow Preventer j�� 43. Backtlow Irrigaiion , � � . 44. .Landscape Irriqation System� 45. Sound Attenuation - � 46. Handicap Regulations °ij 47. FINALS7RUCTURE&BI�ILDING rr 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE�OF OCCUPANCY lo. Date Date POO� �PA Inspector p�ppROVALS Permit# - 52. Pool & Equipment Location . ' 53. Steel Reinforcement , � 54. Forms , 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER-GUNITE 58. Electrica}Conduit-Undrgmd. 59. Gas Pipe, � Undrgrnd., Test . 60. Backwash Lines, P-Trap, O Undrgrnd. 61. APPROVAL TO DECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System - Final 65. Electrical-Final 66. Solar System-Final � 67.. Fencing & Access Approval 68. APPROVED FOR PLASTERING , 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS, Permit# 70. Underground HYdro � 71. Product Piping � Gas ❑ Oil 72. Underground Flush 73. Undergrnd. Storage Tank � Gas ❑ Oil . 74. Overhead Hydro 75. Dry Chemical � 76. DryStandpipe �, 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINqL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes:/ 1/.8B L�GArZD Ge 0 Date � Inspector 5 [K YAUL� WHIN� 'V"C�..FRAI CO \� � 0.412-1 �;��.7 INSPECTIONS ,�� SOiL � GAS WATER � LOT TRACT FIRE PROP. SWR. LIN6 U HOUSE CON. U SPRINKLING SVSTEM MISCELLANEOUS ROUGH HEATING AN� AIR CON�ITIONING TEMPORARV SEFVICE OR POLE UN�ERGROUNO � P�WER � ROUGH WIfiING TRENCHES � fORMS � STEEL RE FLOOR SYSTEM BOND BEqM [� STEEL REINFORCE [ FRAME AND FLqSHING � LATHING - IN OUT n P =R, BAOWN �OAT Sl.__TURAL, FIN/L HEATING, VENT., REFRIG. AND A.C., FINAL PWMBING, FINAL /ND GAS TEST n ELECTRIC. FINAL � UAIt 7 � !7 VAL SUBCONTRACTOR Plum6ino ' 39�3� J COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For App/icant to Fill in Completely BUILDING � Q •-pL � i _ � , � � /� /� /% CITY BRANCH ADDflESS AflCHITECT OR ENGINEER ADDfiESS CONTRACTOR Q ADDRESS CITY $TATE LIC. NO. saE G�('Yla OF LOT USE OF /i EXI5TING BLOG. �G SIZE OF NEW BLDG. EXTERIOR WALL COVERING �TV USE OF BUIL NG AN Qg R TEL. G /�'f NO.' TEL. NO. CITY LIC. NO. �— INO. OF BLOGS. NOW ON LOT NO. OF ROOMS � STOF ROOF COVEFING � /A K T�O➢E PERFORMED l P�11C1 '='^.p'..,�`. I `,�AY —6-75c:;;.00 196.". �.50 APPLICATION FOR BUILOING PERMIT RECEJ�VED;BY OATE�ECE�EO DATE ISSUED � ''� s S- d -73 q,P.NO.�1Z—�QZ � �ERMI ADIDRESS ��75 \ilrsrfRiR C�/1 '� TRACT / 7I Ci IOTI Y BLOCK FIRE ZONE APPROVED N NO.OF � Pl.ANS � VAROS APPqOVED MAIN BUILDING VAR. # 0.U.P. # APPROVED � DATE USE OP NEW��M BUILDING � �� VARDS APPROVEI ACCESSORV BUILO � � O FT a FT. FT. BET. MAIN & DATE APPROVED ,,,,T� 5 —(v -' I hareby acknowledg0 Nat 1 have reatl [his application antl state \ ihat tha above information is correct antl a0/e¢ to comp�y w7t� ell laws reBulatin8 buildinB construction, entl I shall not employ ,. eny person in vlolaUon of the workmen's compen�atlon laws of the Stata of Californie. .r� / I hereby certity thet I am pro0erly Ilcansatl es e contractor untlar SQ. fT. the Smte of Celifornin Business and Professiona Cotle, Olvisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS F Chaptar 9, antl thet suc� licenws erB In full force antl etfect, or I TME PURPOSE OF ESiABLISNING A PERMIT FEE ONL am exampt from the provisions ot the S[ete of CalHornle eusinasa entl Profassione Cotle, Dlvisian 3, ChePtar 9. VALVATION ��_ PERMIT FEE $ Sie�omra ot (//� �_ Pe�mittee `�� X / § � � � PLAN CNECK $ � Authorizatl Ageni � TOTA� FEE $ m � 0 ' i• 2 m N � m E `o LL vnv�R PAUL, Wayne JOB ADDRE55 3375 Wisteria ,GENERAL CONTRACTOR Kenneth W '! o. LOT 125 TI I�. ECTIONS 5 SOIL GAS W ATER �ROUGH PLUMBING PROP. S�VR. LINE Q HOUSE CON. ❑ SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNOERG60UN0 � POWER � ROUGH W�RING TRENCH65 FORMS i STEEL REINF. � FLOOR 51'S EM BOND BEAM n STEEL REINFORCE n SMEATH FRAME ID FLASHING - IN n I BROWN COAT iAL. FINAL UATE 6_15 BUILDING PERMIT N( RIPTION of WORK Patio Cover ZONE VALUE$ 00.00 )UP J TYPE V SUBCONTRACTOR PE . ;� - � 36807 _ s COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely BUIIDING ` — ��J ADDfiESS � .7^ L' K— OWNEPM _f L MAI l Z ADDRESS S � ti��'— W W TEL. �- U CITY .�� j'/,� NO. �` Z Z Q CANSTRUCTION _ I . ._ BRANCH ADDRE55 ARCHITECT OR ENGINEEI ADDRESS TEL, nooaess �� G- 7 i�n e� 4,� n r! /4�ll-. TEL. CI7v ��(I:i�l—LSS N�F"'1'27"4A STAT� CITV r� LIG. NO. �/�'� �� LIC. NO.�L / f SIZE NO.OF BIOGS. OF LOT ��G X��O I NOW ON LOT i VSE OF E%ISTING BLDG. �/-1M IL� ��Sf /i l-X� l= 512E OF � � NO. OF NEWBLDG. C� POOMS I STOflIES EXTEIiIOFWALL ROOF a�(ZL�=TT��-IG COVERING �CNI�- COVEF�NG USE OF BUILDING AND WORK TO BE PERFOftMED M-►a��i^3c�-Szq3 lUh! 15-73PAio001444# ***** cnss 5.50 ON FOR BUILDING PERMIT A.P. NOJVU BUILDING AD�RESS �'j TRACT OWNE FIRE ZONE APPROVE 20NE NO.OF PWNS � YAqOS APPROVED MAIN BUI�DING (FFOM C/L STREET) (iEAF �ISTANCE BET. MAIN BLDC'a5. VAR a/` C.U.P.� APPROVED ; . I / K USE OF NE BUILDING � � VARDSAPGROVED ACCESSORV BUILDING a �� FT. BEf. MAIN & ACCESS, BLOGS. DATE ^ APPFOVED 'Y� .__ �_i!—'�7 I �ereby acknowledBe that I have reatl this applicetion antl stete gj(� that the above informatian is correct and agree [o comply with oll laws regulating builtling construction, antl I shall no2 amploy any person in vlolation ot the wotkman's compensation laws of the 5[ate of CalifOrnla. m b I hereby certify tPat I am properly licensatl as a contractor untler SQ. FT. 7iiX� o the State of CalifOrnie Businass antl Professions Cotle, Oivisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR � Chapter 9, antl N9i s�ch licens¢s are in tull torce antl attect, or I THE PURPpSE OF ESTABLISHING A PERMIT FEE ONLY: Q am ezempt trom t��e provisionsof theStam of Colitornia Businass VALUATION ontl Protessions Cn��a, Division 3, Chepter 9. ��✓� °� � PERMIT FEE $ � Signoture ot(� / -� ] Permittee �/-r�� /*��+.^--' S � PLAN CHECK E � � o LL Authorizetl Agant TOTAL FEE $ . ; V111YCR `JOB ADDR �1ROUGH PLUMBING �PRpP. SWR. IINE 0 HOUSE CON. [] SPRINNLING SVSTEM MISCELLANEOUS ROUGH HEATING ANO AIF �ONOITIONING TEMPORARV SERVICE OF POLE UNDERGROUNO � POH'ER � ROUGH WIRING TRENCHES � FORMS ❑ STEEI REINF. FLOOR SVSTEM BOND BEAM � STEE� AEINFORCE �J SHEATHING FRAME AN� FLASHING LATHING - IN n OUT � PLASTER,BROWN COAT 5 'URAL, FINAL HG....NG, VENT., REFRIG. AND A.C., FINAL PLUMBING FINAL ANO GAS TEST n ELECTRIC, FINAL BUILOING, FINAL UAIt SUBCONTRACTOR •'� ' 3b58.i . �- � COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely BUILDING . � � ��C�\ ��, ADDRESS G OWNEF �Y� �AV�� MAIL _ _ "� ... n_ Z . ww aU F-z Z � O �n am J7 J N Q W a] J J m Q U N Z a W � d W J Q m Z J � W W � ZH w� � � F z Q U J a a a � f' � z � F U � � � N Z GTV �F,s CANSTRUCTION LENDER BRANCH ADDRE55 ARCHITECT OR ENGINEER lc•i TEL. CONTRACTOR �\�AQK C�VQrE6ieJdFa ADORESS QOX �8� �R�. \�OfA.��E TEI. cirv �jQAN6� "o.loyi-� STATE �1i1 � GTV IIC. NO. �I0. NO. SIZE i NO.OF BLIX'aS. OF LOT NOW ON LOT USE OF n� � EXI5TINGBLDG. ��0(�1�� .s\�[.NC•� SIZE OF ^—1 NO. OF NEWBLDG.I�X �fl RpOMS STOflIE: EXTERIOR WALL ROOF COVEFING COVERING US�OF BUILDING AND WORK TO BE PERFORMED I hereby acknowletlBe that I ha�e reatl Mis application antl state that ffie above information is wrrect and a8�ee m comply with all laws regulating building construction, antl 1 shall not employ any pe�son in violaiion of the `Norkman's compensetion lews ot the Stete of Calitornia. 1 hereby certify that I am properly licensetl as a contractor untler ihe State at Calitornia Business �tl Pr t�ions e, Divisic , Chapter 9, antl that such lice ar n f I to e antl eff , or I am ezempt from tlie prov' o s o e S i¢ Calitorn' usiness antl Protessions Coc�a JD'�an ChapSer „ / .� � � i zvate �� ,��t.:y�, • v - �-7_�,,, OC �5:• 5.50 APPLICATION FOR BUILDING PERMIT RECEIVED BV DATE RECEIVED DATE ISSUED 5 —z_ 3 PERMgb�8 � A.P. NO. �� . 1 AD'DRE S „j /s'F�� TRACT LOT BLOCK W ADD Al R P OWNER y" — UG� /� VALUE �� s �r� l•o r s � FIRE ZONE YPE GROyUP q ^c.� APPROV /� � ^/ DATE/7 �/ � / �/ BY / V // ZONE�/NO.OF . PLAN,� VAFDSAPPROVED MAIN BUILDING � VAR. # USE OF NEW� BUILOING / VAR�S APP ACCESSORV eET. MAIN & ACCESS. BLDGS. DATE APPFOVED G � i — m � SQ. FT. o THE AMOUNT SHOWN UNDER VALUATION IS FOR � TNE PURPOSE OF ESTABLISHING A PERMIT FEE ON�Y: Q VALUATION � � �i PERMIT FEE $ � ✓ � m $ � PWN CHECK $ E s� a ' u TOTAL FEE $ Z W �. F Z O a J J Q m J Q U V Z d W Q d LL W e J � m � J Q w �y 0 ZF W � �C 125 � �: ` 35 I �S • 501(; �pOTBOxE,200 C�OSDT�anGn SaFCall OFNFlIA9 626 T ForApplicant Fill in Completely aui�oirvc aooaess � �' Wisteria Circle OWNER Lanvin Southern California, Inc ADDRESS 16255 Ventura Boulevard W TEL. U pTY NO. Z f- LENDER�i�N Larvvin Southern California, Inc � � BRANCH 16255 Ventura Boulevard N J ADDRESS Encino California m ARCHITECT . . _..... . TEL.,�„� , „ H z Q U J a 1 Q � � N z � F U � � F N Z ADDRESS CONTRACTOR ADOFESS CITV STATE LIC. NO. S12E OF LOT USE OF EXISTING BLDG. I��S Encino, California No`986-8890 CITV 191311 LIC. NO. B—� JO X IOO I NOW ON LO S O 512E OF NO. OF NEW BLOG.1] ROOMS STOF COVER�INGALL SYUCCO COVERINGWOOCI S� USE OF BUILDING AND WORK TO BE PERFORMED I hereby acknowledge that I have reatl this application antl state ffiat ffie abave information is correct and agree ro comply wlth all laws regulating building construction, and I shall not employ any person in violation ot the workman's compensation laws of the State of California. I hereby rerxify [hat I am properly licensed as a contractor under Me State of Califomia Business antl Professions Coda, Oivisicn 3, Chapter 9, and ffiat such licenses are in tull force antl atfect, or I am exempc irom [he provisions of the Stace of Calitornia Businass anE Professions Cotle, Division 3, Chapter 9. Signaturao+��y.rJ'X�- D. Downs Permittee / e Authorizetl Agent PA70 � �,,�* �1UG 15-72�n5„001073� 142.85 PP.I TION FOR BUILDING PERMIT R EIV BV DATE RECEIVED DATE ISSUEI ! ��-/-7 � /'� i PERMIT NO. A.P. NO. 7.'- ADIOI7ESS � ��(��A,y� TRACT / �I� LOT/.�G BLOCK OWNER �//I"C�(�.(/I� �� USE/�� / �'�/G—VALUE /)� g0`G FIRE 20NE TYPE GROUP avPRO� D t�M�� DATE /'. /U ZONE NO.OF 12I P�.� , VARDS APPROVED MAIN BUILDING (FROM Gl STfiEET) FRONT .��5 FT. �e1L DISTANCE BET MAIN Bf.DGS. V AR. � C.U.P. # APPROVED . THE AMOUNTSI THE PURPOSE OF VALVATION s�``�//-D � USE OP NEW 7!N � BUILDING �� VARDS APPROVED BET. MAIN ACCE55. el DATE �� V /�, 5/ m i '° u/ o ER VALUATION IS FOR � NG A PEflM1T FEE ONLY: m ¢ FEE $ _ c' 7 m HECK $ � E 0 LL FEE $