HomeMy WebLinkAbout380 WOODLAND PL - Building Permits. �
, � t �
CITY OF COSTA MESA
BlIILDING DIVISION
77 FAIR DRIVE, COS7A 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: 42623203
JOB ADDRESS: 380 WOODLAND PL CM
Viciniry:
Squares: 0
PERMIT NUMBER: B09-00168
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
Valuation:
ISSUED
0 8/2112 0 0 9
CAC
$7,000.00
SCOPE OF WORK: TEAR OFF WOOD SHAKE INSTALL 1l2 INCH OSB 1 LAYER 30 LB FELT AND 30 COMP. SHINGLES
OWNER: GRISCOM, DAVID L
PHONE: 949-2304980
APPLICANT: LEMUS,RAFAEL
F-161
PHONE: 949-735-2377
CONTRACTOR: LEMUS ROOFING
Address: 28247 CROWN VALLEY PKWYUnit:
City/State2ip: LAGUNA NIGUEL, CA 92627
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldg Sld Admin Fund
TOTALFEES
$0.00
$139.25
$0.00
$1.00
$140.25
Address: P O BOX 7506
CirylSlate/Zip: NEWPORT BEACH, CA
Unit:
Address: 28241 CROWN VALLEY PKWY Unit: :UNIT
CirylSfate2ip: LAGUNANIGUEL,CA ;;.���_�^�CQ
License No. 826813
UNIT F-161 - PHONE: 949-735-2377
CELL:
License No.
License No.
PHONE:
PHONE:
A
NOTICE: The work authonzed by this permit shall wmply with all applicable handicap access requirements under California statutes and relaled
regulations. (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 authorizetl under this permit to be considered legal, such work must wmply 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.
40�E t. INSPEG110N TYPE nr iNiRIRLS o� INSYECTION IYPE on� Nimu
1616 Fixed System Final Fire PrevenGon 206 Final Mechaniwl
1266 Pool Spa Final � 208 Final Plumbing
200 Final Re-Roof ��G//[j��-� 210 Final Elecirical
201 Final BIocWRelaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planninq Approval
203 Final Sign 222 Final Site � 1-
204 Final Demolition 250 Final OuildinglOccuOancy
�
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm untler penalty of perjury one of the following declarations:
❑ I have antl vnll mainiain a certificate o( consent to self-Insure (or �+orkers'
compensation, as providetl for by secGon 3700 of the Labor Code, for the
Aormance of the work for which this permit is issued.
I have and vrill maintain v,nrkers' canpensatbn insurance. as required by
s' n 3700 of ltre Labor Code, fw the pertamance of the work lor which Ihis
pertnd is issued. My workers' compensation Insurance cartier antl policy
number are:
Carrier:
(Th' n rrotoro�ouwnpettd�DenGepemutkvaXmOefinenuiMietlabnars(St001aleuJ
Po' y Numb : �D'I S D / G�
❑ certily lhat in the peAormance of the work for which this permit is
issued, I shall not employ any person in any manner so as Io become subject
lo lhe workers' compensation laws o! California, and agree that il I should
become subject to the workers' compensation provisions of Section 3700 ot
the Labo de I shall !o � c mply 'th these provision .
8 a� a�
piwnfs n �e
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT 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 affirm that I am licensed untler provisions o! Chapter 9(commencing
with Se ' n 7000) of Division 3 of Ihe Busines and Prolessions Code, and
' ense in lull lorce and eRect.
Lic. # 2. 8 Cla �"
_ �, �
Gonva a's Sig re te
CONSTRUCTION LEN�ING AGENCY:
❑ I hereby affum that there is a consWction lentling agency tor the
peAormance of the Nork for which this pertnit is issued. (Sec. 3097, Civil Cotle).
lender's Name:
Lender's AtlOress:
SignaWre Date
OW NER-BUILDER DECLARATIONS:
1 hefeby afflrm Ihat Undef penally O( pefjUry lhal I am E%EMPT FROM THE
CONTRAGTORS LICENSE LAW (or lhe f011owing reason (Sec. 7031.5,
Business and Professions Code: Any ciry or county which requires a permit to
tOnStrutl, aller, improve. demolish, or repair any structure, prior to its
issuance, also requires the applicanl for such permit to file a signed statement
Ihat he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencirg with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom antl
the basis (or the allegeC eaemption. Any violation of Section 7031.5 by any
applicant for a permit subjects Ihe applican� to a civil penalry of not more than
(ve huntlrea tlollars ($500�.�:
❑ I, as ovmer of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
oHered for sale (Sec. 7044, Business and Protessions Cotle: The Conlractors
License Law does not apply to an ovmer of property who builds or impmves
thereon, and who tloes such work himself or hersell or through his or her own
employees, provided that suc� improvements are not intended or oflered for
sale. I!, hovrever, Ne building or impmvemenl is sold within one year of
completion, the ovmer-builder will have the burden of proving that he or she
did not builtl or improve for purpose ot sale.�.
❑ I, as owner ol Ihe propeny, am EXCLUSIVELY CONTRACTING wITH
LICENSED CON7RAC70RS to construct the project (Sec. 7044, Busine55 antl
Professions Code: The contractors License Law tices not apply to an owner of
pmperty who builtls or improves thereon, and wfio wntracts fw such project with
a cmtractor�s) license pursuant to the Contractors Ucense Laws.).
❑ I am exempt under sec.
Business antl Professions Code !or this reason:
305]�46(3/0]7
� �
Ovmer ID verified by driver's license. ❑ Yes ❑ No
Dnver's License No. Expires:
Verification of Ownership by (ry0e of documenl, i.e. - propeny taz bill or tleetl):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICA710N:
❑ I hereby certify tha� no excavation fve (5) or more leet in depth into vfiich a
person is required to descend, will be made in connection with wnrk authonzetl
by this pertnit, and ihat no builtling sWCWre, scalfdding, falsew�rk, or tlemolitbn
or tlismantling ihereof, will be more than [hirty-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Tlle B, Califomia Atlminist2tive Code).
❑ As owner-builder, I will not employ anyone to do work which would
require a permit from the Division ot lndustnal Safety, as noted above. unless
such person has a permit to do such work from Ihe division.
AOPhwnl's SgnaWre
Oivision ot Inaustrial Salety Permit Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicaN or present or fWure builtling occupaM need to file ana
certily a Business Plan lor emergency response ro release or threatened
release ol a hazardous matenal? ❑ Yes ❑ No
(Seclion 25505 0( the Calibmia Heallh antl Sa(ety Code requires, with some
exceptions, Ihat a Business Plan be filed with the Costa Mesa Fire
DepaAment by every business which has ai any one lime dunng a reported
year a quantity of hazardous materials equal to or greater than a weight o!
500 pounds, or a volume of 55 gallons, or 200 cuDic feet of compressed gas
at standard temperature and pressure).
2. Does or will Ihe applicant or present or future building occupant need ro file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Sec[ion 25533 of the Cali(omia Health and Safery Code, wilh some
exceptions, requires registration wiih the Cos[a Mesa Fire Department by
each business which al any one time has on hand a quanti�y ol acutely
hazardous matenals equal to or greater than a weight of 500 pounds, ar a
volume of 55 gallons, or 200 cubic teet o( compressetl gas at standard
tempera[ure and pressure).
3. Does or will the applicant or present or fuWre builtling occuDant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 0l the Calilornia Health and Safety Cotle provitles Iha� Ihe
Costa Mesa Fire Depariment may require lhe preparatioq certification and
fiing with Ihe Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials vrith the Fire DepartmeM.
4. If an RMPP is presenlly required, has Section 25534 0l the Calilornia
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will iha applicanl or preseN or fuWre building occupant require for
the v+ork which is the Subjecl of Ihis application a permit for such conswction
of motlifcation from the South Coast Air Quality Managemenl Dislricl or from
any oNer air polWtion conlrol distnct or agency? ❑ Yes ❑ No
(Sectbn 658502 0l the Califomia Govemment Code requires that the requested
infortnatbn be fumished on appliwtions for non-residential builtlirg permils).
6. Will any part of tha laciliry to be consWctetl untler this permil be within
1000 feet from the outer boundaries o( a school? ❑ Yes ❑ NO
p('yes", tha faciliry must meel Ihe requirement ol Sections 25534 and 42309
of the Cali(omia HealtO antl Safety Cotle).
7. If a permil Irom tha South Coast Air ovalily Management DisMct or olher
air pollution control dislrict or agency is required (or the vrork which is lhe
subject of this applicalion, have all ot the disclosures prescribed by Califomia
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. (If'yes", attach ceni(cate of compliance from lhe appropriate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correcl. I agree ro compty wit� all state lav5 and
city ordinances regarding Hazardous Materials and Emissions.
SignaWre Da�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
cenify under penalty of perjury that I have read ihis appliwtion and state that
the information given is correcl I agree to comply with all state laws and ciry
ordinances relating to building construction, and authorize representa�ives ol
the Ciry of Cosla Mesa to enter upon the above-tlescribed property for
inspection purposes. I agree not to occupy or allow occupancy of any builtling
authorized by this permit until fnal inspection.
Sign. ure eg wner(s) D �e
a�-�. ,�.a�, �. -. z� o
Pn /Of Or AOVlipnl _ Ddte
(714) 754-5273 • Fax (714) 754-4858 • wvnv.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
JobAddress: 380 WOODLAND PL
Suite:
Vicinity: 3-UNIT APT BLDG
Parcel Number: 42623203
Applicant: LAUNDERS, LES
Address: 657 BEACH ST
COSTA MESA, CA
Owner: GRISCOM, DAVID L
Address P O BOX 1506
NEWPORT BEACH, CA
Convacror. ROOFING CONCEPTS
Address: 657 BEACH ST
COSTA MESA, CA
Zip: 92627
Arch :
Address:
Zoning:
Phone: (949) 6457518
Zip: 92627
Phone:
Zip: 92659
Phone: (949) 645-7518
License: � 441271
Eng:
Address:
Phone:
ISSUED BV:
Status: ISSUED
Applied: 09/27I2004
Issued: 09/27/2004
Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF 3-UNIT APT BLDG WITH ATTACHED GARAGES: T/O HOT DECK AND REPLACE WITH BUILT-UP HOT MOP ROOF. NAIL 28# GLASS
BASE FELT, 4 X 4 EDGE METAL MOP 2 PLIES. 11#, F�OOD COAT & ROCK. 1050 SQ FT
FEE SUMMARY
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$0.00
$83.25
$0.50
$0.00
$0.00
$0.00
$83.75
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY 'Front 0-0
PARKING Existinq: o
Rear 0- 0
Rear 0-0
Re uired: 0
PLANNING & ZONING
Left 0- 0
left 0- 0
� ' Pr000sed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0-0
52,150.00
s2,iso.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California slatutes and related
regulations. (Ord. No. 92•28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under thls permit to be considered legal, such work must comply with all epplicable codas, and all
requlred Inapeetione and final approval must be obtalned. Failure to obtain inspections and final approval will result in ihe expiration of this permit.
� FOR INSPECTIONS CALL: (714) 754-5626
?aaaas (aroo)
WORKERS'COMPENSAnON DECLARAnON: � � �
I hereby eRirm untler penalty of perjury one of the followinq declarations: ' ' ' .
❑ I have entl will melntein e certifice�e of consent to self�lnsure tor workers' compensetion, es providad for by section 3700 0l lhe Labor Cotle, �or Ihe pertormence ot Ihe
work lar which ihis permit is issuetl. �.
� 1 heve entl will maintain workers' compensation insurence, as requlreA by sectlon 3700 oi ihe Lebor Cotle, for Ne peRortnance of the work lor wNch Ihis pertnit is issuetl.
My workers' compensation Insurance rner a� policy number ere:
Carrier: ����P �.-�iY �n/L'1 �wr Lc'72.vr PolicyNumber: �� YZ l%.S()
(This secNon need nof be comp/etetl il the permi( is veluetl a! one hundre ollars ($ f00) ar less.) , ,
❑ I ceniry that in ihe pehormance of the work for whlch this pertnit is issued, I shell not employ eny person in any manner so as to become subject ta the workers'
compensetion laws of Califomia, end agree Ihai If I shoultl becoma sub�ect to the workers' compensation provisions of Section 3700 of Ihe Labor Code, I shell lorthwl(h
compy with thesa proh ions. A
ApplicantSlpnaNre:1 ��/ 6-%zGl�vG-Lu Date: � %�L%�L'r
WMNING: FAILURE TO SECUFE WORKERS' COMPENSATION COVERAGE IS UNUWFUL rWU SHALL SUBJEGT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED
hKKISPND DOl1ARE ($100,000�, IN ADDITION TO THE WST OF COMPENSATIpJ, DAMAGES AS PROVIDED FOR IN SECTIIXJ 3]Ofi OF THE LABOR CODE, IMEREST, AND ATTORNEI^5 FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby ettirm ihat I em licensed under provisions of Chaptar 9(commencing with Section 7000) of Division 3 ot the Business nd Professions Code, end my Ilcense Is in full
force end enea. Lic. »�� �i �i' / 2'7 ! Ciass a V���%
Contrectofs Signature:� ��LL2ao G.n Date: ?`�'i /Z �� Ay
CONSTRUCTION LENDING AGENCV:
❑ I hereby aftirm that there is a cons�ruction lending agency for the pedormance of the work for w�ich ihis permi� is issued. (Sec. 3097, Civil Code). �.
Lenders Name: Lentlets Atldress:
Signature: Date: ,
OWNER-BUILDER DECLARATIONS:
I hereby aRirm Iha� under penalry of perjury that I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Protessions
Cotle: Any ciry or counry whic� requires e permii to construct, alter, improve, demolish, or repair any structure, pnor to its issuance, also requires iha epplicanl lor such pertnit
to file e signed statement Ihat he or she is licensed pursuant to the D�ovisions of Ihe Coniractors License Law (Chapter 9(commencing wit� Sectlon 7000) ot DlWsion 3 0l Ihe
Business end ProfeSsions Code) or that ha or she is ezampt therefrom entl the be515 tor the alleged exemption. Any violetion ol Seclion 7031.5 by eny apPllcanl tor a permit
subjects t�e applicant to a civil penalry oi not more then five hundred dollers (5500).):
❑ I, es owner oi ihe proparty, or my employees with wagas as their sole compensation, WILL DO TME WORK, and lhe structure is not intentletl or oftered lor sale (Sec.
7044, Business and Professions Code: The Gontractors License Law does not eppty to an owner ot properry who builds or improves thereon, antl who Ooes such work
himselt or herself or ihmugh his or her own employees, provided ihat such impravements ere not intendetl or oNered for sale. If, however, the builtling or impmvemenl is
sold within one year ot completion, �he ownar-builder will have Ihe burden ol proving Ihat he or she did not builtl or improve for purpose ot sale.). '
❑ I, as ownar of the pmperty, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sac. 7044, Business and Protessions
Cotle: The contrectors Licensa Lew tloes not apply to en owner ol property who Duilds or improves ihereon, and who contraas lor such project with a contrector(s)
license pursuant to the Comractors License Lews.).
❑ I em exempt untler sec. 8usiness and Prolessions Code tor Ihis reason:
Signature: Date:
Owner ID verifiad by tlriver's license. Yes ❑ No Driver's License No.
Vetltication ot Ownership by (rype ot tl m nt, i.e. - pmperty ta< blll or deed�:
Expires:
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certity Iha� no excavation iNe (5) or more feet in depih into which e person is requirad to descend, will be made in connection with work euthonzetl by Ihis
permil, entl that no building structure, scaHolaing, lelsework, or tlemolition or dismanUing thereof, will be more than ihirty�six (38) feet high. (Chep. 32, Grp 2, Art 2, Sec.
341, Title B, Califomla Administrative Coda).
❑ As owner-builder, I will not employ anyone to do work which would require e permit trom the Division ol Indusirial Sefety, as notetl above, unless such person hes e
permit to do such work from the division.
Signature: Date:
Division ol Intlustnal Safery Pertnit Number:
CERTIFlCAiE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cenify under penelty of perjury that I have read this application and state t�et the intormation given Is
correct. I egree to comply with all sta�e laws antl ciry ortlinances relating to builtling consiruction, end euthonze representatives ol the Ciry ot Cwta Mesa to enter upon Ihe
ebove-descn6ed property tor inspection purpases. I agree not to occupy or allow occupancy of eny building aut�orized by this permit until finel insDec�ion.
SignaNre Of Legal Owner(s) �, Date
� 1�„-�r�L,�,t�,�, �/z �/o y
And/Or Authorize Applicant • Date )
CODE t. INSPECTIONTYPE
7616 Fized System final Fire Prevention
7266
200
201
202
203
Pool Spa Finel
Final Re-Roof �
Flnel BIocWReteining Wall
Final Factory Fire Place
Finel Sign
204 Final Demolition
QdIF INTRIALS
!d�-S =o`i +^/�
COOE I INSPECTION TYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electncal
212 Final Fire Prevention �
220 Final Planning Approval
222 Final Site .
250 ' FinafBuiltling/Otcupancy
PAg I[�lLS
0
City of Costa Mesa
Building Safety Department
p. o. eox an
Cosla Ma�a, California
CERTIFICATE OF OCCUPANCY N� 2'�25 C
The Bvilding located at �""`� ��� �if'8 A'C' �
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group g� J Occupancy. -
Use of Building ���� �� �' �� � � —
Legal Description ��
($ee reverse side for Mofes and Bo�nde)
Building Permit No. �'� Elecfrical Permit No. �'� plumbing Permit No.�Z7�--
Floor Load Signs have been insfalled as Room Capacity Signs have been instaled as
required under Sec. 2305 U. B. C. . required under Sec. 3301 (1) U. B. C. —
17050. CERTIFICATE OF OCCUPANCY. (a) No apartmenT house, hotel, or lodging house shall be used or occupied
until the owner or operator has been issued a valid certificate of occupancy by the enforcement agency.
(b) A new certificate of occupancy shall be obtained whenever there is a change in:.� � '
1) Occupancy classification of a b�ilding or portion ihereof •
2) The number of apartments or guest rooms . ,
3) Ownership ' � �
If Group H Occupancy, number of aparimen4s and/or guest� rooms as required vnder Sec. 17050.1 (d), California
Administrative Code, Title 8, Chapter 9, Article 8. ,
Number of aparimenis s and/or guesT rooms
ISSUED TO: • � . � � � . ' � ' Building Official',}
� bY—I/����/✓� �%Y "�/�
Date ��= i� �il
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed
except by the Building Official of the Cify of Costa Mesa under Sec. 306 (e) U.B.C. xorm sua�ira—tt-ea—s-s r
Z .
d V
Z
Z Q
O v~i
a m
J7
J �
Q W
p] J
m
J Q
U Q
ZQ
W
aw
WZ
J �
m Z
J �
W w
� _
Z �
—O
w
70
PAIO
!�PR Z�!-7Gc>is<001512� *�•*ZO1.00
F COSTA MESA BUILDING-SAFETV DEPARTMENT
' P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fil/ in Comple[ely
RECE VED B ;A E RE EI � DATE ISSUED
BUILDING Q N� J -a ��
ADDRESS �(JO Woodland P]_3C6
PERMI �7
OWNER Richard Sewell A.P.No. /$-y.a3— -f E�G
MAIL � 4 ADDRE 5�] O �WU L/F/�(C� /i Q.Nj (�5
ADDRESS 3 F. 17th St.
CITY (�'�gta �1'�gga NOL 6�2—� 90 T/S T � �OT � BLOCK
CONSTRUCTION NEW ADD' P
LENDER
BRANCH
OWNER
ADDRESS VAWE �/��v /"�
ARCHITECT TEL. US 5 H
OR ENGINEER N
FIRE �
ADDRESS ZONE TYPE GROUP
APPROVED
CONTRACTOIi R. SP.WO1.1 gV DATE
ADDFESS Above• Z NE NO.OF USEOFNEW � JN(T$
TEL. _�/ pLqryg 2 BUILDING �
CITV NO. 4
STATE CITV VARDSAPPROVED VARDSAPPROVED
LIC. NO. 581 ���. No. 1938 MAIN BUILDING ' ACCESSORV BUILDING
SIZE NO.OF BLDGo. (FROM C/L STREET)/' I' I
OF �OT X lO . 1 NOW ON LOT Q FROM FT. �C WO
USE OF
EXISTING OLDG. R SI � T FT
SIZEOF �Q qOOMS 1�1 STOFIES G L.SIDE � FT. FT.
NEW BLDG.
EXTE{iIOR WALL ROOF Shingle t�CC (/
COVEFING f3 COVEFING REAF 7// FT. � FT.
USE OF BVILDING ANO WORK TO BE PERFORMED' DISTANCE BET. BET. MAIN &
Construct Triplex with Attached MAINBLDGS. — ACCESS.BLDG>.
garage• VAR..$ DATE r/
C.U.P. � (� _ � C APPFlOVED �—Z— / O
APPROVE �'�'' L
^ZO— O
1 hereby acknowletlge Ihet I have reatl this application entl sta[e ' 4L REQUIREMENTS
that me aeove intormacion is correct and ae�ee m comPty with HOLD FOR SPEC�
all laws regulexing builtlin8 construction, and 1 shall not employ
any person in viOlaiion ot tha workman's compensation laws of
M¢ Sxate of Californla. ij /C� A
I hereby certity that 1 em properly litensetl as e cOntractor untler � SQ. FT. O •'
the State of California Business entl Professions Cotla, Divisicn 3, THE AMOUNT SMOWN UNDEF VALU ION IS FOR
Chapcer 9, antl [hat such licenses are in full force and aifeci, or 1 THE PURPOSE OF ESTABLISMING A PERMIT FEE ONLV:
am exempt from the provlsions of thPStete of Calitornia B�siness VA�UATION /? �
antl Professions Cotle, Division 3, Cha tar 9.
PERMIT FEE 5 �� �
SiBnetura of - /7, �
Pe�mittee $ I t—� PLAN CHECK 5 �'
LL3 �•ry �•v
' d�-
aomo,�:aa aea�t l J TOTAL FEE $�