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HomeMy WebLinkAbout125 WILSON ST - Building Permits 1/4 CITY CITY OF COSTA MESA - ff int BUILDING DIVISION t' ' g ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER q• PERMIT B99-00530 s' (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 125 E WILSON ST Status: ISSUED Suite: Applied: 04/19/1999 Vicinity: WHOLE HOUSE Issued: 04/19/1999 Parcel Nunmber: 43927129 Zoning: Applicant: ALEXSON, TROY ISSUED BY: Address: Phone: Zip: Owner TSAI, JEN MIEN TR • Address P 0 BOX 19184 Phone: IRVINE,CA Zip: 92623 Contractor: LEE ROOFING OF COSTA MESA Address: 1653 SUPERIOR AV Phone: (949)642-7222 COSTA MESA CA Zip: 92627 License: 349686 Arch : Eng: Address: Address: • Phone: Phone: Zip License: Zip: License: SCOPE OF PERMIT REROOF-T/O, INSTALL 1 LAYER 30#FELT, USING EXISTING SHEATING&INSTALL 25 YR COMPOSITION SHINGLE ROOF(1600 SF). FEE SUMMARY Plan Check: $0.00 Calc Valuation: $3,200.00 Permit: $87.25 Claim Valuation: $3,200.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $87.75 PLANNING&ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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 .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. Dr 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 issued. My workers'compensation Insurancinarrier and policy number are: 2 /-_ �! Carrier: �,t . (072.41 Yi�.�•,.C7 • Policy Number: /3-00 >t k (This section need not be complet it the permit is valued at one hundred dollars(5100)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 subject to the workers' compensation laws of California r nd a. .: that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these r n Applicant Signature: ll `? /---� " Date: y/9— 5/ WARNING:FAILURE TO S CURE WOR. RkCOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($103.000),IN••DMON 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 • 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.M ..;.p 1 / Class k es C J Contractors Signature: Al�litgar - Date: L/—/f-"9 CONSTRUCTION LENDING AGrN Y: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,CMI Code). Lender's Name: Lenders 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 subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as 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 property,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 property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet 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(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia 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: 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 0 No (Section 25505 of the Califomia 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 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). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 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 Califomia 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,has Section 25534 of the California Health and Safety Code been fully compiled with? in 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 control district or agency? 0 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 Califomia Health and Safety Code). 7 If 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 Califomia Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If Nes',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-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sign. u :Of Le.'I Owner(s) Date 'n• •r Authorized Applicant Date • CODE t INSPECTION TYPE RAIL 111IDA13 CODE( INSPECTION TYPE RAL !MALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final �[ 208 Final Plumbing 200 Final Re-Roof y-21AY 210 Final Electrical • 201 Final Block/Retaining Wall 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 2446-46 COUNTY OF ORANGE /y BUILDING DEPT: • - !J • 636 No. Broadway Pecmi[ No.. Santa Ana, California Application for Building Permit • Phone: KI 2-6211 AND FOR A Certificate of Use and Occupancy�// � nDate.laliC.._/-$.I.J U S 1. OWNER'S NAME e?I/_4-It'/ De (�f 4 A .9 fishc PHONE: MAILING ADDRESS 12 5 F 1t)) (A S D N CITY C.1Q 51 Tib-._-../ Es_k_ Naine ._.. Name_- eg4:6,✓1LFGL+-__ana - _ .__ . (Architect or Engineer) Q. v (Contracto'r,)�O /� Address Address ?LR �1� fiyugof .' __atidg_. City City [>4 u1111 /d / t State State //// ////'' Lic. No. Phone ........_._ Lic. No.._./07_-_T. .__ Phone_40- .3._9,'416 PROPOSED USE: gwi r.R----e .' 3S) ,tis 0,4/ 2. JOB LOCATION.._./2.vt�^' 1A sow 20.57%9 -.�l''ESiI. (House No.) (Name of Street) n (Town or SchoolDistrict) 3. LEGAL DESCRIPTION: Lot__.2.421:..Z$ __4 In X 3&C (Metes and Bounds Description—Use reserse side of form) 4. CORNER LOT ( ) INTERIOR LOT ( d) THROUGH LOT ( ) SLOPE OF LOT ( ) 5. SIZE OF BLDG • _ AREA• __.SIZE OF LOT: AREA: 6. HEIGHT OF BLDG.: CEILING HEIGHT- NO. OF STORIES 7. NO. FAMILIES , / Size of Smallest Bedroom: Size of Kitchen: 8. EXTERIOR WALL CONSTRUCTION- INT /OR WALL ��JJVERING (Frame, Stucco, Etc.) - (Pins. •rywall, Etc.) 9. SETBACKS: Front Yard from Center Line of Sttrree -._ . � �, _.._ Nearest Side Yard Rear Yar. ___./ -/.Distance :n"Fe :. ween Bl.g . -• Same Lot 10. A COMPLETE PLOT PLAN IS R' ! I/ 'ED, SHOWING A'. STRUCTURES AND USE OF EACH. 11. For (a) Footing: Width Depth in Ground Width of Wall Accessory Bldgs. and (b) Size of Studs: Spacing "CC Material of Floor Similar Structures: (c) Size of Floor Joists: Spacing "CC • • (d) Size of Rafters: Spacing _ "t C. 12. VALUATION OF PROPOSE �0ORK: Including all labor, plumbing, electrical wiring, heating, ire sprinklers, paint- ing and sewage disposal $ -04-. 13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATETEOF CALIFORNIA APPLICABLE THERETO. Signed:__C.... es ,6em.e4 Plans Filed: _ _ 14/anter i 14/ant an ass 0 (Authorized Agent) FOR DEPARTMENTAL USE ONLY FEES: ..------ CH ING BY Bldg. Permit - $ ,3 I 0—C2 GROUP __..____. APPLICAT : / HEALTH Plan Check - $ • c� O TYPE ZONING `" FIRE Total - - .�r_L-S_ DIST. MARSHAL ��' — MAP PLANS AND Receipt No. - SPEC'S STATE Paid to �_e �_ SHEET NO CORRECTIONS ENGINEER Date /Z /Mtela __ V�E�RIIFpIED CAL / 01) PERM �L� BDATE v.-f ---------- 5M-7-5a 0 METES AND BOUNDS DESCRIPTI - - i�Pi 72194.7./ 441.2.4 11)-1/ Ino -,19?"- _ b 4.44 9 _4_ ` f >r Aess-4 SC 4 y n & //Q 4/L i O e.4_,../AAarfrifro 110 20 310 410 5p 6I0 --- - - , • 1 I1 1 II M 1 0 o In ---- 0 e • n • 0 0 rn CITY OF —STA MESA PARA FEES N2 2 01 Fee Payment Receipt Project Address /cal W ! ISO S0 h Park Area p A. P. No. « 7 —'Y oil —/OW Building Permit No. 2.076 Owner's Name 8urgcs, y-- 1,diI/e4/77 .5 6 S Mailing Address 3 7 61 Si rail / 51- ' ` FEE Single Family * No. of Units @ S455.20 = Multiple Family ** No. of Units 3 @ S321.32 = 9'63.p94 p Total Fee ins.s. ! 6 Planning Department Ap. • late O 3 74, By Pile. Applicant's Signature t * City Ordinance 72-44 ** City Ordinance 72-45 "** City Resolution 74-124 gig. ��U White-Planning; Canary-Planning;Pink-Finance;Goldenrod-Applicant CMF 0174-26 J"�' DUL't.DO - W1LL. ari "nL i5-10-/O JOB ADDRESS 125 East Wilson Street BUILDING PERMIT NO. 42470 GENERAL CONTRACTOR Mead Hse. Wrke. Co. DESCRIPTION of WORK Demo. Res. t. 114-011-27 LOT TRACT FIRE ZONE VALUE $ 400.00 ECTIONS Signature Date TYPE p GROUP j ZONE R-7 QSOIL SUBCONTRACTOR PERMITS ISSUED GAS Date I Number I Signature WATER Plumbin• ROUGH PLUMBINGr-� 7Jre44il�• • dr- Ig-/6. 7414,94f/ .4- PROP. SWR. LINE a HOUSE CON. ❑ SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER ❑ ROUGH WIRING Heating and Vent. TRENCHES C] FORMS ED STEEL REINF. fl FLOOR SYSTEM BOND BEAM In STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING - IN n OUT n PLA-TER, BROWN COAT S' URAL, FINAL Electric • HEADING. VENT., REFRIG. AND A.C., FINAL PLUMBING. FINAL AND GAS TEST In ELECTRIC, FINAL BUILDING, FINAL CPFr ICI RFnIIIRFIJFNTS 42470 '1'r 16-76FR:7001198* *****5.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 For Applicant to Fill in Completely —Use Ink Only APPLICATION FOR STRUCTURAL PERMIT / REC IV BY T RECEIVED DJ�p� IS UE/mss BUILDINGDRE / I.— I.W I LS Ott E � `r•/ ADDRESS ZS Ca R ��/) t 7 PAF T OWNER Bu e,6% s'ViLb(A, ms , A.P. NO.f�BUILDING /7�i���`�iJ !Ii'"'"r MAIL ADDRESS JZ.5 gV1A I L fl%) ADDRESS TEL...� q TRACT 7OD LOT 7, BLOCK CITY CONSTRUCTION ND4G—fit NEW ADD ALTER REPAIR MOVING DFM01 . LENDER BRANCH OWNER n/tQut6Es5 1-..9/il /+ ADDRESARCHITECT l D • /VALUE /�w �� ARCHITECT TEL. USE /]Lf/�� OR ENGINEER NQ. FIRE ADDRESS t� ''j ZONE �y /� TYPE GROUP / CONTRACTOQRpMGR ) /H� E,Wex coc • ByPROVED/ /t III��� DATE Qf/!p/7� - ADDRESSaO /5SjeR ap GRi Np 2T �A P' / ZO/N NO.OFF�s����� USE OF NE Pp p{� ` '/� y(., 4 TEL. / Z✓ PLA NS�f BUILDING l,�t C CITY pas r'T_Y E/Y f..l /�n07 NO7g4-7K7i '_ 1/l/� STATE _q „jam CITY YARDS APPROVED YARDS APPROVED LIC. NO,3 OO.5 13 - a e', LIC.NO�e7 MAIN BUILDING ACCESSORY BUILDING IV SIZE NO.OF BLDGS. (FROM C/L STREET) 0. OF LOT NOW ON LOT I FRONT FT. FT. Q USE OF , ) � FO// ski EXISTING BLDG. RE n_i p a �c • R,SI FT. rA F Separate permits are required for L.SIDE FT. FT. electric,plumbing and heating work. c REAR FT. FT. IV Q USE•SEr� OF BUILDING AND WORT>�p/p BE PERFORMED DISTANCE BET. BET.MAIN& c J/E MO Li —LLD 10 . /C �5 . MAIN BLDGS. ACCESS. BLDGS. :.1 VAR.# C.U.P.# DATE jobAPPROVED Q /f > DAT( 4I07 .•1 c4 0 I hereby acknowledge that I have read this application and nate n m C that the above information is correct and agree to comply with aB all laws regulating building construction, and I shall not employ i Z any person In violation of the workman's compensation laws of 2 Sthe State of California. -- I hereby certify that I em properly licensed as a contractor under SQ. FT. CM 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: am exempt from the provisions of the State of California Business to VALUATION PERMIT FEE E and Professions Code,Division 3,Chapter 9. ' a�� n 1 • m PLAN CHECK E re n Signature of �,p1 �• U. J• e Vv $ TAX E air 2 Permittee r ✓ � U Authorized Agent TOTAL PAID E • E 14 4207.6 PA.0 :UN -3-?5r„ 00 128* ***185.14 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 For Applicant t ill in Completely — Use Ink Only P ( ION FOR STRUCTURAL PERMIT 2 �I Sr, J RE�EI E :BY DATE gEC;IVJD� AEIgSUED BUILDING C/r s/i_” 2 ! .6 -3-7z ADDRESS ' I /��s� /� OWNER grle e wtU-.ANIS INC.; A.P.NO.)19--o So I PERMIT NO. MAIL _/�' R �( BUILDING ADDRESS "s,,�s�`J rest -EQ/littia+',T.' ADDRESS)19-a ((��((JJ1 IY /' ,, 3 CITY r'I -WYO�1 (sY/yfN) NOL *- TRACT POLOJ IQ3LOCK CONSTRUCTION /LOy tj �/ NEWADD ALTER REPAIR MOVING OFMOI ISH LENDER L ,[� A BRANCH I I /SL OWNER f .I% C-a, 'NC. As-- r V•LUE srryi �.k�7:��4�+•j �.�.�'`. TEL. �� _S i• s /s r $ W OR I 1 ER .I1.aA IS `reA" Ai" ri . a,d_� .. . J1�1 FIRE ADDRESS go 4 / 1 ./ LQIJL..'-W �Tlyi r ZONE YPE.. GROUP+) sr APPROVED I[/ CONTRACTOR O I /e , BY DATE ell - - ADDRESSTEZO NO.OF USE OF NEW . CITY NOL IPLANs BUILOIN��z� 0.�V/ • F STATE CITY YARDS APPROVED YARDS APPROVED LIC.NO. 1 A LIC.NO. MAIN ..aaBUILDING(FROM /nJ ACCCESSOO R'Y /BUILDING ��,,(/ S+ SOF LOT �a )C '� I NO.OF NOW ON LOT I FRONT C/Li bFTIO rET) / S� G.WF'�quJ 1 USE OFca G111 ,/ �'-r�.s� �+ EXISTING BLDG. �` '�b� µ,/�CY� R.SIDE J FT, FT, CA E-. Separate permits are required for L.SIDE SFT- FT. - electric,plumbing and heating work. �5�� Ci REAR C-25-F.T. FT. t-. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& GMAIN BLDGS. ACCESS.BLDGS. ..1 � O ry f " 0 VAR.+ DATE Q, J �/(�/C7-�• / T C.U.P.-$ //,ry�t APPROVED ./r [, >. 5 7 . d)t7 / PS^ APPROVrRY E✓�/ . lnA-- I Cl'-DATFer-6- l ...6 Ce IR 4� Iii' C� POLD l/1J�_/?.AJ/i(C\CiA_ REQUiREMENTS o I hereby acknowledge that I have read this application and state in CA that the above information Is correct and agree to comply with n 0. all laws regulating building construction, and I shall not employ m Z any person in violation of the workman's compensation laws of 2 x the State of California. / Q/' ,� 3 I hereby certify that I am properly licensed as a contractor under 373S0. FT. j;--- % i� a the State of Ca fornla Business and Professions Coda, Division 3, tHE AMOUNT SHOWN UNDER VALUATION IS FOR & Chapter 9, an./ •. such licens•s aro In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: - to am exempt frp provision • the State of California Business and Professlo Divisio. hapter 9. VALUATION PERMIT FEE $ n T rn Signature of I , /l / / r. ft �� LAN CHECK $ /7i/7 r Permittee at $ TAX $ Jl b. 2 U Authorized Agent IPTOTALPAID S./ey5./ 14 26 P.tIL C 7 'nl: -3-76E r..00 : " 7.69 u-*.z ip."0 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 AP LI AT N FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only r REC I D DATE RECEIVED DATE ISSUED LDING /?5 a1n ¶o 5 I SQJ J` -/]' ADDRESSBUIi/R07` rp/�r.-� WI �+ 1 PERMIT NO. OWNER IAE55t LLi/4-045 1NG A.P. NO. ) /�'�j MAIL I BUILDING /� �/ z frau` r ADDRESS ADDRESS /I(/(..J J TEL. TRACT LOT BLOCK CITY NO. CONSTRUCTION NEW , ADD ALTER REPAIR (MOVING DEMOLISH LENDER .v+.��/ 41 BRANCH OWNER ESS1Wil9 L14415 ADDRESS .,O/W &� ,rft$ ` OR TEL. USE\JY `/_7�Ir`i►111 E �wJ�' OR ENGINEER NO ,y FIRE '�/ / �I ADDRESS ZONE TYPE"; GROUP �d//� APPROVED CONTRACTOR BY DATE ADDRESS TEL ZONE NO.OF USE OF NEW CITY NO. PLANS BUILDING F STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING (.13I 3 SIZE NO.OF SLOGS. (FROM C/L STREET) Cl., OF LOT NOW ON LOT FROM FT. FT. Q USE OF cn EXISTING BLDG. R.SIDE FT. FT. Ca ^xI-.- Separate permits are required for L.SIDE FT. FT. electric,plumbing and heating work. WREAR FT. FT. [.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& - (- nQ MAIN SLOGS. ACCESS. SLOGS. n VAR.# DATE -C.U.P. APPROVED 7 APPROVED .}.l ___ay ATE CC ly 0 I hereby acknowledge that I have read this application and state n C that the above Information is correct and agree to comply with m - all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of s W e T the State of California. m I hereby certify that I am properly licensed as a contractor under SQ. FT. H the State of California Business and Professions Coda, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m 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 California Business VALUATION PERMIT FEE $ v and Professions Code,Division 3,Chapter 9. v+ n PLAN CHECK $ es o Signature of Permittee SLL TAX $ f U Authorized Agent TOTAL PAID $.716-....