HomeMy WebLinkAbout110 YORKTOWN LN - Building Permits 'JJECT ADDRESS: 110 YORKTOWN LN CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 069476
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OWNERS NAME: RYBARCZYK, EDMUND
ADDRESS: RYBARCZYKTAWNYA PERMIT NO; B 069476 PLAN CHECK NO; N GOVT: N SUPP ; N
110 YORKTOWN LN
COSTA MESA,CA 92626 CONSTRUCTION TYPE: V—N PERMIT TYPE; STR PURPOSE: ALT
ARCH/ENGINEER: REG.N0.: JOB DESCRIPTION ; T/O RESTH & REROOF W/G0PM & HOT MOP SQ FT: 2, 508
ADDRESS: UNIT: CO MP
CLAIM VALUE: 2, 508 .00 CALC—VALUE: 2, 508 . 00 GROUP OCC: R-1 /
PERMITTEE: STOUT ROOFING, INC. ( 310 ) 923-6775
ADDRESS: 9700 WASBURN RD COMMENTS: REROOF SLOPE SIDE W/COMP FLAT SIDE BUR SMOKE DETE. REQUIRED
DOWNEY CA 90241 +6*****BF******rBrrBF**************BF*********************■**********BFRFBr************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS
CITY LIC.: 059377 TATE LIC.: 402536 cuss: C-39 EXP: 10/95
te:-tD �h signature:_ _. MAIN BUILDING ACCESSORY BUILDING
4 FRNT; FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
MILERS'CO PENSA ION DECLARATION: I hereby affirm than have a certificate of consent to sell-insure or a certificate of Workers' LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
Compensation Im6appS�gg,,,,ppcc tidied copy thereof(Section 3800,Lab.
POLICY HO.: —1O L O � EXP.DATE) 5/19/9 S
COMPANY: PARKING REQ.' PROV: PARCEL; 41916235 ZNE; REF NO;
7 Certified copy is hereby furnished. C Certified copy i filed with the city Building Division. PLANNING NOTES>
ate. Applicant: �� ********************************************************************•
***********
EXEMPTION FROM WO KERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred(5100)or less). DEVELOPMENT SERVICES R E Q U I R E M E N. T S
I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as 10 become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE:
Date: Signature: BUILDING APPROVED BY
NOTICE:II,atter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY; DATE; • a 2 r Pi
which this permit is issued(Section 3097.Cry.CI. ********************************** * ***************************** **
LENDER:
********************************** *******************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm mat I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 54 ,00 , 50
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)o1 Division 3 of the Business PLAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
any applicant tot a permit subjects the applicant to a civil penalty of not more than live hundred dollars(5500). ISSUE FEE
I. as owner of theproperty or my employees with wages as their sole compensation. will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
ctt. TOTALS— --> 54 , 50 0 , 00 0 ,00 54 , 50 54 , 50 , 00
❑ stnot is not intended or offered for sale(Seddon 7044,Business and Professional Code: The Contractors'ds State License Law
does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sale.II.however the building or REVENUE DIVISION TOTALS--> COLLECTED• 54 . 50 OVER/SHORT• 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
0
I.as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54
5
❑ and Professions Code: The Stateprojects with
License Law does not apply to an owner of property who builds or improves thereon *******************************************************************************
and who contracts for such projects with a lor(s)license pursuant to the Contractors'State License Law).I am aware
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
o I am exempt under Section: B.&P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: SFR 2508 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 2, 508 . 00
I do hereby certify that I am aware of and understand the requirements 01 California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
( permit lot construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant:
I hereby certify that I have read this application and State that the above information is correct.I agree to comply with at city and county
ordinances and stale laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
Property for insppeectiioon /�
nPurposes.
signature: _ 01 00170465-00170466 T�]T
DATE: 10/28/94 TIME: 12:10 54.50
e:
101 dh/gl
Driver's License or Social Security x:
/1641-46 Wtete—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
AA
IlibiL
JSTRUCTION AND PLANNING POOL SPA
APPROVALS Permit Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement
�
4.'1Li€:r
E] ical Conduit.Utility-Undrgrnd. 54. Forms
•
-, 4.jElectrical Conau S-Undrgrnd. 55. Electrical Bonding
• -5. Stec! Reinforeerent 56. Rough Plumbing & Pressure Test -
`: 6. .Elestrical UFEk brnd. 2 57. APPROVAL TO COVER-GUNITE
l 1
,.;_Fbdtings 58. Electrical Conduit-Undrgrnd. e.
`-•:853. pundation • 59. Gas Pipe, 0 Undrgrnd., Test I.
-5: Water Pipe-Undrgrnd. 60. Backwash Lines, P.Trap, 0 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 54. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit . 66. Solar System-Final
16. Rough Electriowiring - 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
in
20.IRou h FactoryFireplace ' • 1 t i .R --1
_r o .-:1t-1 a• F. r
9 ^, _ 14PPROVRL . .::•.: Permit #
21:'Duc(s, in,Stf ctu e - - -•° 4k `'`''t y•• in
. . e. • 170. dergetczat Hglro
22. Ducts, Ventilating • n Z. _' ' 171. Produce-Cc-ping 3tYas QOil
1 & n -1Y r - ro n -3 'n
23. Gas'P1pe;R oyigh SI Test .,t _ -„ X72. Undergropd F4ush1•_, p. .•
24.:Ro6f Framing . Ic
. - • - + t E73WUndergrn:T.StorageTankCCGas ❑Oil
. - _. a -1 1 ••.T r
25. Rogt f Sh athin -" l ° ` . q QQc,41 `1 _'
9 > 2�( t F 74��Oyerhead�}iydro
26_7-84 Ceiling (Structural) SAI • _ Do C1 t7.1,; J.. 75S:Dry Chemical 1 r - M
27;frame a`d Flashi• ` T. ' r.::::-.I.:, ' -• n1 ?=
� ; 1: .• t _ T. U . 76. Dry StardPlL�e +
•
_28. Latfjing-& Siding, -i y.:• -i, t _ •• 1 + 77: FIXED SYSTEM FINAL' .�
y �.
29. Insulation II, _ `' _ i r , 782FIRE PREV. Fl M,L n• 444
-7-30. Drywall Nailing .ny• i 15 • .4 HEALTWDEPT•. REQUIREMENT,
x'31. Plaster Brown Coat'• _ „ r I 1 I; ` „79. 'FINAL IIcISPECTION A ' '
1 >
32. ElectricatPos'ver:Mater.Final. ' tai . g80tr1FOOD CERTIFICATE ISSUED
33."Final Electric - - -o ' I to . n =1'2 _
';34. Final Heating& Air Cdnditioning: I IL. a _� r- r i
• -, 1 t pr - „ - .. -• rn
35.',Final Gas Pipe-Teft= ~ '17 r I • ^'
.36. Hood or Cano • , i.1 • . ,*c
PY r •', •
, •
r a inn) . Y
-37. Fin91 Factory Fireplace., ' ' • ' "' I L: r "• • ' / t`1
- .. .. , t' is %
38. Fina( Plumbing -. ' I :
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
- PERM NO. TRACT NO. LOT NO. UNIT NO.
CITY OF COSTA MESA CONSTRUCTION PERMIT A.P.# Zone
Project Address 1/O vorrMevh - 7 0 99
Applicant's Mailing A cess •233Y� ~en)#E TYPE OF CONSTRUCTION U NEW LI ADD U ALTERATION ;kr-REPAIR E Main Building: Accessory Building: Z
'VP
El CONVERSION ❑ DEMOLISH ❑ OTHER T Front 0
Owner's Name ,
ear Phone `Yl'��'' DESCRIPTION OF WORK/USE OF BLDG. I B Rear N
Address
Arch/Eng. License No. TYPE OF PERMIT U GRADING_❑ FOUNDATION ❑ STRUCTURAL C Right G
Address
❑ TENANT ❑ ELECTRICAL YJ PLUMBING ❑ MECHANICAL S ; Left R
❑ OTHER
Contractor's Nam- WO . 1 llA • Phone61° Ping. Ref.# Parking Req./Provided E
/1 �j�( / PROJECT DESCRIPTION SQ. FT. OCCUPANCY Q
Address(mailing) ai �T � 1 Planning Notes: T
`1 qV} / CONSTRUCTION TYPE VALUATION$
City License No. Y (/ '77 ZONE GRADING CU.YDS. ACRES RECEIVED DEC z 9 1988 S
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing 'Remarks:
with section 7000) of Division 3 of the Business and Professions Code,and
my license is in full fort d effect. / ELECTRICAL FEES
Licen 1.55 •� a ick:a `e -
Date .-
Iit Signature trap-. �fL�/ PLUMBING FEES Automatic Washer Transformer 0 15.50 KW
WORKE•5' OMPENSATION DECLARATION Construction Pole Sub. 0 512+KW
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I hereby affirm that I have a certificate of consent to self-insure or a Certificate Bar Sink Showers
Workers' Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter ❑up to 100 amps
Jo, Lab. C4.- //jj .(� �./ Backflow Preventer Service Sink
Policy No:7 /y,�1u-it Company -�/`t+`� /l.�iLbf Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps
_Eertified copy is hereby furnished. Dryers DGas '❑Electric Sub Panel
\ Cert ifyayfiled with the city Id ri. Bathtubs Sewer Connection
Date P ION F ApplicantR 'C [Q Clarifiers Solar Collectors Fan Motors❑0-1 HP ❑1%-8
(This
N need
ROM WORKERS'COMPENSATION DECLARATION
(This section nenot be completed if the permit is for one hundred ($100) or •D F.A.U. Inc.Solar 09-15 HP 016-15+
less). I Dishwasher Solar Piping 04-
I certify that in the performance of the work for which this permit is Issued
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fixtures ,y Microwave
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool vv/Spa ../Spa Device Boxes Pole Light
NOTICE:If,after making this declaration, you should become subject to the e Outlets Ran
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal 9
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCYSwitches
Gas Service Outlets Water Closet Sign
I hereby affirm that therewhiis a erion ssue (Section
for the performance Garbage Disposal of the work for which this permit Is issued (Section 3097 Civ. C.) Interceptors Water Heater 9 p Standing Sections
Lender's Name
Lender's Address Kitchen Sink Water Service Generator 00-5 KW 05.15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays
any structure, prior to Its issuance,also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions Of Roof Drains
the Contractor's License Law (Chapter 9(commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee $ 3
lerefrom and the basis for the alleged exemption. Any violation of Section
)31.5 by any applicant for a permit subjects the applicant to a civil
enalty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS:
❑ I, as owner of theroperty or my employees with wages as their sole Reinspection Fee $15 Issue Fee
p Zoning Approved By Date
Compensation, will do the work, and the structure is not intended or-offered —
for salese (Section Business and faProfessionalprCode: The Contractor'smroves MECHANICAL FEES Building Approved By �Date
ereon Law does not apply to owner f a property who builds or improves - _
thereon,empland, who does such work ohimself/herselfem s or through tende his or eel own - Application Issued By Dat
employees,hthat such improvements are not tor offered for Boiler Candy Type ❑
sale. If, thehowever,wthe building dof pro isg within one year of dm
Canopy Type II 0 SUMMARY OF FEES
Plebe the owner will have the burden of proving he/she did not build or im- Duct-Under Ground
Drove for the purpose the oBUILDING PERMIT $ SMIP $
rU t as owner tr the property,roject am exclusively contracting ing with licensedioncon- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT
hetors t construct the project (Section 7044, tBusiness ontl of property
Code:
The Contractor's License Law does notgraapply to an owner ie pr withta who Duct-Ventilating ❑0.100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $
se-
builds or Improves thereon. and who contracts for such oroiects with a con- __
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $
proof of their Worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING $
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBO# Fire Dampers MICROFILM $
— PLAN CHECK 50% $
Date Owner Heating System& Ducting Registers MECHANICAL $ TOTAL FEE $ 15-V"mm
I hereby certify that I have read this application and state that the above ❑0.100,000 BTU 0100,000 BT PLAN CHECK 25%
Information is correct. I agree to comply with all city and county ordinances $
and state laws relating to building construction,and hereby authorize repre- I
sentatives of this city to este u•on the above-mentioned property for
Inspection pur•--es '7l� ei
Signature / Y„'.j / Date pgoa
Drivers' License or SS 9P. - Reinspection Fee $15 Issue Fee $ 3 01 00027562-012023552 TOT 5.01
0865-46,rev.5/88 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor DATE: 31/04/C? TIM:: 11:21
N
CONSTRUCTION AND PLANNING POOH .
.APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Tem 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. SteelReinforcement • - 56. Rough Plumbing & Pressure Test
-
6. Electrical UF ER Grnd.: 57. APPROVAL TO COVER-GUNITE
7.'Footings 58. Electrical Conduit-Undrgrnd.
8.•Foundation • - . 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 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
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
t18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
X19. 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 0 Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24, Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall 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
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing (jz/gc( O
39. Water Service-Final (I`i
40. Gas Service-Final 1.1,4
41. Solar Domestic-Final]
42. Backflow Preventer
43. Backflow Irrigation
44. .Landscape Irrigation System
45. Sound Attenuation "'
46. Handicap Regulations-
47. FINAL STRUCTURE;& BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co - .-1 ;!r
51. CERTIFICATE OF OCCUPANCY
No, Date
OWNER SAN VISTA BUILDING COMPANY DATE 6-1-613
JOB ADDRESS 110 Yorktown Lane BUILDING PERMIT NO. 22231E
GENERAL CONTRACTOR game VALUE $ 12,635.00
A" No. LOT 301 TRACT 5160 FIRE ZONE DESCRIPTION OF WORK ret Ws/fli
L ECTIONS Signature D•T GROUP j&J TYPE V ZONE R3
Soil Air 3 PERMITS ISSUED
Gas " t4/4 SUBCONTRACTOR DATE NUMBER
Water / e","Rough ComeRefrig. ■ Air Cond. fl __
Rough Heating /�/ 7aftri [a�/)��j1//%1�7 . 7-i/-7,41_//- ( ,4
Rough Plumbing s li /� _.1 e� it -f 1-/-to v cc ,j i17/ A..
Miscellaneous �, A ,,o
I�f
Prop. Swr. Line House Con. 1! St. Swr. 0 //s , 6 ,r4 -c.a-�
-X_ n , DEC 9 1963 ¢U A;i ,�e /✓�
S.rinklin_ S stem / �I,il"J
Construction Pole
Underground 0 Power 0 • y
Rough Wiring f7"�- �G -,
Rough �/. -/p-G� _ ��
Trenches 0 Forms 0 Steel Reinf. 0 [hf Q _$t JC"Z
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing Pirko it
Frame and Fla.shi / �i y 0 "w
L g-In P Out Y7 4727/1/1/0 IEWC
-
r, brown coat /f, a- -I nita'
Rt1-21g. 0 Air Con. 0 Final ['tannin De
Heating, Final 7.2--/,//0/ Sam Rco. esbfroit
Plumbing Fixtures, Final l /Final Gas Tes �
t / 1 s• bawls Vats
Electric Fixtures, Final _ q ,
Building, Final /V/ G
OCCUPANCY
Form BU4-6M-3-63-S-B P IYOLH FOR SYES. ALyUIKCMan 1,,
• 22284 FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT CY 1 9 tIV
P.O.BOX 917 COSTA MESA.CALIFORNIA FINANCEQ� TDEPT..
For Applicant to Fill In Completely APPLI2ATTION Flit MITSA
• TYPE OR PRINT BUILDING
BUILDING For Office Use Only
ADDRESS 110 Yorktown Lane +'t .�y,4
RECEIPT NO. PE9^' F
COSTA MESA, CALIFORNIA
RECEIV BY DATE RECpE ED �` DATE ISSUED
OWNER San Vista Building Co. / * JUN 1 1954
BUIL ING
MAIL
o
ADDRESS 1166 E. 58th Street ADDRESS
FIRE
TEL..
oily Los Angeles 11, Calif.NDAD 37187 ZONE TYPE GROUP` 4-
ARCHITECT TEL \I---
APPROVED DATE
ORENGINEER Raymond Levanas ND 'OR 37010 BY
A ; s 3432 Via Oporto, Newport Beach - a NING J V
Z E NO.OF USE OF NE, jr
CONTRACTOR San Vista Building Co. PLANS - BD]LDI
GAL Tract 5160 - of 30
ADDRESS 1166 E. 58th Street DESCRIPTION
CITY Los Angeles 11, Calif. A.P.NO. / /
,�//
/- 3til
NOTE: NO EAVE OVERHANG SHALL BE LE S THAN
STATE LIG.NO. 192782 T . AD 37187 90^TOSIDE 8REAR P.L ( N
SEAVES
OIZEOT 20 x 70 NO.OF
TB. 0
NOW ON LOTALLOWED (U.B.C.REQUIREMENT//.
L
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. None ('-
(FROM CIE.STREET/
FRONT / 1
SETBACK LINE PROM
CENTER OP STREET 13' REAR YARD FT. FT. c/
I0I 0 R.SIDE 0 FT. FT. ;11.
SIDE YARD LEFT RIGHT
DESCRIPTION OF WORK L.SIDE O Fr. FT. e"'
0v,
NEV' R ALTERATION ADDITION REAR FT. FT. z
DISTANCE BET. BET.MAIN S DJ
REF._.(i MOVING DEMOLISH MAIN BLDGS. - ACCESS.BLDGS. c
BUILDING M/1 y �J NO.OF �-Z E VAR.4# ‘IL/
DATE [ / ) a9
SIZE of O J( Z. / ROOMS -5 STORIES C.U. / APPROVED 6//" u J -
EXTERIOR WALL ROOF APPRf@may ,} C ( /) Ii .�
COVERING Stucco, COVERING Shingle BY JY 1` DATE .J r/J L' a'
USE OF BUILDING AND WORK TO BE PERFORMED V -< od
Residence Eceavpert Ol, .2
a
9-1/174 L' ( lcry' _ a
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN DER VALUATION IS FOR THE I r,/
AND STATE TH HE ABOVE IS CORRECT AND AGREE TO CON. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL IT ORDINANCES AND STATE LAWS REGULATING VALUATION _ 0 U.
�
BUILDING CONSTRU ION. /Y N
SIGNATURE OF PERMIT FEE $ m Q
PERMITTEE /{ c 1I c 4 .(, —
1 �• $ 7/ ,) 3J PLAN CHECK $ ^Z' 0
AUTHORIZ OA NT TOTAL FEE $ (213 .i
LL