HomeMy WebLinkAbout2766 MALLARD DR - Building Permits CITY OF COSTA MESA
F`v �l BUILDING DIVISION PERMIT N ER
�,�.i� DEVELOPMENT SERVICES DEPARTMENT
k rigt, PERMIT � �
o C/ -01383
(714)754-5273 • Fax(714)754-4856 • 77 FAIR DRIVE,CO A MESA,CA 92626
BUILDING PERMIT
Job Address: 2766 MALLARD DR Status: ISSUED
Suite: Applied: 08/30/1999
Vicinity: Issued: 08/30/1999
Parcel Number: 13954204 Zoning: R1 R1
Applicant: LUDWICK, LAWRENCE M ISSUED BY: r M2�
Address: 2766 MALLARD DR V '
/.: -Phone: 949-858-2.445, ,
COSTA MESA,CA--/ ,— .' _ - - Zip: 92626' -_ -
Owner: LUDWICK, LAWRENCE M
Address 2766 MALLARD DR
'• , •
'COSTA MESApCA , -
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Contractor. 7 2 // �, /
Address:' v / '%
NN i " V Phone:
Licensed
Arch : ' : : • ' Eng:
Address: r Address:
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-Phone: Phohe:
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Zip: / \ _ License: -2 * License: '
SCOPE OF PERMIT
"' AS PER CUSTOMER, PERMIT WAS ISSUED ON 12/22/97, B86257, NO RECORDS WERE FOUND.A 1 HOUR INSPECTION
PERMIT WAS ISSUED.TEAR OFF AND;REROOF WITH COMP.SHINGLES.
FEE SUMMARY - •
Plan Check: $0.00 i- Calc Valuation: • $0.00
Permit $0.00 _' - -0. ' Claim Valuation: so.00
SMIP Res: • r $0.50 / i - 1
SMIP Com: " $0.00 •
- , ,
Other $0.00 - ,
Inspection: $47.00 t -
`' Total:. $47.50 ., ' ,
, : 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 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
DECLARATIONS :�
1 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 issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed it the permit is valued at one hundred dollars($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 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 DOLLARE(5100.003),IN ADDITION 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.Uc.it Class a
Contractors Signature: Date:
1
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).
Lenders 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 o1 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:
S
O* natO r erified by driver's license. cQ es ❑No ver's Lice O (VIM!:
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(36)feet high.(Chap.3.2,Gm 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:
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 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 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? ❑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 0 N
(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,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this Application aggermit for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? ILII Yes u 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? ❑Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California 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 California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (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:
CERTIF TE 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 gree 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- scribed�irt�opp�erry/J(�fprrinsspection-eu ses.I agree not to occupy or allow occupancy of any building authorized by thi permit unti final Inspection.
Ci �JT7- V`JV0I 9 � � �•\
Sign eget Own r
And/Or Authorized Applicant Date
BODE I. INSPECTION TYPE DAM INTITIALS CODEI INSPECTION TYPE PATE INTRALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final L 208 Final Plumbing
07 I-11 200 Final Re-Roof P - `-C�4 ",/ 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
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTR UCTI •N PERMIT - PERM�r NN a� 3� TRACT NO. LOT NO. UNIT NO. 8378 14/08/3U
�1/y 150lJ' TI
Project Atldress ,,2/ 6,61 4/I rs r�,�
Applicant's Mailing Addres /�/y� Sr , I' TYPE OF CONSTRUCTION LI NEW U ADD LI ALTERATION Vit REPAIR
Owner's Name IR ���/ • / U CONVERSION ❑ DEMOLISH ❑ OTHER A.P.#/, Zone
Phone Sall DESCRIPTION OF WORK/USE OF BLDG.
Address I / .61 S Main Building: Accessory Building:
E Z
Arch/Eng. License No. TYPE OF PERMIT U GRADING L_yFOUNDATION 0 STRUCTURAL T Front p
Address - ./7 �/1 / ❑ TENANT 0 ELECTRICAL PLUMBING 0 MECHANICAL B Rear N
Contractor's Nam- S. ii J I' Phonil'clq W) U OTHER
/OL0�';0 .g7 ,1°°/----
✓ PROJECT DESCRIPTION 5O. FT. OCCUPANCY C Right N
Address(mailing) 3 K G
IQ�� CONSTRUCTION TYPE VALUATION$ S Left
City License No. ZONE GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION Ping. Ref. # Parking Req,/Provided E
D
I hereby affirm 7 that0) I am licensed under provisions f charter (commencing Remarks: Planning Notes: RECEIVED APR - 5 1988 M
mysectionis tell) of :Divisionof 3 of the Business and Professions code, and ' T
my license is in ful f. c:and effect.
once I. s ✓ / 'cense No. s v S
to - In Signature /WA/ . _ _ PLUMBING FEES
WORKE .5' Cs MPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
I hereby affirm that I have a certificate of consent to self-insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
3900, Lab. C� n/n� _or c��„ //„ ,f Automatic Washer Transformer ❑ 15-50 KW
Policy No. 4?
( "/ S Company cc.
7Zt?4 i[f f ( Backflow Irrigation - Sewer Cap0 50+KW
Construction Pole Sub.
certified copy is hereby furnished.
t Ce° fifes pr($- ed with the city Bu g lr /�1 / Bathtubs Sewer Connection Cooking Unit Meter Our)to 100 amps
Date ✓((y�/ 0 Applicant � (� �Ji( �i(/�/ .
EXEMPfION IIROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or
less). I Dishwasher Solar Piping p` + Dryers OGas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors 00.1 HP 01'h-8
Workers' Compensation Laws of California. •_
Date Signature Floor Drains Swimming Pool w/Spa F.A.U.
NOTICE: If,after making this declaration,you should become subject to the _ InC$Olar e0 9-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Li ht
I hereby affirm that there is a construction lending agency for the performance 9
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater
Lender's Name p Outlets Range
Lender's Address Kitchen Sink Water Service Switches .Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry y Tra s Generator ❑05 KW ❑515 KW
any structure, prior to its issuance, also requires the applicant for such permit - - Trash Compactor
' /to file a signed statement that he/she is licensed pursuant to the provisions of ROOF Drains
the Contractor's License Law(Chapter 9 (commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt
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 T— —
E
LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3
' compensation, will do the work, and the structure is not intended or offered — - Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
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 DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑
sale. If, however, the building or improvement Is sold within one year of cum- Canopy Type II ❑ Zoning Approved By Date
prove , the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By Dat
prove for the purpose of sale).
0 i, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con-
license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ �' PERMIT
'f
0 lam exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG Fire Dampers PLUMBING
$-71 ISSUANCE $ _
•
1111_Dale Owner Heating System& Ducting Registers I_ PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above 00.100,000 BTU 0100,000 BT —
GRADING $
information is correct. I agree to comply with all city and county ordinances ELECTRICAL $
and state laws relating to building construction,and hereby authorize repro- PLAN CHECK 50% $ MICROFILM $
sentatives of thi city o enter upon e above-mentioned property for � .1
inspection pure /�j p /('p MECHANICAL $ TOTAL FEE $ ( �
Signature {J' / •
'��
CMF 0865-46,rev. 10/114 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1.,Temporaryi.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 t•= •
rr.
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 UMdrgrnd.
10. StructuralF-loor System 61. APPROVAL TO DECK I- '
11. Property Sewer Line & House Connection 62. Backwash & Receptor-FinalL,
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 I 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 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT •
31. Plaster Brown Coat 79. FINAL INSPECTION . -
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38.- Final Plumbing, Li/ei/8e
•
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.-Special Requirements Completed - r,-
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co `-
51. CERTIFICATE OF OCCUPANCY
No. Date
%J' I
OWNER MESA VERDE BUILDERS, INC, DAM 4-19-b'(
JOB ADDRESS 2766 Mallard Drive BUILDING PERMIT NO. 26918
GENERAL CONTRACTOR Meas Verde Builders DESCRIPTION OF WORK Residence W/Att• Garage
AP No. LOT 41 TRACT 6237 FIRE ZONE VALUE $ 35,338.00
INSPECTIONS Signature Date GROUP I & J TYPE V ZONE -B-1
Soil ties L 4 I PERMITS ISSUED
SUBCONTRACTOR Date Number Signature
Gas (,/ owes" t SI6G'1/ t�i 6--i6-G'7
Water U,F, ,,3'0 - f/6-C7 M.- /• (-r6-C7 Plumbing
Rough Plumbing
- ti-i#-6 ' L_i l . - 4 Ai
Prop. Swr. Line mouse Con.Cl.---- 7_'3--{„�j (. ��//�r/P/r.' 10-- ifira
Sprinkling System // /
Miscellaneous .Lr k CQ_6- (k.- - -G 4O-cic, C(6 ctcn' -
Rough Heating and n,it Conditioning V -
Temporary Service or Pole
Underground 0 Power 0
Rough Wiring file (•z(. Gry eating and Ve t.
Trenches ® Forms ® Steel Rein!. p Ip(W 1--7--Cy �i . - A.nU'Pr Fd-67 -,rh 7
Floor System /AM 7-5-6.7
(Ql /
Bond Beam 0 Steel Reinforce 0
Sheathing 4;/pi/ 6-.G -67
Frame and Flashing n0y14 C-79_49
Lathing— In N Out vg 7-,r-cy ,j, J 7_ rc-6/
Plaster, Brown Coat 4,y31, 7-17-47
Structural, FinalBectric /� 1
Heating, Vent., Refrig. and A.C., al (Q� j e-e- . `g747 /-a-a7 7,7„��Plumbing, Final and Gas Test S act¢ rer:
Electric, Final /P Building, Final �j
2G91 g
COSTA MESA BUILDING-SAFETY uEPARTMENT APR 25-, ,,;SAOO121+6 158. 5
P.O.BOX 317 COSTA MESA.CALIFORNIA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
Lot 41 TYPE OR PRINTTraCt 6237 BUILDING
LDn n/ / /� --)t, For Office Use Only
ADBUIDREINa SS / 66 �R//A-/tD
RECEIPT NO. Mit
COSTA MESA, CALIFORNIA ��� q ,�G rn��r1 tT•J,(
mesa Verde Builders, inc. REELt Y DATgn-/7E 7 �,F'eSI,E°l/
OWNER 1 'cK7�LXX `f9 `I(({1,J7{1.' L/F /�
BUILDING
MAIL ADDRESS
ADDRESS 2850 Mesa Verde Drive `/�
C.�105 FIRE l
TEL. 111�11((�3F``�)�J''(( ZONE TYPE GROUP
CITY Costa MPGA NO.
ARCHITECT TEL. '547- APPROVED DATE
OR ENGINEER Kaltenbach NO. 8046
ZONING
ADDRESS 1823 E. 17th St. Santa Ana
Mesa Verdes BBuildersL�lSiX]Y,Yiinnc Y. nix r/ I NO. I BUILD G
CONTRACTOR Ie11eet4xv134APMW1%1SX-yac , ////�J�/�" /yam- `� �l
LEGAR v 5-,� I/-///, '3-"V
ADDRESS 2850 Mesa Verde Drive DESCRIPTION C
CITY Costa Mesa A.P.NO.
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE
LIC.NO. 187318 NO'EL. 549-0395 30'TO SIDEft REAR P.L.
/ u X EAVES
SIZE OF LOT (O / (0 / I NO. F LOGE 0 ALLOWED (U.B.C.REQUIREMENT)
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C//L.STREET)
SETBACK LINE FROM FRONT 9/A FT. FT.
CENTER OF STREET REAR YARD
SIDE YARD I LEFT I RIGHT R.SIDE SFT. FT.
DESCRIPTION OF WORK L.SIDE. 5- FT. FT.
NEW X ALTERATION ADDITION REAR .30 FT. FT.
DISTANCE BET. BET.MAIN 11
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS.
BUILDING NO.OF VAR.# DATE
SIZE ROOMS STORIES C.U.P.# APPROVED /
EXTERIOR WALy4. ROOF Shake APPROV r�
COVERING 0LUCC0 I COVERING Shi
BY j� DATE �jP�/
USE OF BUILDING AND WORK TO BE PERFORMED
New Residence 14Y
,r // �/ 4 // Cl
1 ,/J /�d BG.FT.7 `7 7� 01
I HEREBY AC NOWLEDGE ATI HAVE READ THIS APPLICATION THE AMOUNT SH N UNDER VALUATION IS FOR THE
AND STATE HAT THE A E IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. FO
PLY WITH ALL CITY ORDINANCES AND LAWS REGULATING VALUATION
BUILDING CONSTRUCTION. PERMIT FEE $ APO 45-0 n
SIGNATURE OF,' •i'/ (�k?Jl��
PERMITTEE YV $g6, D� io
JJC
AUTHORIZED AGENT
$ /5-1;125---LL
TOTAL FEE