HomeMy WebLinkAbout3113 YELLOWSTONE DR - Building Permits Y _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - __ _ .
CONSTRUCTION PERMIT • P�MyT N � TRACT NO. LOT NO. BL•DG.•NO. •
• . �L �O 4/I J/B ..27.;:, TI_
Applicant's Mailing Address • • - L ,Cs i I
CITY OF COSTA MESA . �TYPPE(OOF CONSTRUCTION . Li NEW U ADD;%ALTERATION U REPAIR -
Project Address Sit n L�Ce 5TO/1 F /`- • m El CONVERSION 0 DEMOLISH ❑OTHER, - - - ' ,-
Owner's
Name ' '.15 P1 /4 CR-E. Phone9l•0_(•r LSIR - DESCRIPTION OF WORK -SG /�
• ZONING REGULATIONS
30 t
ABdress 3 )FL I n t6KToN to . m'-. - _ TYPE OF PERMIT ❑ GRADING' U FOUNDATION STRUCTURAL A.P.tV' ‘-ZONE - ' '
Arch/Eng. ' License No. 0 TENANT ❑ ELECTRICAL CI PLUMBING 0-MECHANICAL PLNG.REF.# BUILDING -
Address - ; `,t I ' CI OTHER - • TO BUILDING •
ePTRe Cr Cn gT
( Contractor's Nam e'sVQynL F^ 1, Al Phone tl.Q. PROJECT DESCRIPTION SQ.FT. 'OCCUPANCY PROPERTY LINE REAR YARD (TO P/L) -
` oar•
• - LEFT SIDE YARD RIGHT SIDE YARD _
)\ •
Address(mailing) ''I, [ • CONSTRUCTION TYPE VALUATION$:3�j �
License No. __ N IL• ZONE GRADING CU.VOS• . ACR S PKC.SPACE,REQ. • PROVIDED
LICENSED CONTRACTOR DECLARATION -
, , Remarks: ;07x7 STREET WIDTH PARK FEE $
•
I hereby affirm that I am licensed under provisions ofCharter 9(commencing f
with section 7000) of Division 3 of the Business and Professions Code, and ' SPECIAL CONDITIONS:
my license Is In full fo�Jlsce a py�{fTect. • 0 8 Q 9 -
Llcen CI E�,..,�S.� l -- License Nct,/'••f `C.7 1 `f C PLUMBING I
Date A—V-1,— Signature Bar Sink Sewer Cap ELECTRICAL
WORKERS'COMPENSATION DECLARATION - - ' -
'ereby affirm that I-have a.certificate of consent to salt-Insure or a certificate- Backflow Preventer Sewer Connection - Automatic Washer -Meter-Dover 100 amps .. , ,
Workers' Compensation Insurance, or a certified'copy thereof (Section ' _
Backflow Irrigation •
Solar Collectors Construction Pole
_e00, Lab.�s•�` /•/ (� �s� Sub Panel '
re: No.plR)l DIG7 4-Ra CompanyCT l C /J�. o _ -
t]l.Certified copy Is hereby furnished. Bathtubs Solar Piping Cooking Unit Sub Pole ,
iJ t fi op s{Nptl with the city D n. Dishwasher :Motors ❑0-1 HP ❑1' -S
Date ' - 4 Appncant Clarifiers _ Solar Tank - _
EXEMPTION FROM WORKERS'COMPENSATION DECLARATI N _ Dryers ❑Gas ❑Electric Inc.Solar,•09-15 HP ❑16-15+ '
This section need not be completed if thepermit is for one hundre
Dishwasher - SwimmingPool w/Spa
less) p ($100) or f _ - - P _ _
' I certify that In the performance of the work for which this permit is issued, I ' Drinking Fountains Urinal Fan Microwave
' shall not employ any person in any manner so;as to become subject to the ' - - F.A.U. - Pole:Light I
Workers':Compensation'Laws of California.i i , , Floor Drains t � Water Closet. -
•
Date - Signature _ Fixtures
NOTICE:If,after•Making this declaration,you should,become subject to the - -' Floor Sinks ' - Water Heater - ' - ' . - Range - -.-• - - . -- .
I Workers'. Compensation provislons•of the Labor, Code, you must forthwith, , - ,
comply .with; such provisions.or this -permit shall be deemed revoked. - Gas Service Outlets' Water Service - Device Boxes Sign '
CONSTRUCTION'LENDING "AGENCY ' Outlets •
I hereby affirm that there is a construction lending agency for the performance, • , Interceptors .• Standing Sections
of the work for which-this permit is 'issued ,(Section 3097- Clv. C.} - - •
• Switches '
Lender's Name " - Kitchen Sink . • ' - Trash Compactor
Lender's Address - -
OWNER-BUILDER DECLARATION ' Lavatories - Garbage Disposal-
I hereby.
affirm that I am exempt from the Contractor's'License Law for theP-.fro - Generator ❑o's KW ❑5-15 KW •
following reason (Section-7031.5 Business and Professional Code: Any city or • P ,
county which requires a permit to construct,alter,improve,demolish or repair - Transformer ❑15-50 KW
•
any structure, prior to Its issuance,also requires the applicant for such permit Roof Drains - ' .
to file a signed statement that he/she is licensed pursuant to the.provisions of - I
the Contractor's License Law(Chapter 9(commencing with Section 7000)of 050+KW. Reinspection Fee $15
the
3 of the Business. and Professions Code) or that he/she Is exempt Showers - ' Reinspection'Fee $15
-efrom and the basis for the alleged exemption. Any violation of Section • - - Meter ❑up to 100 amps 'Issue Fee t
.$ 3
.1:5 by any applicant for'a.permit.subjects the applicant to a civil .. Service Sink _ 3 - --
0 natty of not more than five hundred dollars($500). - - Issue Fee $ Zoning Approved By Date
I,-as owner of: the:property or:mY employees with wages as their sole -
compensation' will do the work,andrthe structure is not intended or offered MECHANICAL• Application Approved By - • nate
for sale (Section 7044, Business and'Professional.Code:,The,Contractor's - ��[[, •
License Law does not apply to an owner of a property who builds or improves Boiler , Refrigeration System Application Issued By ,/p} T' X�j��S}
thereon, and who does such'work himself/herself or through his or her own _ - PP - `l Date ��_✓ ✓
, employees, provided that such improvements are not intended or offered for DO100,000 BTU ❑100,000 BTU
sale. If, however, the building or Improvement Is sold within one year,of com- ' ' Duct.Under Ground - • �..rr�
pletIon, the owner•will have the burden Of proving he/she did not build or im- - - SUMMARY OF FEES w ,
rove for the purpose ofsa le). - ' Duct-Structural 1 System Repair/Alteration //�7
UI,as ownero of i the.project rortam exclusively 7044,Business ting with,' con- BUILDING PERMIT $ Of / '��' SHIP $ �_
I,as owner of theproperty,roje contra ,
p Isand Professionsfproperty
who 4. _. Duct_yen[ilating. _ _- __--, -- _ _-_ 'PLAN CHECK' $ PERMIT
The Contractor's License Law does not apply to an owner je property who 1
' builds or improves thereon,and who contracts for such projects with a con- i Exhaust System ❑ Multiple❑' „ i PLUMBING - $• ISSUANCE $
tractor(s) license pursuant to the Contractor's License Law): GRADING $
0 I am exempt under Section " B.&P.C.far this reason ! Firepl/Fact.Blt. ICBG# � ,. , j PLAN CHECK : $- - $ .
• Date • ' : Owner i ' ' i • I Heating System& Ducting , ELECTRICALi I $• •
-I hereby-certify-that•Il have-read this application-and state that the above -- --'"L�❑0100,000 BTU ❑100,000BTL— - - - - -- I PLAN CHECK $, .• MICROFILM - $
Information Is correct. I agree to comply with all city and county ordinances' , : . " i -rTOTA LFEE; $
" antl•state laws relating to build ,• const uction„and hereby authori : rep e- Hood or .MECHANICAL $ ;
sentatives of this ..11.1-t• e . upo, the above-mentioned p o•'Hy or I Type I 0 , I I ,
Inspection purposidi , Canopy!- Type II ❑: Reinspection Fee, $15 PLAN CHECK' e LESS ••
iP Signature Date •� 1 I , I , ADVANCED,PC $ [r
Driven. Llcenso orSS-• - ' ; Registers I , , ' : Issue Fee i 1 ' i p/l7:J�'�
�� i ,. $ 3 ' i FINAL FEE ' $
CMF 0865-46 rev.12/82 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor '
•
n ()CONSTRUCTION AND PLANNING, ^ . _ POOL A - - _
;; ; - - .Date ,Inspector - - - - . Date- Inspector
r 'APPROVALS Permit-4" - - ' o - ,APPROVALS - P.ermit# .• .
ti. Temp'orary'Electrical Service or.Pole:. " , - ' . . 52 Pool &IEquipment Location - - '
O., 2: Soil Pipe-Undrgrnd:'. - - - - •'", r L . " ' 53: Steel Reinforcement -
3` Electrical Conduit.Utility-Undrgrnrl: .. - •y3 ' a - '.54.• Forms - - • - : ' ,
•
Z 4. Electrical Conduit-Undrgrnd' 17'1- • j ' ' ,. li" ;,- , _55Electrical Bonding -
5 Steel IReinforcemeni , • :-i. - ' ' .:: •.0 ' = ;; ' ,.56, Rough Plumbing& Pressure Test . • - • : --
6: 'Electrical UFER Grid:' •- ` , c '' - : 57 APPROVAL.TO COVER-GUNITE- ,
7. Footings • i -..• ' , t 4-' I t ; - 58' Electrical,Conduit:UndrorWii - ,
8. Foundation ' 1 ,* ' r'i s + 59 GasPipe,,O Undrgrnd:,Test - l
9. Wate i PipetUndrgrnd.,., • - _ ' ?'60. Backwash Lines,P:Trap, 0 Undrgrnd.. '
10. Structural Floor System ,;`- • � •.I X161. APPROVAL TO DECK - -• _ .
11. Property.Sewer Line'. House Connection ',62. Backwash & Receptor-Final - - '
.7,
12. Sewer. Cap_1 ' ;. -- :63. Heater &Vent,Final . -
13. Roof'Drains , • = : i ,64. Plumbing System - Final_ - '
14. Rough Plumbing I.- ' - ` �. 65. Electrical-Final- - - -
4. - •
'
"1,:15-Rough-Electrical-Conduit - - -'ll 1 "T--,---,:::: '-I-17" p6.!Solar System-Final •, '- , . .. , -i.
25
C16. •Rou h Electric Wiring ' ' -" ^" - _-- -- O -- - -- -
_ 9 • , ;•� t . • ,-I-- j-' 67. Fencing &Access ADProval; I � ,,.
ji , 7•.-Rough Wiiing'Sign ' , l : I `, ' : ; • : : , 68.1 APPROVED FOR PLASTERING • : •
- 018. RoughElectricalrTBariCeilingi .1 1 I . ! I I ' - ; 69 POOL/SPA SYSTEMS FINAL - - -.
;, ' 19. Rough Heating&'Air'Conditioning ' 1 .- i I ' 't.. i I FIRE DEPT. REQUIREMENT" - 1 I,-
-. '1 20. Rough:Factory Fireplace; I 1 , h ' : ' • APPROVALS Permit# .•
✓ 6 ri, '> , -
I; 21. Du'cts,:in Structure '! , 1,iI ' ' � ' I 70. Underground Hydro ' '
:,22. Ducts, Ventilating , i 71,' Product Piping 0 Gas 0 Oil
r.Ni23. Gas Pipe-Rough &Test . 1 , ' • • 72. Underground Flush
T. 11C24. Roof Framing`• : • ' • ' ' . ; -I , 73.; Undergrnd.StorageTank 0Gas- 0Oil • I
c 25. Roof Sheathing • i ' ' I i, ,, I i. _ • • : 74. Overhead Hydro - •
: '• 26. T-Bar Ceiling (Structural•;& Monocoat' • . I , 75. Dry Chemical i : ' - -
p 27. Frame•and Flashing ' I " I • 1 I j I 76. Dry Standpipe
c ;l 28. ;Lathing &.Sid ng ! ',n I • '' .I I 1 i. 1 I`; ' 77.I FIXED SYSTEMhFINAL ' ' - ,
i. h 29�Insulation, ..s". .' °r .•, ' 11 ' 1 i i I 78,1 FIRE PREV. FINAL ' -. . - l ,
30. Drywall Nailing - ' - I , ,, , 1 ; 'Notes:' : • I
✓ -'31. Plaster Brown Coat , ' •
32. Electrical Power Meter=Final 1
1 , I ,,
. r
33. Final Electric ! - l 1 , ! , •
34. Final Heating&'Air Conditioning • - , I • ' I .
•
35. Final Gas Pipe-Test _ ' ; •• ; I _ . j' ' -• '
36. Hood or Canopy, ! ' - - I i • I., ,
37. Final Factory Fi'r`eplace.: , - ; - i . , -. 1 . ' I ; _ . , . .
38.
38. Final Plumbing ' 1 I c1 '- I I' t I ' I I I I - " •, '
39. Water Service-Final• i I I s I i I - I , • ,
40. Gas Service-Final , l I I •' , ' ' •
41. Solar Domestic-Final - - '
42. Backflow1"Preventer' - , ' • - - _ __- __ _ _
43. Backflowil Ligation , - ° -
4 44. Landscape Irrigation System r ' 'I - _, I -
45. Sound: Atterivation, 'a I I `T.••
, ' , ": • 1 'c -• -• _ - _
46. Handica`p••Regulations'• , ' : -r- i _ - I -• - r • " .
47.-FINALS RUCTURE & BUILDINGa 1I `l " I
�i }/�
48. Special;Requirements Completed • , t I l
49. Electric Release to Edison II i '
50. Gas Release to Southern Ca litGas Co • , ' /'1
for '
51. CERTIFICATEOFIOCCUPANCY • : _ ..... „,.._;.___IrJr_;._ :- _ ' ,
•
No ,: I - I r Date -_' l. I---- •- ... -
APPLICAI ION I-OH A BUILDING VLHMI I
. J
BUILDING PERMIT NO. Electrical CO
Tract IjO{f/ Block l 3 g Lot 6Permit No. E.
LLL C
Building /' /.r r Plumbing
Address r3///3 Il/ // z- S-� �^� 7 Permit No. rc
2 Ob/C,er.t P /'/d e V ` D
Cross Mechanical 0.
Area Street k/ I Permit No. p-
`_ , e,,..in Ad C Ti
Owner �C�r<, ,ffA SA—.
a(� Type of Project: 0 New 0 Alter 0 Addition
Address "`���" )/I� " /��s J y e I"7/v 4...: 0 Repair 0 Convert 0 Demo ❑ Occupancy Pmt.
City �(!� (r` M ZID l�7 Jl L�/L/Phone g61�1 A.P. \ Insp.Dist./ra /
/o 7 i Sup. Area
Architect/ /
Designer License No. Zone \ SDI.Pmt. No.
Setbacks I P/L Front C/L St. Street'Width
Address
Yards Left Right Rat
City Zip Phone
Eave Prol. Left Hight I-P.
Engineer License No. .
E Parking Spaces Required Provide /Covered •
a Address
N Strutt No.of No.of/
n City Zip Phone Height Stories Family
Ca LICENSED CONTRACTOR'S DECLARATION Park Fees [l Jps Fee
1? Required El N§\ C.T. Receipt
T7 I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000 of Division 3 of the Business and Zoning Approved By: Date
Professions Code,and my license is in full force and effect). /
License Class _ License Number \ /
> Date Contractor Misc.
E Andress Proposed Use %
Z
City and Zip Phone of Structure
an 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, Type Code
Class
Civ.C.1. Class Const- Year
y Lender's Name USE/OCCUPANCY / SIZE SO. FT.
eLentler's Address
t\ /
OWNER-BUILDER DECLARATION 1
LI hereby affirm that I am exempt from the Contractor's License Law
Sthe following reason: r \ /
I, as owner of the property, 2.
E (^r" ^+mnensnting, will do the work, and the structure is not
„c, intended or offered for sale. \/
a ❑ I, as owner of the proper „ am exclusively contracting with 3. A
a licensed contractors to con t the project. I \
d ❑ 1 a e mpt nder Sec, :&PC fy this reason
P /a Dat Owner t -.--e - ,.1— _. iii
WO KERS' PENSATION DECLARATION Total Valuation
/ \
3 I hereby affirm that have a certificate of consent to self-insure, Encroachment Permit Required/ L1 Yes 0 No
or a certificate of Workers' Compensation Insurance, or a certified r
copy thereof. Grading Pmt. rad j Policy No Company Required ❑Yes 4No t.mNo.
D. 0 Certified copy is hereby furnished. Rough Grading
D. ❑ Certified copy is filed with Orange County, EMA. / rt
Dale
Q Approved by:
Date Applicant / 3
CERTIFICATE OF EXEMPTION
FROM WORKERS'COMPENSATION INSURANCE Z
(This section need not be completed if permit is for $100 or less). _/ c
I certify that in the performance of he work for which this permit is E
issued, I shall not employ any p n in any manner so as to b me r
subject}o he W kers'CompenYon La.. ofZfor
inia. PERMIT FEES
Date er to/Applican ^
Is.J r -
NOTICE TO(/APPLICA �l� I1, after making this Certificate of Structural S Plan Check S
Exemption, you should b:come subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply with suchElectrical Special
provisions or this permit shall be doomed revoked. 5 Invest. S
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO Plumbing S
COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
RELATIN: TO BUILDING CONSTRUCTION, AND HEREBY RUTH- Mechanic., S
ORIZE -,PRESENTATIVES OF THIS COUNTY TO ENTER UPON
THE A:OVE MENTIONED PROPERTY FOR INSPECTION PUR- Pre-Grad! •
POSE ^I''/ /� / / pre-crInspecOgn $
�� - '��� Cs� Pre-Gradin Permit
G. .,tare of Appli .nt or Agent Date Rec.No. S Issue
•+/A ME.S M. BA2-Nork6
All spaces within this box must be completed to process Chn I
Approve
Chock By: Approved:
CMF 0335-46(BU-28)rev.6/80. :
FEE RECEIVED
\, 13542 S' DEC 291960
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
.P.O.BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA
EOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING
ADDRESS 3113 YELLOWSTONE DR IVE o t
COSTA MESA, CALIFORNIA FOR OFFICE
USE ONLY
RECEIPT NO. I i.l B I N2
OWNER KWK CONSTRUCTION CO INC l'J`I\'D
MAIL RE IVSD BY T RECEIV DATE ISSUED
ADDRESS 1555 PLA CENT IA AVENUE EL.JM' VE I 73 Y7�� ncnn
CITY NEWPORT BEECH CALI FTNO.p-3227 ADDRESS
I
O 'VLu
ARCHITECT LIC. COSTA MESA, CALIFORNIA
OR 1INEER NO. f
FIRE / ■I N
ADDRESS. ZONE TYPE GROUP I`/\ �./'
STATE APPROVED 111 (/J/
CONTRACTOR K. W. KOLL LIC.NO. 61195 BY DATE
ADDRESS 1555 PLA CENTIA NEWPORT BEACH ZONING 44'
LEGAL LOT 4041 IO NO.OF USE OF NEW ✓
DESCRIPTION I NO. 40 I BLOCK I TRACT /( I PLANS Y I BUILDING r`
A.P.NO. BBAVPROVED u /� IIS ��/B ��.ppTE ' -y -0)
OF LOT SIZE box 1 00 I NOW ON LOTS O YARDS `I, ALLOW
REQUIRED ALLOWED
USE OF (CENTER LINE ST.) II // � /� (�^JJ
EXISTING BLDG. FRONT L.Ic FT. 0 G 1/11
33-4N.
SETBACK LINE FROM 4C,t 30,
CENTER OF STREET l REAR YARD R.SIDE FT. IN.
i t
c5
SIDE YARD I LEFT J (RIGHT 5 L.SIDE . IN.
DESCRIPTION OF WORK REAR 3 FT. IN.
NEI I X II ALTERATION I II ADDITION I
REPAIR I II MOVING I II DEMOLISH I
BUILDINGNO.OF
SIZE 13203E ROOMS 6 STORIES 1
EXTERIOR I LALL COO 1ROOF
COVERING MPDS IT ION
COVERING JfU SH INP( FS
USE OF BUILDING AND WORK TO BE PERFORMED
SINGLE FAMILY RESIDFNCF ANn
ATTACHED GARAGE PLAN No. 1-D
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.
PLY WITH ALL CITY ORDINANCES AND STATE WS REG ATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTRUCTION. \ VALUATION
SIGNATURE OF /)�/ PERMIT FEE $ a --
PERMITTEE / j/��J
V $ /5 /O7 PLAN CHECK $ /g,
/ e
AUTHORIZED AGENT TOTAL FEE $ 4/CS r
OWNER JAMES M. BARNOSKE DATE 6-25-81
JOB ADDRESS 3113 Yellowstone Drive BUILDING PERMIT NO. 52075
GF"rRAL CONTRACTOR Owner/BUi l der DESCRIPTION of WORK Patio Cover
A ). 141-073-03 LOT 40 TRACT 4041 FIRE ZONE VALUES 1,330.00
IN-SPECTIONS - Siana Date TYPE V GROUP /M'-1 ZONE RI
SOIL
•GAS SUBCONTRACTOR I PERMITS ISS4ED
- 111 Dote I Number Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE El HOUSE CON. ❑
SP-RINKLING SYSTEM
MISCELLANEOUS •
ROUGH HEATING AND AIR CONDITIONING t
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWE ❑ _
ROUGH WIRING/ 1 Heating and Vent.
TRENCHES L/ FORMS l]Y STEEL REINF. ❑ mPA &e ^30.1
FLOOR SYSTEM
BOND BEAM STEEL REINFORCE ❑
SHEATHING
FRAME AND FLASHING B 77--10-51LATHING - IN ll OUT 1^1
P' F.R. BROWN COAT �y�I `,
S. rURAL, FINAL E r'1 7-,20-14 Electric
HEATING, VENT., REFRIG. AND A•C.. FINAL J ,. Jj(` --e reg343
PLUMBING. FINAL AND GAS TEST ❑ ✓ ^ -49-87
ELECTRIC, FINAL �./
BUILDING, FINAL '7/•( 7-2.0-11/
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FQ!TRIiYTUR�AL PERMIT .50 GA
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ) _
RECE. V PERMIT —' - ,r -- 27 TL
For Applicant j //to Fill in CompletelyleN —Use Ink Only SZ J O 7
BUILDING
uu1 m �1'ro [= a I IIC A.P. NO. — • -a3
ADDRESS •
,7
OWNER OR
TENANT l SS.. N AS-KOJAe
UNIT OR
MAILING / -• .
ADDRESS3J LJ/3 /�ocuJ'XONC fi3'e a
LOT BLK.
CITY POSY We A0 ,, KO NO. 4/ 439
NEW ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION �� 11111.LENDER /ya/tC
s
BRANCH "` •OWNER Ja..rH 4'//
1 -4 o3Ae /7 v
ADDRESS • Si 77o �vC-tALUE' / ,,
ARCHITECT TEL. USE r '` _ b --
OR ENGINEER /yn x e- NO.
ADDRESS r-- ZONE . TYPE V GRODUP Nt SDI
•
CONTRACTOR OCv,U&Q DATE 6/2S p l
I
ADDRESS ..---
TEL.
CITY NO.
l'^ STATE CITY APPROVED SETBACKS •
c LIC. NO. LIC.NO. I
ba SIZE
LOT /QO/ I NO.OF NOW ON LOT { (FROMOC/;STREET)
,r .n.il'Lueir1
Q USE OFI It
cn
.-. EXISTING BLDG. RG4/e4de r C R.SInE CP FT. u+ •
VI
9 Separate permits are required for L,SIDE l'_Am t ktet.+
electric,plumbing and heating work. -7 / /`If
2
W REAR / FT. V
I,, USEa�p F BUI}-DING AND X[WORK,/TO BE PERFORMED PLANNING ACTION .
rate not 5.• e!r.rr•P -- At b /Q ►
UQ
DATE
APPROVED
APPROVEDLn.cit DATE6-7J—63/
C
la
a.
o I hereby acknowledge that I have read this application and state r- S
O C
gg that the above Information is correct and agree to comply with
a. all laws regulating building construction, and I shall not employ i
Z any person in violation of the workman's compensation laws of
Sthe State of California. 333SO. FT. m
I hereby certify that I am properly licensed as a contractor under N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR w
Chapter 9, and tha .uch licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: -
am exempt from provisions of the State of California Business e
VALUATION PERMIT FEE b
and Professions C..e,Division 3,Chapter 9. J „�r„I it
m
�� PLAN CHECK b I • 27 2
PermIttre of :4' py��• F
Parmofttpa .� c- 5 `YGa--'- TAX b ® • Sb V
Author,Agent Date •S ; /3 30 TOTAL PAID • a •27