HomeMy WebLinkAbout148 YORKTOWN LN - Building Permits PROJECT ADDRESS: 148 YORKTOWN LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 069633
OWNER'S NAME: DICAMILLI JAMES A
ADDRESS: 148 YORKTOWN LN PERMIT NO; B 069633 PLAN CHECK NO: N GOVT: N SUPP : N
.t COSTA MESA,CA 92626
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/O RESTH 6 REROOF W/COPM 6 HOT MOP SQ FT: 2, 508
ADDRESS: UNIT:
CLAIM VALUE; 2, 508 , 00 CALC—VALUE; 2, 508 , 00 GROUP OCC: R-1 /
PERMITTEE: STOUT ROOFING INC ( 310 ) 923-6775
ADDRESS: P 0 BOX 4309 COMMENTS : REROOF SLOPE SIDE W/COMP FLAT SIDE BUR SMOKE DETE, REQUIRED
DOWNEY CA 90241 ***+L***rT60r*************fir******************yr************Orr****s*T6*****Sir*******
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 : C • • : 10/95
M,�
/ MAIN BUILDING ACCESSORY BUILDING
Dale:.'_Q� signature:_ _ _ FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
WORKERS'C MPENS TION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
Compensation Ipslpatge2pp a.peraified copy thereof(Section 3800.Lab. R 5/1 9/9 5
POLICY NO.:COMPA7: 77ACCIGGG CC 7777 EXP. PARKING REQ: PROV; PARCEL : 41916261 ZNE; REF NO;
❑ Certified copy is hereby furnished. ff Certified copy is I ed wi h the city Building Division. PLANNING NOTES>
Date: ID 1pigiqi Applicant: �' *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: ( section need not be completed it the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS
I certify that in the performance of the work for which this permit is issued,I shalt not employ any person in any manner so as to become
tt •
subleco the Workers'Compensation Laws of California. ZONING APPROVED BY . DATE:
Date: signature: BUILDING APPROVED BY
NOTICE:II.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor _ DATE
Code.you must Ionhwith comply with such provisions or this permit shall be deemed revoked. I, Wiz
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY ; 'LL'(�,L • DATE
which this permit is issued(Section 3097.Civ.C). **************************** **iR********************************** **.
LENDER: **************************** ******************************************* *****
ADDRESS: LEGALIZATION:N E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l 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)of 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 for a permit subjects the applicant to a civil penalty of not more than live hundred dollars 1$500). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS ——> 54 , 50 0 , 0 0 0 , 00 5 4 , 5 0 54 , 50 00
does not apply to an owner of a property 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. d,however the building or REVENUE DIVISION TOTALS--> COLLECTED • 54 . 50 OVER/SHORT; . 00
improvement is sold within one year of completion,the owner wit have the burden of proving he/she did not build or improve
for the purpose of sate). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMI P/TOT GRADING PLAN—CHECK
0
I,as owner of the properly.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 5 4 5
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law). I am aware *******************************************************************************
Nat proof of their Worker's Compensation insurance should be provided to me, INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: OwnerSFR 2508 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 508 . 00
I do hereby certify that I am aware of and understand the requirements of 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 for 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 all city and county
ordinances and state laws relating to building construction and hereby authorize representatives of This city to enter upon the above-mentioned
property for inspection purposes.
qq !�^-, / 0100170672-00170673 TUT 54.50
Date:10 / Signature: DATE: 10/28/94 TIME: 13:26
Driver's License or Social Security.: .
1641-46 Wlete—Building:Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL PA
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
3.-Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical OF 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 Drains64. 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
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. 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 QGas ❑Oil
23.,GasPipe-Rough &'Test • ,72. Underground Flush
24. Roof Framing . 73,'Undergrn&.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing (Yj-act 464 74:Overhead Hydro', ' ' '
26. -T-82r Ceiling (Structural) & Monocoat 75. Dry Chemical •
27.,Frameand Flashing 76: Dry Standpipe .1) '• ,
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-Final80. .FOOD CERTIFICATE ISSUED
-
33. Final Electric • '•Notes: _ '
34. final Hefting & Air Conditioning
35. •Final Gas Pipe-Test' - - ,
,36. Hodd or Canopy . -
37. Final Factory Fireplace .
38. Final Plumbing , . ' .
39. Water Service-Final- -
40. Gas Service-Final . '
-
41. Solar Domestic-Final : I !
42. Backflow Preventer -
43. Backflow Irrigation ,
44. Landscape Irrigation System -
.45. Sound Attenuation •
46. Handicap Regulations _ -
•
47. FINAL STRUCTURE & BUILDING a lei q f4tc t . i
48. FINAL PLANNING
49. Electric Release to Edison - - i
.
50. Gas Release to Southern California Gas Co ,
51. CERTIFICATE OF OCCUPANCY -
No. Date
Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations.
CITY tF COSTA MESA PERMIT 1•19 - TRACT�� NO. LOT NO. BLDG.NO. 0615 I Il'-� I•"„ :d- TL
CONSTRUCTION PERMIT (Q�J 5�zf5
Project Address p 140 xOt KUL.
OW11, 11 ` TYPE OF CONSTRUCTION --
Owner J/ Simon H. Levy •
Phane54 Q-7455 New ❑ ADD ❑ ALTERATION L' _ -
Address \ 148 Yorktown, Costa Mesa 0 REPAIR 0 CONVERSION ❑DEMOLISH ".�J/ 'd ZONING REGULATIONS
Arch/Eng. License No.3y'�go 0 OTHER aori,'�• A.P.#
Address DESCRIPTION OF WORK r .....
✓ ZONE PLNG. REF..• -
Contractor fl/EEpp n o'ci Phline TYPE OF PERMIT, • BUILDING 'fo BUILDING
Address l v/ rSETBACK C/L ST. PROPERTY LINE
.�T - A.�[µ-)pb fi at:A.01 o GRADING ❑ 'FOUNDATION '0 STRUCTURAL SIDE YARD
LICENSED CONTRACTOR DECLARATION 0 TENANT 0 ELECT ICAL ❑PLUMBING ❑MECHANICAL . LEFTRIGHT
YARD
I hereby affirm that I am licensed under provisions of Charter 9(com- RIGHT - i
mencing with section 7000)-of"Division 3 of the Business and .❑ OTHER /0Q ' _
Professions Code, an. y license is In f I f. c and effe t. REAR YARD(TO P/L)
• .. b PROJECT DESCRIPTION
License .ss!_ /,' -� No, ' CO SI. r-c- . . . PKG.SPACE REQ. . ' PROVIDED. '
Date - iJ Signature' - .i� SQ. FT
WORKERS'COMPENSATION DE L; -ATI•N OCCUPANCY ._CONSTRUCTION TYPE STREET WIDTH PARK FEE $
I hereby affirm that I have a certif • to of consent to self-insurese � �reor a VALUATION VO�ZONE certifi - ZONING APPROVED BY • i 'DATE
thereof(SeOOigp joVte of StaA C.).Company-Insurance kede a fe[(s "`-s "-'d copy GRADING CU.YDS. ACRES SPECIAL CONDITIONS:
'ty No.1-I YY // LL l-/ 1� •
ertifled copy is hereby furnished. -• REMARKS: re KO • - •
ea Certifled copy is filed with the city Building Division. • . .
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - - '
(This-section need,not be completed if the permit is for one hundred - -
($100) or less). • -
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 to become PLUMBING PLAN CHECK. ELECTRICAL PLAN CHECK -
_
subject to the Workers'Compensation Laws of California. - DWELLING
-Date Signature BATHTUBS • - SHOWERS - . SO.FT SO -FT • •
-NOTICE: If after making this declaration, you should become subject- TOILETS _ . • URINALS GENERATOR 0-1 KW_1.10 KW '
'to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER - • -• -- - • - -
forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS . - . , APPLIANCE 10-50 KW 50 + KW •
_
CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS MOTORS _ 0-1 HP_1-10 HP -
. I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS ' . (INC.SOLAR) 10-50 HP 50 + HP . •
-
formance of the work for which this permit is issued (Section 3097 - -
Civ. C.). - FLOOR SINKS ' FLOOR DRAINSFI%TURES OUTLETS SWITCHES - -
Lender's Name .
Lender's Address DRINKING FOUNTAINS '" - GAS TUBE SIGNS .
OWNER BUILDER DECLARATION • INTERCEPTORS CLARIFIERS ' - POLE LIGHTS - .
I hereby affirm that I am exempt from the Contractor's License Law for .
the following reason (Section*7031.5 Business and Professions Code: SWIMMING POOL'- ' P TRAP - ' LUNE I Nut.I ION . '
Any city or county which requires a permit to construct, alter, 'POLES METERED SUB
improve,demolish or repair any structure, prior to its issuance,also re- WATER SERVICE • ALTERATION . PANELS -MAIN - SUB
quires the ap,licant for such permit to file a signed statement that he •
•is licensed pursuant to'the provisions of the Contractor's License Law GAS SERVICE OUTLETS SERVICE - AMP - •
'(Chapter 9 (commencing with Section 7000) of Division 3 of the - - -
Business and Professions Code) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT - -
brr; for the alleged exemption. Any violation of Section 7031.5 by
iiiii.Cp plicant for a permit subjects the applicant to a civil penalty SEWER-CONNECTIONS . . - - - -. . .
c'^i;• -•t more than five hundred dollars ($500). •
- - •
1, as owner of the property,'or'my employees with wages as their SOLAR TANK COLLECTORS - - - .
[ . - '
Sole compensation, will do the work, and the structure is not intended -
or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. • - ISSUE FEE •
Contractor's License Law does not apply to an owner of a property APPLICATION APPROVED BY
who builds or improves thereon, and who does such work himself or ISSUE FEE - . ' . •
through his own employees,.provided that such improvements are not '
intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK SUMMARY OF FEES
•
is sold within one year of completinn,.the owner will have the burden
of proving he did not build or improve for the purpose of sale). HEATING-SYSTEM 0-100,000 BTU .PERMIT BUILDING $ /� 'SNIP $
❑ I,-as owner of the property,-am exclusively contracting with AND DUCTING
licensed contractors to construct the project (Section 7044, Business 100,000 +BTU PLAN CHECK $ . PERMIT
and Professions Code: The Contractor's License Law does not apply to ISSUANCE $
an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU • PLUMBING $
tracts from such projects with a contractor(s) licesned pursuant to SYSTEM -- GRADING $_._
the Contractor's License Law). 100,000 +BTU PLAN CHECK $ - .
❑ I am exempt under Section B.-& P.C.for this
ELECTRICAL
BOILERS BTU $ • $
reason • - ' MICROFILM $.
Date - Owner SYSTEM REPAIR,ALTERATION PLAN CHECK $ TOTAL FEE $
I hereby certify that I have read his application and state that the above EXHAUST SYSTEM . MULTIPLE MECHANICAL •$
LESS AD •
-
ordinancis is correct. agr e to comply with all cityand county rize PLAN CHECK $ - VANCE PC $_--_ _
preand st. e law re ing to construction,on and hereby authorize _ --�r�
representatives .' hi- y to enter upon the above• - •
/ /\ S V
•
Signature property fo/�,c ...//'...s `-- - Date „ �r � _ FINAL FEE $_/
Drivers'Li ens: or SS qF _ - ISSUE FEE . -
CMF 0865-46 White-Building;Canary-Applicant; Pink-Accounting;Goldenrod-Assessor
•
CONSTRUCTION AND PLANNINQ/CG��� POOL'&SPA
APPROVALS Permit# U:S-VI Date Inspector APPROVALS Permit# Date - Inspector.
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location - - - - -
2. Soil Pipe-Undrgrn 44. Steel Reinforcement • - •-
3. Electrical Conduit Utility-Undrgrn . . -_ 45. Forms -
4. Electrical Conduit-Undrgrn _ 46. _ Electrical Bonding - - -
5. Steel-Reinforce 47. Rough Plumbing& Pressure Test - - • - - - -- .
6. Electrical UFER Grn 48. APPROVAL TO CdVER-GUNITE - - • • - --
7. Footings _ - • - 49. Electrical Conduit-Undrgrn
8. Foundation 50. . Gas Pipe, El Undrgrn,Test •
9. Water Pipe-Undrgrn - _. 51. Backwash Lines,P-Trap. ❑Undrgrn N .L. ---- ' - -' • ' •
10. Structural Floor System _ 52. APPROVAL TO DECK -`-_ ` -. -.
11. Property Sewer Line & House Connection 53. Backwash& Receptor-Final • '
12. Street Sewer Connection -- . - 54. -Heater &Vent-Final • - -
13. Rough Plumbing - . _55. Plumhina System -Final - - -. -
14. Rough Electric-Conduit :56. Electrical-Final -
15. Rough Electric-Wring - 57. Solar System-Final
16. Rough Heating & Air Conditioning 56.. Fencing&Access Approval •
17. Ducts, in Structure -- . - 59. APPROVED FOR PLASTERING
18. Ducts, Ventilating - .
19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing - '
21. Roof Sheathing NOTES:
22. Frame and Flashing •
23. Insulation - -
24. Lathing &-Siding -
25.-- Drywall Nailing - •
26. Plaster Brown Coat - • - •
27. Electrical Power Meter-Final - •
28. Final Electric -
29. Final Heating & Air Conditioning - - -
30. Final Gas Pipe-Test -
31. Final Plumbing - -
•
32. Water Service-Final -.
33. Gas Service-Final - . .
34. Solar Domestic-Final - • - • .
35. Landscape Sprinkling System- - -
•
36. Sound Attenuation - •
37. Handicap Regulations . - •
38. FINAL STRUCTURE&BUILDING ' -
39. Special Requirements Completed - _
40. Electric Release to Edison
41. Gas Release to Southern California Gas Co. ..
_
. 42. CERTIFICATE OF OCCUPANCY - ' .
No - Date -- - - - ''
PAID
NOV 13-6700 540* ****90.00
P 27796
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1208 COSTA MESA, CALIFORNIA 92620 -
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
eDILDINa For Office Use Only
ADDRESS 14 /�(,` K.`
- eten YelW.1L
v RECEIPT NO. PERMIT NO.
COSTA MESA. CALIFORNIA 7
i`� I� e
�;,Y TeE
OWNER San Vista Bldg. CO.
MAIL BUILDING
ADDRESS 2249 Wanderer Drive ADDRESS r/(�/
San Pedro NO.
833-3320 ZONE TYPE GROUP te" jL
CITY (/
APPROVED
TEL.HITEC ER Clif Olsten NQ. 923-1221 BY' DATE
9025% E. Florence, Downey ZONING
cm ADDRESS - �i/.�} �/"��
Zf /fj I NO. S ^ I BUILDING or NENP��" U `�
Same 'J1!` 10/� PLANE 'f/_ BYILDINO
CONTRACTOR
or
LEGAL
ADDRESS {1.�, r1r l LJ
Same DESCRIPTION ' air' ISi 12 C)
1— /}�
CITY Same A.P.NO. /U_ 01- 3
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE TEL SO'TO SIDE&REAR F.L
LIC.NO. NO.
SIZEEA`, �7ES
ND..of OS— ALLOWED (U.B.C.REQUIREMENT)
YARDS APPROVED YARDS APPROVED
USE OF _Ermic------
MAIN BUILDING ACCESSORY BUILDING
EXISTI HG
(FROM C/L STREET)
SETBACK-LUAZ/ROM - FRONT O FT. FT.
CENTER OP STREET REAR YARD ff
SIDE YARD LEFT RIGHT R.SIDR V FT, FT.
h
DESCRIPTION OF WORK Lame( 0 Fr. FT. F'
z
ELI
ti ALTERATION„- ADDITION REAR 0 Fr. Fr. W
DISTANCE BET. BET.MAIN& CC
REPAIR MOVING DEMOLISH MAIN BLOCS. ACCESS.SLOGS. 5
BUILDING^^ -- NO.OF �[ 'I VAR.�t DATE / QI
HIZE O�X 1� ROOMS ( STORIES v C.V.P.# / 7 APPROVED 6'4-63 W
IX
EXTERIOR W 0e - ROOF APPROVE
COVERING lj._t.. .C/!ra COVERING EY DATE /O'30`G7 a
USE OF BU HatIN
�AND'W"O'R)K TOB[�PERM[RpMED
,IQ
�3� CO.
,e /3f4.Frj-V764-, to
I HEREBY ACKNOWLEDGE THAT.' HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
Oy
ANO STATE TH I ABOVE is COECT' AND AGREE TO CAM. PURPOSE OF ESTABLISHING A PERMIT PER ONLY. AG
PLY WITH ALL 'TY DINAMCES AND STATE LAWS R[GYLATING VALUATION
BUILDING CON U N. O____
SIGNATURE OF PERMIT FEE
PERMITTEE �/ it /i//// �j
V 4./ a /J' PLAN CHECK S �7 0— w'
AUTHORIZED AGE % —
TOTAL FEE $
• COSTA MESA BUILDING—SAFETY DEPARTMENT AY 30-75� UO01279 i** ***5.00
P. O. BOX 1200 ..,„ee .,A
Costa Mesa, California
PLUMBING PERMIT APPLICATION TRACT NO. RECD. BY PERMIT NO.
CONTRACTO'� / �,� /2 h. I - LOT NO. DATE ISSUED
Address 7� 74001 / yA
BUILDING USE i}O {���(
City / 4_44v., Tel. N� a 'N/� BUILDINGDRESS / Y C� .44/4...„.‘„)74%.—)
. 7hv/ /t1
p( g(Era
/ U
State License No. / // 911 Class. /3 / COSTA ESA. CALIFORNIA
!7t ! NEAREST
O CROSS ST. -f
w City License No. 3 9 2 / �-/-27
I— l — OWNER /C �- (l'-- - \ 1\ /l-/
Q NUMBER TYPE OF FIXTURE ORITFAf FEE MAIL f Oi/ „A—e.,..A
Q ADDRESS
Water Closet(Toilet)
Bath Tub CITY . r ''' L. NO... 4 o2
Jrr''
rS
Shower I hereby acknowledge that I have read this application
Lavatory(Wash Basin) and state.that thelabove is correct and agree to comply
T Kitchen Sink with. allCity Ordinances and State Laws regulating
¢ Laundry Tub or Tray .rplumbing,
I
l n Certify that I possess the above valid state of Call-
a Service Sink ‘fornia classification or I am the legal owner of the resi-
o Floor Sink dentia] property described a ve.
Q Floor Drain VI ‘- (Q//7
1 Dishwasher _4[' 'I'wJ' Signature of
Permittee p
Z Drinking Fountain i \L-
w Urinal . x",.. -
= Garbage Disposal .. '1-..\X...; - INSPECTION RECORD
Automatic W'ashing'M ch. 1 •
I— Water Softener 1 '
/ Water Iteitcr&`Vans OZ
4U_
WRecebtor^.J
a Swiin'Pdol Filter System
2 Gas System . . . Outlets
D Lawn Sprinklers
Installation or Alteration
Water Pining APPROVALS
Back Flow Preventer
C/) Prop. Sewer_ it. INSPECTOR DATE
_ }louse Sewer Connection U/G Soil
I— Cesspool, Septic Tank U/G Water
Services—Water 0 Gas 0
Miscellaneous Rough Plumbing
_ Sprinkler System
Gas
Property Sewer
Pool Receptor
Filter System
_ Pool Heater
Miscellaneous
Issuing Permit 00
St FinalGas
. TOTAL FEE (7(� Plumbing
Final 2 w 6 - S
Utility Co. Notified
PORM e0-34 BLDG. PERMIT NO Alef