HomeMy WebLinkAbout3105 YUKON AVE - Building Permits •
7.4.: TADDRESS: 3105 YUKON AV UNIT: •- CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 048187
OWNER'S NAME: WRIGHT
ADDRESS: SAME PERMIT NO: B 048187 PLAN CHECK NO: -. N GOVT: N SUPP : N
CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: ALT
979-8435
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REROOF SQ FT : 6, 500
ADDRESS: UNIT:
CLAIM VALUE: 6, 500 . 00 CALC-VALUE: 6, 500 . 00 GROUP OCC : R-3 /
PERMITTEE: CAL PAC ROOFING ( 714 ) 583-0884
ADDRESS: 9272 JERONIMO COMMENTS : REROO W/ DECRATILE ICB0#3409
IRVINE CA 92718 *#******#N*> ****> *************** E#*#******#->F*#****it ************:r**#***** *****
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETH ACK S
art uc.: 04 2n314STATE UC.:512 8 01 .• : r—79
-----. Date: 2- I V--q.0 Signature: ea '�� MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a bate b consent to self-insure oracertificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR : FT IN
Compensation 1p.suratie,yracFifledcopy thereof(Section 3800,Lab. LEFT: FT IN RGHT; FT IN LEFT : FT IN RGHT: FT IN
. POLICY NO.: v.L W C e l z u t L H EXP.DATE: 3 4 /01 /91
-wPANY: SUPERIOR NATL . PARKING REQ: PROV: PARCEL : 41806201 ZNE: REF NO:
Certified copy is hereby fumished. 0 Certified copy i '•d with the city Building Di`ion. PLANNING NOTES>
7 >
r 1. #1 171 ******#***************#**********************#***********************`;t*********
Date: -'e (]-LApplicant _ .� A A At V1
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section n Illt complied if the permit is for one hundred(5100)or less). DEVELOPMENT SERV ICES REQUIREMENT' S .
I certify that in the performance of the work for which this permit is issued,I shal • employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE:
Date: Signature: BUILDING APPROVED BY : DATE )
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. -i' mI� n
CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY . �� iier�� DATE•0•' •r'O • , 0
which this permit is issued(Section 3097,Civ.C). **********************n iTl. ., -- jpw.-- --e?F'�`#"*'iF3FiF'iF*�F*********# ?r iFir*-n„n#
LENDER: ************#*****#*************?vrc** , ****##*******##*****#****3E************#*#
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from theContractors'State License Law for the following reason BLDG PMT PLUMBING EL E'.TRIC 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 90 . 00 5 0
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.My violation of Section 7031.5 by ISSUE FEE
any applicant Lora permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the TOTALS----> 90 . 50 0 . 00 0 . 00 90 • 50 90 . 50 . 00
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law
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.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED • 90 . 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 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING P3,AN-CHECK
for the purpose of sale).
90 . 00 . 50
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon #,***,#*#*,E"7E#,#*#*#,,E**#*#*******##******##*******,*#*###******#***##*****iy**#**##*#
and who contracts for such projects with a contractor(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
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTI 0 N UNIT COST TOTAL COST
Date:. Owner: •
SFR 6500 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 ' 6 , 500 . 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 Quality Management District.Residential construction applications are exempt from
these provisions. •t\ '
I her Applicant: \G\ E DETE�T�R
hereby certify d that laws
s td this ingtlon and stateiothe above iteinformationns Isnt corrties of I is agree to comply upon with all city and county 1\` )-1[�\ S NI0 K
ordinancesfand inspectionerelatingpposto building construction and here uthod7e representatives of this city to enterabove-mentioned J\ /
property for seor purposes.
— Date: '1� 2 'ID Signature: .L A REQUIRE
Driver's License Social Security w: F • 01 00065586-000655$7 Y Y_t 90.50
DATE: 07ii8/90 TI91E: 09:11
184146 White-Building;Green-Code Enforcement;Canary-Applicant:Pink-Revenue;Goldenrod-Aasesior
• . i
CONSTRUCTION AND PLANNING . PO. 9 SPA
APPROVALS Permit# : r 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 UFER 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. r
10. Structural Floor System •. - - - - 61. APPROVAL TO DECK
11. Property Sewer line & House Connection -1 - 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final - .
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing65. 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 0 Gas 0 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 j ; j 77. FIXED SYSTEM FINAL
29. Insulation 1 78. FIRE PREY. FINAL
30. Drywall Nailing j/rj ; HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat ; II' 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
• i-
s
33. Final Electric d Y Nates:
/
34. Final Heating & Air Conditioning j ! I 2'
• ,l ,
35. Final Gas Pipe-Test Vls' jI
d
36. Hood or Canopy ' II
37. Final Factory Fireplace 4 1 1 'I
38. Final Plumbing I -
39. Wafer Service-Final
40. Gas Service-Final -
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation -
44. Landscape Irrigation System •
45. Sound Attenuation -
46. Handicap Regulations .
47. FINAL STRUCTURE & BUILDING S
lif),� Ca--
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co _�
-51. CERTIFICATE OF OCCUPANCY
No. Date
2542 I CITY OF COSTA MESA
`COSTA MESA BUILDING-SAFETY DEPARTMENT MAR 23 1966
P.O. BOX 1200 COSTA MESA, CALIFORNIA 9262S
For Applicant to Fill In Completely At7CalallPERMr
TYPE OR PRINT BUILDING
For Office Use Only
BUILDING
ADDRESS 31115 4
Yukon Avenue RECEIPT NO. PERMITPNO.
COSTA MESA, CALIFORNIA 25421
nem •'Sr D • RECEIVED 4L...D
P•^-I 22 •x
OWNER ti.S. Financial
BUING
MAIL ADDRESSI /
ADDRESS 1355 Front StreetFIRE
yy,,,� ^1 // pp//�//��//11
city San Diego, Calif. NOPFr96L41 ZONE TYPE / GROUP.� � }�'
APPROVED v//
ARCHITECT
EN ER A. S. Herityck 174hTP-33194 BY DATE
ADDRESS 12061 Santa Rosana. Stanton ZONING /
z0 NO.OF USE OF NHWA✓ILy'/G
K_/ I PLANS SUILDIN'GG 1 Ji f `,I�
CONTRACTOR I.nwtq R. SC�17d / / ��AI////�LL
LEGCR / // -}', L 6 y�./'
ADZ/HESS 2940-A Randolph DESCRIPTION /, ( ///✓✓✓cGCc C.--e...A. (/)'-
CITY Costa Mesa, Calif. A.P.NO.
NOTE: NO SAVE OVERHANG SHALL BE LESS THAN
LIcTN o. 234399 NO. 540-o96o SO'TO SIDE RREAR P.L.
SIZE II NO.OF BLDG
&. ALLOWED (U.B.C.REQUIREMENT)
OF LOT 62 x 100.05' l NOW ON LOT 0
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM rC/LSTR T)
CENTERETBECK LINE FROM 1 I FRONT J: FT.
OF STREET 5O REAR YARD p3 I !/
SIDE YARD I LEFT 6' I RIGHT 5.611 R.SIDE I,. PT. Fr.
DESCRIPTION OF WORK L.510E S,(Z. Fr.
R
REPAIR MOVING NHbH DDIST NC SE . ACCESS.ITT.MAIN SLOGS.
BUILDING .,� � NO.OF VAR.* DATE
SIZE 1/11.9 q(�]Yt{ I ROOMS 6 STORIES 1 C.U.P.* /', APPROVED
EXTERIOR WAOOd ROOF Shakes and APPRO // /
COVERING L'V1a$terl COVERING chi nalaq er I ' l/�'6Q� DATE ��/ / —6
USE OF SUILDINS AND WORK TO BE PERFORMED' h
Single Family Dwelling with Attached tri---- w
Garage 7)-/9 _ 1
/ 94jSQ.PT. (nOQ/ T
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIO THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CO . PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. R1
PLY WITH ALL CITY ORDINANCES AND STATE LAWS R GULATIIIY VALUATIONOC ]
BUILDING CONSTRUCTION. �� SJ
SIGNATURE OF PERMIT FEE 5 T I P
PERMITTEE ,AJv G
r s /9 5 PLAN CHECK S .
RUTHRI ED AGENT I •l J Gi A 6�
TOTAL FEE 5 //-r
I PMO
28328 RAR 1s-6e NSaOO 501* *.***3.00
- COSTA MESA BUILDING-SAFETY DEPARTMENT
p.O. BOX 1200 COSTA MESA, CALIFORNIA 02020
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
Du11. N
0a �j I/uleoio 4/£ For Office Use Only
ADDRESS J �Q� l
RECEIPT NO. 832
28
COSTA MESA. CALIFORNIA Ly./(Jj//LLJ
/ Viten.)
RICEI [D BY D T[R[h[IV[ TC ISSUE
OWNER ALG L 6/ 935 EDJ c-J7-fog c -/9—
BUILDING
kX'
MAIL .�I0.S �llL f/n✓ ADORQQS (,/f!4[,isa2f�
ADDRESS F- FIRE J
CITY 1.0.5 ' '<-5P7 TN -sagZONE
gyq�J,,,///��� TTP/Rp,/(�/�r�/ GROUP /7/Q�
_A�NGINBQR N9.EL BYPR Q,, ) k/!/ Z DATE 19-&
ZONING MVV, 9
ADDRESS j
//� ���/� -1 ZO NO.OF USE Or NEW L'4
CONTRACTOR 1GW Ni� 1,\•- ( PLANS ✓)I BUILDING `L{'./�'7:6./�
ADDRESS
DESCRIPTION/Jia h /1 1 ,f ! 1G I/
A.P.NO. T /U 0*.;/ -a
CITY
E TEL NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STAT
LIC. E NO. sr TO SIDE n REAR p.L.
NVES
SIZE No.OF BLOCS. ALLOWED I U.B.C.REQUIREMENT)
OF LOT 6 Q 4 1 U v I NOW ON LOT
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. - (FROM C/L STREET)
SETBACK LINE PROM
CENTER OP STREET REAR YARD FRONT PT.
SIDE YARD I LEFT I RIGHT R.SIDE FT. `-C
DESCRIPTION OF WORK L.SIot PT. Orr.
ALTERATION ADDITION l REAR PT.
DISTANCE BET. BET.MAIN&
REPAIR _ _MOVING DEMOLISH MAIN BLDCS. ACCESS.BLDGS.
BUILDING NO.OF VAR.>IF DATE
SIZE ROOMS STORIES C.V.p.* APPROVED /J
COVERINGEXTERIOR
I COVERING MYOF
DAT[ //� `j/
USE UILDINS AND WORK TO BE PERFORMED/ I• / 11P.
z.ecK W 4-11- o/(( 77 a G�£P7' /4-------
9
Sin or -aus� laver
!O 'Ai/Vic X 7O/ lave- SQ.Fr.
I HERESY ACKNOWLEDGE THAT.I NAVE RAO THIS APPLICATION THS AMOUNT SHOWN UNDER VALUATION IS FOR THE 2
AND STATE THAT THE ABOVE,IS CORRECT AND AGREE TO Co.. PURPOSE OF ESTABLISHING A PERMIT FE[ ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION
BUILDING CONBTRUCTI /5/ or,
2F
PSIGNATURE ERMITTEE O�f/ LD1 ��j,�.,/� PERMIT FEE 5 (�.---
g
G�
a /c 3 PLAN CHECK S (a.
.‘ AUTHORIZED AGENT �./!\/
TOTAL FEE $ S In
28412r-4-6a 1n* ****27.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
COSTA P.0. BOX 1200OSTA MESA, CALIFORNIA 92626
For Applicant to HU In Completely APPLICATION FOR PERMIT
TYPE OR PRINT_ BUILDING
/ �Ka/✓/ �c'cf For Office Use Only
BU ILDI NO 3/O r V
ADDRESS
RECEIPT NO. O%P![Ry1T 2
COSTA MESA, CALIFORNIA d(/'Y
l/5 LIZ- ,g C a Jr' RE Pr ynyScc�riy V-7 u k �,/
OWNER 7 `'/' �t'S Jj
MAIL BUILDING .2/D6 �'f�. .� • i
ADDRESS 3 /O f Yoke -' /QvF ADDRESS IJ/Z/_G(.! . !9{/
�1 y FIRE '/
Co r%/'T /!af/T NO. _' y rJ 4:-
APPROVED L� TYPE ,/L GROUP .2-
erreI"HITECT TEL APPROVED
BY DATE
NGINEER NO.
-
ZONING
ADDRESS
SO ( NO.OF"...V UY[OP N[W�r ��,�'�{Afii“jIL,
� I rpm
I emLDING „rola
CONTRACTOR /71N�✓�� ViLQ 61- -j- / Led• [ �.`�
DESCRIPTION
2 (% / / / r A U 6 7 ci
ADDRESS /L �j
CITY A.P.NQ. rL � JT - o 6 7- o
NOTE: NO HAVE OVERHANG SHALL BE LESS THAN
STATE NO. TEL 80'TO 810E&REAR P.L CPA ,I �I_
SIC. NO, �RMn.X//q//u.�qJ/"HJ
EAVES
OIZE C,S-2( /3 0 I NO.OF SLOGS. / ALLOWED (U.B.O. EQUIRHMENT)
OF LOT
YARDS APPROVED YARDS APPROVED
USE OP „ MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
!T/(/elf f
30 / ?/ FRONT C/L�R ( O n
CENTER OP STREET M REAR YARD✓ 6 / y A`LT�Y T]V
/ SIDE YARD I LETT /' 0 - I RIGHT C 1- R.SIDE 29 . { On.
DESCRIPTION Of WORK /� LSIOH /D FT. / 1� ------C4> REAR cp.I PT. �F �
- ALTERATION ADDITION V
DISTANCE SET. BET.MAIN IS
MAIN SLOGS, ACCESS.SLOGS.
REPAIR ..MOVING - DEMOLISH
BUILDING �'/ NO.OP V.R.P. DATE
SIZE TX 2- ROOMS STORIES _ C.U.P.# APPROVED
EXTERIOR WTy I�,,ROOF ,( APPROVED ' /��/
COVERING T” J�,YI.OVQRING €11. L BY /,(/ AT! .ffi/
yAz
USE't BUILD! S AND WORKTQ BE PERF66RME� � - // (` D'
V,/,(V / i INad�/ � n ✓ m
!zaR�-rare, / /c� l_ ry
.•-fl _ r4erz ijrArmak 3'�O BG.PT. o
I HEREBY CKNOWLEDOE 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- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. F
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION V •.
BUILDING CONSTRUCTIO PI
SIGNATURE OF G(�� al PERMIT FEE p
PERMITTEF tel.�pr 9 yij G
I -- PLAN CHECK S ��ll
AUTHORIZED AGENT •� (J'�- ,,.//J 7
2 le,/ TOTAL FEE SjO /. ap
28477
`COSTA MESA BUILDING-SAFETY DEPARTMENT APR T9-68of#'`**3•��
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92623
• For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
• BUILDING c� For Office Use Only
ADDRESS 7 ,'D S Y//teO -
RECEIPT NO. PH-SIT NO.
COSTA MESA. CALIFORNIA • r
k
// C �/!7.SY • EC I ZD 3P • TR IS • T
• OWNER Ps-Li L lro S J -7/ •/ - / -
BUI
ADD •� / � ADDRESS
NG
. ADDRBS�S• 3 it) S �U((^^ n�I
:. CITY CO c rig- M EJ 1'F NO.sy6-3Y9 ZONE TYPE 1 GROUP �.
`H TEL- , APPROVED
NGINEGINEER NO. O7 DATE
ZONING
ADDRESS n
ION[_ NO.OP USE OF NEW
'1/l\ PLANS -� BUILDING y
ST
CONTRACTOR yn �I//'
LEGAL .�✓ `' 1 / 7
ADDRESS
Di3CRImoN�/ / V
A.P.NO. /// R -_ o G I- o -
CITY
STATE TEL NOTE: NO NAVE OVERHANG SHALL BE LESS THAN
SO•TO SIDE a REAR P.L.
u LIC.NO. NO.
• SIZE I NO. BLDG!.SIVES
ZE (U.B.C.REQUIREMENT) -
OF LOT MOW ON LOT
YARDS APPROVED YARDS APPROVED
. USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
SETBACK LINE PROM IMONT ♦ PT
:1 DENTEN OF STREET REAR YARD
SID!YARD I LEFT I RIGHT
FT.
' `
DESCRIPTION OF WORK t' L.SIDE PT. PT.
TERATI N ADDITI•N REAR PT. FT.
DISTANCE BET. BET.MAIN&
i, MAIN BLD• '. ACCESS.BLDOS.
Z1 REPAIR MOVING - PENCILLER
=. BUILDING NO.OF VAR.tC DATE
': SIZE ROOMS STORIES C.U.P.# APPROVED
• EXTERIOR WALLROOF • AP' OV • / �/
COVERING ( COVERING B7 ;L DAT! { rr/�(OQ
I EOFBU I LIN N NNND WOR/K TO BE MIRROR % • IL
• i
BO.IT.
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. •J'R,
PLY WITH ALL CITY ORO CES AND STATE LAWS REGULATING VALUATION
r. BUILDING CONSTRUCT) � //
SIGNATURE OF �'J/!y - PERMIT FEE $ 3 P1
PERMITTi6 -�` / 4 .� V-/x�QA y/� �- w
'; $ - PLAN CHECK $
'• AUTHORIZED AGENT
TOTAL FEE $
2RF(l5 KAv 20 ao�,s,OO1AO9 u***•*3.00
' COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92323 .
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
eu1LDINa For Office Use Only
ADDRESS 3�O �T �'ICC Y✓ dr.('
RECEIPT NO. PERMIT NO.
COSTA M A. CALIFORNIA 52flor
�j�'�� /�7 ��/}/�i, ,, R[C 1R�p./BY DAATE RECEIVED D T[ISSUED
OWNER % ""CJ /�/- -•->a '.-' - !� "! � 2Q��0? r- 'oma
BUILDING
MAIL ADDRESS
ADDRESS, // ® / r, L (
• FIRE ,/
CITY 1 /CJ' NO-SYS ZONE TYPS GROUP jC
�j z %6-3411 Y�/
C NGOI RR TEL ABY PPROVED DATE
N9.
-
ZONINGail—
ADDRESS
E NO.OF
USE OF NEW )�
/ /9j�} / PLAN[ O I BUILDING
CONTRACTOR "\ 9[J
ti /
LEGAL j a r /^ '\v /
ADDRESS
DESCRIPTION
i- J-- / �i 7
A.P.NO.
CITY
TEL NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE
SIC.NTE 30"TO SIDE&REAR P.L
EAVES
SIZE I NO.OF B1-DGS. ALLOWED (U.B.C.REQUIREMENT)
OF LOT NOW ON LOT
YARDS APPROVED YARDS APPROVED
USE OP MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. -
(PROM C/L STREET)
SETBACK LINE FROM FRONT PT. PT.
CENTER OP STREET REAR YARD
SIDE YARD LEFT RIGHT R.SIDE FT. PT.
•
DESCRIPTION OF WORK L SIDE Fr. FT.
ALTERATION ADDITION I REAR Ri. FT.
DISTANCE BET. BET.MAIN&
REPAIR MOVING DEMOLISH MAIN BLOCS. ACCESS.BLOCS.
BUILDING NO.OF VAR. DATE
SIZE ROOMS STORIES C.V.P.# APPROVED
EXTERIOR WALL I COVERING APPROVEDTt / ,I ,V/ TIATE GCI/6.
COVERING /v"
USE OF BUZIneND_WO&F TOB PREFORMED 0.vI Q �cT P.
91
•
/c 3o + c a c _
re e.8 o. gt7 /.s SQ.PT. A
0
1 HEREBY ACKNOWLEDGE THAT.I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS POR THE
AND STATE THAT THE ABOVE.IS CORRECT AND AGREE TO CAM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE MWS REGULATING VALUATION
BUILDING CONETRUrn � 01
SIGNATURE
EOF (-O �7. (f0 PERMIT FEE J
sr E
PERMIT
S /. 0 PLAN CHECK S w
AUTHORIZED AGENT •
. r. •t. iL; f t n5:;^�... ;.., � _. TOTAL FEE $ (3____