HomeMy WebLinkAbout3165 YUKON AVE - Building Permits ' Mt CITY OF COSTA MESA -
4I pe BUILDING DIVISION
>: r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
F 1 ^W`e, 1 PERMIT
4, E07-00048
-,• •
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ECTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 3165 YUKON AV Status: ISSUED
Suite No Applied: 01/22/2007
Vicinity: Issued: 01/22/2007
Parcel Nunmber: 41805101
Applicant: MANZO, GILBERTO
Address: 3165 YUKON AVE
Phone: 714.708.3026 ISSUED BY:
COSTA MESA,CA Zip 92626-2921
Owner: FOWLER, RONALD D •
Address 3165 YUKON AVE it
�
Phone: tT
COSTA MESA,CA " Zip: 92626-2921 ,f A,•,
DA•cE `Ia
Contractor: OWNER-BUILDER
Address:
Phone:
" Zip:
License:000000
' SCOPE OF PERMIT
REPLACE EXISTING SERVICE PANEL WITH A 220 AMP SERVICE.
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
Res.a/c package $0.00Standing Section $0.00 0
New Res(1-2 units) $0.00 \ 0 Misc Electrical Equipment $0.00 0
, New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0: .. up to 10 kva/kw $0.00 0
Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0
Recept Outlets $0.00 • 0 up to 100 kva/kw $0.00 0
- Switches $0.00 0 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 Misc.Conduit $0.00 0
Service to 1000a $62.15 1 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1hp ' ` "$0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 10hp \�'S0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp "50.00, •- 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp', $0.00 : - 0
Communication drops $0.00 . 0 Investigation-Fee $0.00
Sub panel to 200a "$0.00 . '0 Plan Check Fee $0.00
Pole Light Pkg " 50.00 - 0" - Reinspection Fee $0.00
Sign Circuits \- $0.00' , 9
Temp Pwr Pole ' $0.00 " 0 TOTAL CALCULATED FEES $85.65
Intermed Pole " . $0.00 9
COMMENTS /SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21.92)
EXPIRATION: This permit shall automatically expire and become void If 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 this permit to be considered legal, such work must comply 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.
FOR INSPECTIONS CALL: (714)754-5626
2448.46(6/00)
1
DECLARATIONS
WORKERS'COMPENSATION DECLARATION;
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is isvled,
My workers'compensation Insurance carrier and policy number are:
Carrier: j:—__, �x� Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or{9ss.)
❑ 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 subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
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(5100,000).IN ADDMON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full
force and effect.Lic.q Class a
Contractor's Signature: Date:
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,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subs the applicant to a civil penally of not more than five hundred dollars($500).):
1_eft owner of the property,or my employees with wages as their sole compensation.WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions
Code:The contractors License Law does not apply to an owner of propeny who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
C_ I.amex t u d r c. Business and Professions Code for this reason:
.Signature: l—
f Expire-sr n
Verification of Ownership by(type of document,i.e.-properly tax bill or deed): L
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feel in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
r
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal 10 or greater than a weight of 500 pounds,ora volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? in yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,hes Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution c0ntrol district or agency? LJ Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 11 a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
e (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above- escr'b d prope for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Sr 'OFLegat.Owner(s) _2 (_Date
And/Or Authorized Applicant Date
CODE L INSPECTION TYPE DATE RI1mAL5 S4gE! INSPECTION TYPE QAie INTMALE
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing c
200 Final Re-Roof 210 Final Electrical 3/2�(j.
201 Final Block/Retaining Well 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy _
ki PRLONT ADDRESS: 3165 YUKON AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 054939
o ER'SNAME: LYNN, CHESTER V JR
ADDRESS: 3165 YUKON AVE PERMIT NO: B 054939 PLAN CHECK NO: N GOVT: N SUPP; N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
545-1446
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF REROOF W/COMP, SQ FT: 5, 000
ADDRESS: UNIT:
CLAIM VALUE: 5, 000 . 00 CALC—VALUE: 5,000.00 GROUP OCC: R-3 /
PERMITTEE: WESTERN SIERRA ROOFING ( 714 ) 255--2761
ADDRESS: 1541 PSTKESY LOOP COMMENTS; SMOKE DETECTOR REQUIRED IN THE HOME
TUSTIN CA 92680 *** ***4***iE*SE*+E*****Tt***kE ************x >ESE*BETE*****N***s6****>E**?r**** *****Tt
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 lull force and ellect. SETBACKS
CITY CIL.: 5465 STATE LIC.:5824? • CLASS: r 39 ---
ate: _.I►r,'-ti Signature MAIN BUILDING ACCESSORY BUILDING
• WOR ERS'COMPENSATION DCLARATION: I hereby atfirm that I have a certificate of consent osell-insure or a certificate of Workers' FRNT; • FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 380).Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
POLICY NO.: O1WCP12072D EXP.DATE: 04/01 /92
COMPANY: SUP• NAIL PARKING REQ: PROV: PARCEL: 41805101 ZNE; REF NO;
'] Certified copy is hereby furnished EX Certified copy' filed with the city Building Division. PLANNING NUTES>
r
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it x e permit is for one hundred(S1W)or less). DEVEt O P M E. N T S E R V I C E S 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 to become f
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY
DATE: -
Date: Signature:
NOTICE:It.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE:
Code.you must lonhwith comply with such provisions or this permit shall be deemed revoked. • .. i.
CONSTRUCTION LENDING AGENCY: I hereby affirm that mere is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; , V 12•-�_ •
DATE: kl C_
whtchthis permit is issued(Section 3097,Civ.Cl. *************)(******** ' • ' ' x ' ' *rr / • • ' • ' ' r ' **********x**!**#: *y**
LENDER: ************************************* ****if****************** ****►*i:*******iF
ADDRESS: LEGALIZATION:N F 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 SHIP/RES 'GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish,or PERMIT 72 . 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
pursuant to the provisions at the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business S M I P/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE :•--•
I. as owner of the progeny or my employees with wages as their sole compensation, will do the work, and the BUILDING—D IV' > PERMIT ISSUE PLAN—CHECK TOTAL PAID •, DUE
❑ structure is not intended or offered for sale(Section 704x,Business and Professional Code: The Contractors'Slate License Law TOTALS——--> 72 . 50 0 . 00 0 . 00 72 . 50 72 . 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 a,offered for sale.If,however the building or
improvement is sold within one year of completion,the owner will have the burden 0l proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 72 , 50 OVER/SHORT: . 00
mrMepurposeofsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting wren licensed contractors to construct the project(Section 7044,Business 72 . 00 • 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner DI properly wto bWds or improves thereon .•
i and who contracts for such projects with a contractor(s)Iicense pursuant to the Contractors'Stale License Law).I am aware ****************************************************************a(*******i.;******
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 DESCRIPTIO N UNIT COST TOTAL COST
Date: net SFR 5000 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 _5 000 . 00
I do hereby certify that jam aware of and understand the requirements of California Health and Safely Code Sections 25505,25533,and END OF FEES ' e
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 cerhty that I have read this application and state in I the above information is correct.I agree to comply with all city and county A
ordinances and state laws relating to building construction an ereby authorize represen Wes of ties city to enter upon the above.mentioned
property lot Inspection Purposes. x .
D".. l
rltI—CJ l ) Sig - _
Diiver's License or Social Security#:
1641.46 White—Building:Green—Cone Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor •
1., CONSTRUCTION AND PLANNING , POOI PA
1e APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe•Undrgrnd. j 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
ry
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
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 G Oil
25. Roof Sheathing #72_qf 6a//t 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 PREY. 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
w
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backf low Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
/./.1,_11/-‘44/4
/,1 tj 1I /w4
48. FINAL PLANNING ` "-I/ �K !//62-• /- 101--6 / ,e del , oe
49. Electric Release to Edison /4Z o it--44
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY -
No. Date
A
ADDRESS OF MALMO: 3165 YUKON AV 26 we: CITY OF COSTA MESA - BUILDING PERMIT
OWNER'S NAME IF KNOWN: LYNN, CHESTER VERNON FLOOD: X 47 PERM NO: M 071838
ADDNESS: LYNN, JANICE ORR 1
3165 YUKON AVE PERMIT NO: M 071838 PLAN CHECK NO: N GOVT: N SUPP : N
:OSTA MESA, CA 92626545-1446
APPL.MAIUNDADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: MEC PURPOSE: OTH
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : REPLACE FAU, INSTAL NEW A/C SQ FT :
ARCH.OR END.'S ADDRESS: UMT:
CLAIM VALUE: CALC-VALUE : GROUP OCC : R-3 /
CONTRACTONSNAME INLAND HEATING & A/C ( 714 ) 734-2238
CCNTRACTOWS MAILING 1696 COMMERCE ST COMMENTS : NO THER OWRK AUTHORIZED BY THIS PERMIT
ADDRESS: CORONA CA UC.ND.: 448349 ***** *****+t****+c**r-+ *********aF***************+ ********rP******ter-*ar-********+E*****
91720 WIT: Z ONING R EQU IR EMEN TS
LICENSED CONTRACTORS DECLARATION:I hereby dlkm under penalty of perjury that I am licensed under provisions of Chapter 9 S E T B ACK S
(commencing with Section 7000)of Division 3 d the Business and Prdbeiaa Code.end . License b in IUD force end sited.
CITY UC.No.:0. 59 1 UC.CLASS: C 20 UC.NO: 4489 EXP : 05/95 MAIN BUILDING ACCESSORY BUILDING
Date: L drr Contractor a. FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER ECLAR TION:I hereby arta Under penally• perjury that I at, • from the Contractors License Law to the
'
'*lowing reason( ion 70 .5 Busofness and Professions Code:Any cryo county whim •uiree a permit to construct,alter,improve, PARKING I NG R E
demah,or repai any structure.prior to its .issuance,also requires the applicant for such• to Tale a signed statement wet he or she Q• P ROV: PARCEL: 41805101 INE: REF NO:
is licensed pursuant to the provisions of the Conrado a License Law[Chapter 9(comm ening with Section 7000)of Division 3 of the PLANNING NOTES>
Business and Professions Code]or that he or she is exempt therefrom and the basis for i alleged exemption.Anry violation of Section >
7031.5 by any applicant for a permi subjedsthe epdcant toaciwl penalydnot more than five hundred dollar[5500!), *******************************************************************************
❑ I.as on,of the ro3PNWer my employees with wages as then sole compensation.WA do the work,and the structure is not intended
or offered for sale(Smarm 7044,Basins and ProfessionsCode:The Contractors License Law does red appyloanOwnerof properly DEVELOPMENT SERVICES REQUIREMENT S
who burnts or improves thereon,and who dos such work limned or herself or through his or her own employees.provided that such
improvements are not intended or offered to sale.It however,the building or improvement is sod within one year of completion,the ZONING APPROVED BY DATE:
owner•buido win have the burden d proving he or she did not bold or improve for the purpose d sale).
❑ I.as owner of the property,an exclusively contracth g with licensed contractors to rorutmd the project(Section 7044.Business and
Professions Code:The Contractors ors License Law does notapply to an comer d properly wbuor improves thereon end who BUILDING APPROVED BY : DATE:
contracts for such projects with a cairado(i)licensed pursuant to the Contractors license Law). /
❑ Iamexempt under Sedicn: B.aPc..for this reason: APPLICATION ISSUED BY: DATE: ((,O (4/Y
Dale: Owner: ******************************************* * **************.******* * *********
Ido hereby Panay that lam aware of end understand the requirements of CaliforniaHealthand Safety Code Sections 25505,25533,andLEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:N
25534,end the)I or any future tinkling odvpent will lone not(circle one)need to comply vim laid state code°end the requirements for •
a permit focomuuctbn co modifimtionhon theAilluakty Management Datdp.Revidemal cene)ruao appicatidnen exempt horn these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 18 . 0 0
Date: Applaant: 25% SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty ci perjuryone of the following declarations: PLAN
❑ Ihave end wilmaintaace dconsent iiworkers' ISSUE FEE 15 . 00
n
Code,for the performancedwewkforwhichthispermaaasued. BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ I have and will maintain work.'compensation theorems.as required by Section 3700 ol the Labor Code for lhe performance of the TOTALS----> 18 . 00 15 . 00 0 . 00 33 . 00 33 . 00 . 00
work for with this permit is issued.My eskers'compensation insurance owner and policy number we:
Canter: FTNTCARF EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 33 . 00 OVER/SHORT: . 00
Policy Number: I ' IIa11 /01 /95 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completed i the perm]is for one hundred dolma(Stool or - _-,)
33 . 00
❑ I Panay that in t . performance of the work for which this permit u issued,1 . not. .. any person in any manner so its to
become su:.. to the • pe laws d Cdoema,and .. ,, Dud if I.. v • became°ubjedto the workers' *******************************************************************************
compensat• • • Sins • �° the Labor Code,I shall I.• h I•.ply , provisions.
p�(.7l////•� IND I V IDUAL F E E BREAKDOWN
/ Date: A + Applicant: (
Weminp:Failure to *curs •mere ronpacnuden cove Kls unlawful,and shall Jrel an amployw to criminal penalties and TYPE DESCRIPTIOQTY .
I O N'. UNIT COST TOTAL COST
civil Dnrs W to• hind thousand dollars(SIOD, A In addition ro theca*o/-. • . tbR eamgs a pmvMed ler In
Section 3X15 of the Labor ode,Interest,and eternity's lees MEC 1 INST FORC-AIR/GRAV FURN <= 100 K BTU 9 . 00 9 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirmunder penalty of perjury r there is a oonMmdion lending agency for the MEC 1 REFRIGERATION SYSTEM <= 100 K BTU/H 9 . 00 9 . 00
performance of the work for whim this permi is issued(Section 3097.Civ.C).
LENDER'S NAME: END..OF FEES
LENDER'S ADDRESS: [
I ceNy that l have read this application end hale that the above irdormN coma*I agree to empty with an city and county ordinances . /
and stele laws raisingcoast -ion end hereby authorize *this city to enter upon the stove-mentioned property /
this
for inspection •
gr Print L� I r 01 00179594-0017:59: T C 7 33.08
— ` ..... Dale: \\\l (p OiiTE: 0L/dy;a: ''lfi_. :1J:10
_—I -dOwmr/ .nVAppkcarq/Cmtracto
(5151.46.WP) While-Building& dy:Green-Rte;Canny-AppFant;Pink-Revenue:Goldenrod-As
CONSTRUCTION AND PLANNING PG S 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
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. Fodndation 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
71. 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
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 0Gas 0Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing • 73. Undergrnd.StorageTank 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 PREY. 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
39. Water 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
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
OWNER LYNN, CHESTER V. DATE 4-6-7i(
JOB ADDRESS 3M/s Yukon Avenue BUILDING PERMIT NO. u3"foo
VERAL CONTRACTOR San Juan Pools DESCRIPTION of WORK Pvt. Swirl Pool
9 . No. 418--051-01LOT 26 TRACT 4674 FIRE ZONE VALUE $3,300.00
INSPECTIONS Signature Date GROUP J TYPE 5 ZONE H1.
Pool Location AI['
1t- iC-7Y SUBCONTRACTOR PERMITS ISSUED
Date Number Signature
Forms
Main Drain • `\/\
Steel Reinforce
Elec. Bond Electricy� / �y�J�1��- '/
Approval to Cover /4C tat t c-') 4,d/.�I�G����'f�la . 4 1 7 /Aviv—
Underground Electric
Plumbing
Gas Piping Test F--��'✓ c
Filtering System Lines 7 41 /✓!e r
Backwash Lines and Recep. PRC- 4- I$-V
Electrical Final RL LAZO-7/
iter and Vent Final
Filter System Final
Backwash and Recep. Final
Fencing Final .c. 5
illir—
43768 PA1a
TR -6-7727, 00 ?21 .:- *<':tc)1?_.5G
COSTA MESA BUILDING-SAFETY DEPARTMENT
R.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
A PLI TION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely— Use Ink Only f�
7 / ` ry.` . //� I 1 L^/ RE I (Y DATE RECEIVED D/!(�TE/ISSUEE/D
BUILDING 3ite.”l / s�L/1o0 /Y ve• lY r�
ADDRESS 1J
k/ t2 .I[ V n PERMIT NO.
C,
OWNER E /Q (f../ kJ t "A .P. NO. -7 I 7t "(71r. �'d
/ BUILDINGr OL' f(AT-
MAILADDRESS J
MAT-
ADDRESS
RESS 4 As M.
/
M1I CITY NOL /M.. TRACT 96-7r" LOT 2P BLOCK
CONSTRUCTION NEW ADD Al TFR I REPAIR MOVING DEMOLISH
LENDER X
BRANCH `-'l l A I,t �/ ,t '
fOWNER c3/4/1‹,-� V I-VA-A
ADDRESS / c��-y��7�7�) •
ARCHITECT a TELe3t-/ da S-<</r/s
+M to s7ALU�. �-C./V
OR ENGINEER qiw {e45 W J NO (O
/(� /C N
FIRE
ADDRESS 46-1 CA r,...,%., 2eet.I/ tot; ZONE (YPE i GROUP a)`V� APPROVED
fil
CONTRACTOR SA-IJ Lt 10 t.J 14 .1/S BY DATE
ADDRESSJ51
*2a (e lVIIIJ 14 ✓ c
•
TEL. ZONE NO.OF
CITY Z-72_Z-72_U, t\11t NO. S40-0401 PLAN$ .. BUSEUILDINGOFNEW�/,�(ps.s�i.` cO
F STATE '1 (/ CITY YARDS APPROVED YARDS APPROVED
gLIC. NO. OC 90 o o c. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE NO. BLDGS. (FROM C/L STREET) 1;
J.q�,
O. OF LOT NOW ON LOT RONT FT. I d FT
y y USE OF _ c - ` ,/�/GI17 P- C
EXISTING BLDG. RQS r a. — - FT. !C7 FT.
Vs
F. Separate permits are required for L.SIDE FT. 1 /-tFT.
electric,plumbing and heating work.
W • REAR FT.PL // 7L-FT.
[-, USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
'C - MAIN BLDGS. ACCESS. BLDGS.
r.IJAl /I SW•IM av-.1vj A / VAR.# DATE
' C.U.P.# �/� APPROVED +7
1
7 APPROVEI y q// c/_ /. //� /
>. - rYt'F DATE (9
.-1
CC
ry ..
a.
Q I hereby acknowledge that I have read this application and state n
r{ that the above information Is correct and agree to comply with
C• all laws regulating building construction, and I shall not employ m
i
Z any parson in violation of the workman's compensation laws of v
$, the State of California.
I hereby certify that I am properly licensed as a contractor under SG. FT. N
the State of California Business and Professions Code, Division 3, - THE AMOUNT SHOWN UNDER VALUATION IS FOR re
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e
am exempt from the provisions of the State of C Hernia Business or
VALUATION PERMIT FEE $ — <
end Professions
Cotle,�Division 3,Chapter 9
ri / m
• Signature of • PLAN CHECK S / Si c
Permittee X4-...-(f 2 $ TAX S / LL
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Authorized Agent TOTAL PAID S ir
'OWNER SMITH, John DATE 6-23-71
\ JOB ADDRESS 3165 Yukon Drive BUILDING PERMIT NO. 1,96
` � RAL CONTRACTOR Owner-lildr. DESCRIPTION of WORK Patio Slab Only
Ar No.tib-05i-03- LOT TRACT FIRE ZONE VALUE $ 150.00
INSPECTIONS Signature Date GROUP 3 TYPE V ZONE R-1
�` SOIL SUBCONTRACTOR PERMITS ISSUED
GAS Date Number Signature
�fffj WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. Li
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER
ROUGH WIRING / Heating and Vent.
@ Cj A
TRENCHES fl FORMS fl STEEL REINF. .h 444
FLOOR SYSTEM
BOND BEAM fl STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
I 'ING - IN n OUT El
_ FER, BROWN COAT
STRUCTURAL, FINAL Electric
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL J�s� -
J - / t - "
NW - ,
33196
Ni! 23-71F4F00133n 0'A****5 PO
COSTA MESA BUILDING-SAFETY DEPARTMENT .
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 .
For Applicant to Fill in CompletelyRECEAPPLICATION FORBUILDINGPERMIT
BUILDING / {_ , J �/ I / DA/_(fR'/JVEO DATE ISSUED 7/
ADDRESS``3110 �/ rel//� [/ /� 7 fC/� o'�T 3
Jr/ roc's i Tl'I 7"-"elf-e2-67— 0/ PERMITNO.
OWNER / roc-. A.P.D ��µ�6
�)3i( ��0i BUILDINGDRS /� /
MAIL ADDRESS a
W W ADDRESS TEL / �J
a O CITY l crit 44 e--5/1- NO��yc S TRACT LOTS( BLOCK
ZZ NEW ADD ALTER REPAIR MOVING f1FMO16H
< CONSTRUCTION a /
O-N LENDER / U/(/j✓
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J D BRANCH
J U) OWNER
Q m ADDRESS '�-�� n� �
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ARCHITECT .r J / TEL.+ USE A $ /.J D
J N OR ENGINEER O Ate— NOI
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APPROVED
J
Z CONTRACTOR /Lit}w"i[,: BY DATE
mZ ----------- '
J cc ADDRESS 1
W W TEL. ZO NO.OF /J USE OF N W �L(/
Z= —/ PLANS 'S BUILDIN
F- CITY NO. CG1.t,
— O a
W STATE •
CITY YARDS ED S APPROVED
to CC LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
O SIZE NO.OF BLOCS. A (F S EE
OF LOT NOW ON LOT �/ FT.
USE OF Q
EXISTING BLDG. C A SIDE .3/ FT. FT.
F' SIZE OF NO.OF /O FT./ // FT.
Z NEW BLDG. ROOMS STORIES L.SIDE
UEXTERIOR WALL ROOF � // `
_ COVERING COVERING REAR o/JFT FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
a
a MAIN BLOCS. ACCE�.BLOCS.
Q -/-, VAR.sV'+ DATE
O /�t / D 5-La APPROVED
/� APPROVED /// /— /J3-7/
in 7, Y /^ .0 p/ _ B . /DATE (O
Z
0
VI hereby acknowledge that I have read this application and state
D that the above Information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ
I— any person in violation of the workman's compensation laws of
An the State of California. to
? I hereby certify that I am properly licensed as a contractor under SQ. FT. o
the State of California Business and Profession ode, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are In full f e and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: R
am exempt fro.- . provisions of the State Californi Business
and Profess'. j Islon 3,C peer 9. VALUATION s',� n
(/ V PERMIT FEE $
D
Signature . s• / m
Permittee / $,75?) PLAN CHECK $
`o
Authorized Agent -3----- u.
\ TOTAL FEE $
\OWNER SMITH, John DATE 7-13-71
ti4 JOB ADDRESS 3165 Yukon Avenue . BUILDING PERMIT NO. 33255
$ c 'ERAL CONTRACTOR D. W. McFarren DESCRIPTION of WORK Patio Cover
a.418-051-01 LOT ' TRACT FIRE ZONE VALUE $8!{0.00
INSPECTIONS Signature Date GROUP 0 TYPE IV ZONE It-1
SOIL SUBCONTRACTOR PERMITS ISSUED
' 1 GAS Date Number Signature
WATER Plumbing
ROUGH PLUMBING .
PHOP. SWR. LINE ❑ HOUSE CON. 0
SPRINKLING SYSTEM
MISCELLANEOUS ,
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE _
UNDERGROUND n POWER ❑
ROUGH WIRINGHeating and Vent.
�R
TRENCHES n FORMS a STEEL REINF. ❑
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE n .
SHEATHING
FRAME AND FLASHING I I .
LATHING - IN n OUT n
F ER, BROWN COAT
S, TURAL, FINAL Electric
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL
_.... _..._ �..... CF/// /
33255
JUL 13-71 PAID v*'r***9."0
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
34 N RECEI D$Y Dt}TE RECEIVED' ti-3-
/ UE'
BUILDING �1 f0 S x O 6.7
J+ �Q/'" /,�'y 7 (/ 7 �1J` ,/
ADDRESS // zJ l�S TJ�1.p�C
OWNER \/ON'z/ Sin IT// A.P. NO. S/S- /OI PEa�� 5
MAIL
,..+ BUILDING / Al)
Z ADDRESS `qj b' s Aix 6 /V ADDRESS (7//�6t. y„.„
i.., /(/
tlU CITV $?� ��SfJ NO.Lu ui TRACT 9. / / LO ' BLOCK
I- Z
Z Q CONSTRUCTION 4/0426/` NEN/ ADD ALTER (REPAIR MOVING DFMOI I.SH
-I- LENDER //\�/ III
am
J D BRANCH ,
JN OWN ERnqJOr+4/ /l1/TH/
m J ARCHITECT S / d y� TEL. .q )� USE�/"T 77 �a dF.�e VALUE
JN OR ENGINEER .('ITY �O NO ��0 �'rV"I 7'(/,
W Q ADDRESS,3/757J/ /9A1 Co /6BG6$ 42. ZONE TYPE FIRE jGRO/UUP
0-Val JZZ I) u),Y�? ^il,CX En) APPROVED �•�12 DATE //.t'7 (
CONTRACTOR BY LLLII�
mZ
Jir ADDRESS �,h7/ r 7 Li ,7pew qci ,�/
WW TEL. ZONop NO.OF USE OF
�= CITY NO.En PLANS BUILDIN. •
Z HFir/ rik
gr
W° STATEy CITY YARDS APPROVED YARDS APPROVED
j O LIC. NO. 24/—�Q y LIC.NO.p7a0 4 MAIN BUILDING ACCESSORY BUILDING
SIZE NO.OF BLDGS. (FROM /� L$Z FFT) A {/
OF LOT 7/" /Al
ON LOT FRONT FT/'Jri�(/p./ FT.
USE OF -A
EXISTING BLDG. T�GJELL /Al R.SIDE4SFT FT.
Z SIZE OF NO.OF L(
Z NEW BLDG. ROOMS STORIES L.SIDE FT FT.
< EXTERIOR WALL ROOF
(
COVERING COVERING REAR .flai
FT. FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
CL CL MAIN BLDGS. ACCESS.BLDGS.
0 / //f 3' c} / /91-71_o eva cle, C.U.P.# APPROVED
yAAPPROVED//�/ ,/ DATE /.�- //
Z 6, U/yl
0
PI hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
cc all laws regulating building construction, and I shall not employ
F any person in violation of the workman's compensation laws of
(n the State of California. CO
b
? I hereby certify that I am properly licensed as a contractor under SO. FT. o
the State of California' Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR i
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: R
am exempt from the visions of the State of California Business VALUATION
and Professions Cod. a Ision 3,Ch:•ter 9. q�— co
ele PERMIT FEE $ nr
- O
Signature of 7 L / L'�/ m
Permittee i _r / / Sino _� $ /d PLAN CHECK $ E
_rji \ C o
/ u.
Authorized Agent A�7� ` TOTAL FEE $
IIIIF
2.`'663FEB 17-67LIIsA PAm00 694* ***'99.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 62626
For Applicant to Fill In Completely - APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING For Office Use Only
ADDRESS 3165 Yukon Avenue
RECEIPT NO.
r -.rim
COSTA MESA. CALIFORNIA JI•�]t'�3
RE VED/ST -DATEDARCCEI ED DATE
ISSu D
OWNER U. S. Financial , „'*"-' - -7'x'67 01-/y-6 7
MAIL BUILDING 0j/ reit,qti //„ ,
ADDRESS 1355 Front Street ADDRESS
FIRE
(O 5 oGj (./!Nice' �MT/>-
T[ ZONE I,/ TYPE J.L.� GROUP_Z.�'
cln San Diego, Calif. NGL?34-7912 ((Y��
APPROVED
OR ENG ARCHITENEER No
A. S. Henryck . 546-5610 BY DATE
ADDRESS 091 Liard Place, Costa Mesa ZONING
6IE_/ I NO.or� I us&or NEWW11.1 '
(€ PLANS BUILDING .0
CONTRACTOR Lewis R. Schmid _ Ny(,/� f�If'/J L
LEGAL
DESCRIPTION '& !,V 7/ 79 �,'[/
ADDRESS 2940-A randoloh Ave.
A.P.NO.
CITY Costa Mesa, Calif ornia
NOTE: NO RAVE OVERHANG SHALL BE LESS THAN
LIC...NO. 23439? '`{1 N[EL fig
0-0960 SO'TO SIDE&REAR P.L.
•OFLOT 75.64 x'�to .9g X MOWOOLDO .N LOT O EAVES
(U.B.C.REQUIREMENT)
USE OF YARDS APPROVED YARDS APPROVED
EXISTING BLDG. MAIN BUILDING ACCESSORY BUILDING
1 FROM C/ STREET)
SETBACK LINE FROM
CENTER OF STREET Approx. 50 R
1 REAR YARD 35.45 FRONT R
SIDE YARD I LER 211 I RIGHT 61 R.SIDE 2/FT. Fr.
DESCRIPTION OF WORK L.SIDE 4 PT. PT.
K
NEW '4 T[RATI N ADDITION REAR 3 I� R.
y DISTANCE BET. BET.MAIN B
q MAIN BLDGS, ACCESS.BLDGS.
REPAIR MOVING - mom:n it
'lVAR.# DATE
BUILDING NO.OF
SIZE 1 6G ROOMS 6 STORIES 1 C.U.P.# APPROVED
EXTERIOR WALIp1j °. ROOF
COVERING j�1�S Shake-Shingles APPROV[O erl COVERING _ BY �/ DATE qn-11-'J/
e7
USE OF BUILDING AND WORK TO BE PERFORMED P.
Single Family Dwelling with attached T
Garage Lot &4 /j�/[/� �' // `/ 1
�� 4C/ /�fr/� SQ.R. /�/ o
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VAL AVON IS FOR THE j
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CON. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. i13
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION
BUILDING CONSTRUCTION. f /& ' IE
SIGNATURE OF �(I/�/ ,�� . � PERMIT FEE
PERMITTEE '"��"^""� -5 V.3j k
O ✓/ PLAN CHECK S 3
\AUTHORIZED AGENT J
TOTAL FEE $ 59--