HomeMy WebLinkAbout971 JUNIPERO DR - Building PermitsApplicant to /ill in all spaees ezcept lhose wit�in heavY borEer lines an0 slgn all apOropriate tleclarations.
CiTv OF cOSTA MESA C�VSTRUCTION PERMIT.
. Project Address , 9� �7prrh r�._ra DY • '/
Applicant'sMailingAddrPss /) C. /P� � r(� '
Owner'sName ��CP,�'. Phone`
Address Jl �
Arch/Eng. License No.
Address
Contractor's Name Phone sg400 s
Address (mailing) +� C 2
City License No. _S/ �,"> s
LICENSED CONTRACTOR DECLARATION
I hereby affirm [hat I am licensetl untler provisions of Charter 9.(commencin9
with section 7000) of Divislon 3 ot the BUSiness antl Prote55ions Cotle, antl
my license is �n tu I antl effect. �
� License I s 'c e o. .
•� Date— Signaturo . _
U WORKER 'COMPENSATION DECLARATION, - �
`Lhereby af}i�m tM1at I have a certificate of [Ons¢nt to self-insure ot a ce�Hficate
1 '� Workers' Compensation Insurance, or a certitietl' copy thereof (Suctlon
00, Lab. ) �p� � /
olicy No. �.��_(.g_tL Company ��(6.�
ertifietl cooY is hereby (umishetl.
Cer i" c py is titetl with the ciW�� ��^p7� i o}�/
Date_ ApvlicantJlV� J^/�'�_��
EXE P I FROM WORKERS' COMPENSATION DECLARATION
(Thissec ion nee� not be completetl�if the permit is tor One huntlrotl ($300) ot
less). '
1 ceriify �that'In ine pertormante of lhe work fOr whlch this Oerm�t is.lssu¢tl I
shall not employ any person in any manner so as to become subject to t�e
Wo�ken' Compen5dtion� l.aw4 of Califomia. � �
Date Signature ' �
�NOTICE: If, after making this tleclaration, you shoultl becOme subject fo the
Workers' Compensatlon provisions o� [he ldbo� Cotle, you musl fortllwith
comply -with such provisions or this permit'shall be tleemetl revoked.
CONSTRUCTION.LENDING AGENCV
1 hereby a(iirm that tnere is a construction lentling a9ency for the performance
of the work for which this permi[ is issuetl (Section 309] Civ. CJ
Lentler's Name �
Len�er's Atltlress
OWNER BUILOER UECLARATIOfJ � � ' �
I hereby affirm-fhat I am exempt irom the ConVactor's License Law tor Ihe
following reason (Section 7031.5 Busines5 antl Professional Cotle: Any city or
county whiclt requires a p¢rmi[ to cOnst�uGt, alteq ImOrove, tllmolish o� repai�
any structure, p�iOr to its issuance, a150 reqWres the applitdnt 70� Such parmit
to fiie a signetl s[atement that.he/she is Iicensetl pursuant to (he provisions o/
the Contractor•s License Law (Chaoter 9(commendng with Section 7000) ot
Division 3 ot the BusinEsz antl Profe55ion5 Cotle) o� that he/She i5 exempt
ttterelrom antl tne bazis for the allegetl exemption. Any vlolation of Section .
931.5 by any applicant tor a Oe�mit Subject5 Ihe applicanl t0 a civll
nalty of �not more than five huntl�¢tl tlollars (E500).
J I, as owner of the property or my employees with wages as their sole
Comp¢nsation, will tlo the work, anC ihe struCture 75 no[ in[entleG Or offeretl
for sale (Section .7044, Business antl Professional Cotle: The Contractor'S
License I�w tloes not appty to an owner ot a property who Duiltls or improves
thereon, antl who tloes such work himselt/nerself or through his or har own
employeei, prOvidetl tnal such ImprOvemenls are not mtontlatl or oHeretl far
Sale. If, however, the builtling or Imp�ovemen[ is SOI��wlt�in one year Ot COT-
pletion, tne owner will have the burtlen of proving he/she tlitl not bulltl or im-
��ova for the pu�pos¢ of sale). �
I, as owner of lhe proPerty, am exclusively cont�acting with IiCen5a0 con-
tractors to construct the project (Section 7044, Business an0 Professions Cotla:
' The Contractor's License Lzw Goes not appry [o an owner ot property who
buiitls or imDroves thereon, antl who contracts tor such projects witn a con-
Vacto�(s) license pursuani�to the�Gon[racfoYs License Law�. I am aware that
proot Of tbeir Wo�ker's Compensation insurance shoultl be provitletl to me.
❑ I am exempt untler Section B. & P. C. for Ihis Yeaion
Date Owner
I hereby. certify that -I have reatl-thls appliwtion antl state Ihat tha abovo �
information is correct. I a9ree to compty witb all city antl county ortlinances
antl.state laws relating to buJtlmg consVuction, ana here0y autnorize repre- '
sentatives of'this city to en[er upon the above-men[ioned property for
insPection poSpq5q5A /i � �/Li-, i . / !n !N
Drivers'
TYPE OF CONSTRUC710N NEW AOD ALTERATION ,REPAIR �
❑ CONVERSION ❑ DEMOLISH ❑ OTHER � A.p, � -.
, DESCRIPTION OF WORK/USE OF BLDG. �
' . � . ' S Main Building:
� E
TVPE OF PERMIT GaaDiNG FOUrvDATIorv � STRUCTURAL T Front
❑ TENANT 'Q ELECTRICAtL �❑ PLUMBING ❑ MECHANICAL B Rear �
' ❑ -OTHER ' A
PROJECT DESCRIPTION Sci. FT. OCCUPaNCv ' C Right
CONSTRUCTION TYPE VALUATION $ S �eft
ZONET_ GRADING CV. VDS. ACRES Ping. Fef. #
aemarks: � . Planning Notes:
Preventer
Irrigation
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service OuUets
I nterwptors
Kitchen Sink �
Lavamries
Roof9rains -� .
Reinspection �Fea . $15
Boiler �
Duct - Under Ground
Duct-Structural '
Duct - Ventilating
Exheusi System ❑ Multiple
Firepl/Fact. Blt. ICBO 9W
Heating System & Ducting
❑0.100,000 BT.0 � 100,000
Reinspection Fee � $15
CMF 0865-46, rev. 10/84 White - Builtling; Canary - Applitant; Pink - Accounting; Goltlenrotl - A55essor
PLUMBING
$hOW2f5
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Soler Piping
Solar T6nk
Swimming Pool w
Urinal
Weter Clozet
Water Heater �
Water Service
Auto-Wash �
laue Fea
HOod Or Typel �
Canopy Type I I ❑
Refrigeration Sys[em
❑0�100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers -
Registers
Issue Fea
FEES
Automatic Washer
Construction Pole Sub.
Cooking Unit '
Dishwasher
Dryers ❑Gas ❑Elec�
F.A.U.
Fixtures � '
Device Bozes
Outle[s '
4668 II/22/85
, I 2one
Accessory Building:
Req./Provided
ELECTRICAL � � j
Transformer ❑ -15-50 KW
❑ 50+KW
Garbage Dispoul
Generator O0.5 KW �5-15 KW
5a0'_ Tl.
FEES
Meter LJup to 100'ampi ,
Meter ❑bver100amps
Su6 Panei
nnoto«oo-, HP O7X-8
�Inc.Solar��9-15HP�76-15+ '
Microwave - �- ' - ' - �
Pole Light
Range '
$ign
! Standing Sections
Trash Compactor '
$'�' Reinspettion Fee $15 luue Fee
FEES '
�DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Appraved By '
Application laued Bv
$ 3
2
O
N
1
N
G
R
E
Q
M
T
S
. SUMMARV OF FEES ' �
� BUILDING PERMIT ' 3 SMIP ' $
�
PLAN,CHECK $ � PERMIT -
� PLUMBING 5 ISSUANCE $ ' .
PIAN�CHECK 25% � $ ENERGY P.C. $ �
.ELEGTRICAL �$ GRADING $
P�AN�CHECK 50% $ MICROFILM $ �/��)
MECHANICAL $ , TOTAL FEE $ �j�
PLAN CHECK 25% $ � � ,
�
CONSTRUCTION AND PLANNING POOL 'A
Date Inspector Date Ins Prror
�APPROVALS Permit # APPROVALS Permit # �'""
�1. Tert{potary Elecvical Service or Pole 52. Pool & Equipment Location
2.. Soil Pipe-Undrgmd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms �
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Rainforcement 56. Rough Plumbing & Pressure 7est
6� ElectriCal UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings ' 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P�Trap, � Undrgmd.
10. Structural Floor System � 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
72. 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. RoughWiringSign 68. APPROVEDFORPLASTERING
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 77. Product Piping � Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Freming 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 7,6: D�y Standpipe
28. Lathing & Siding :77. '�FIXED SYSTEM FINAL
29. Insulation .;78• FIRE PREV. FINAL
30. Drywall Nailing (;,r r HEALTH DEPT. REQUIREMENT
37. Ptaster Brown Coat �7.9� FINAL INSPECTION
32. Electrical Power Meter�Final ��80. FOOD CERTIFICATE ISSUED
33. Final Electric *�Notr.s: 7J._3(-�'(e L�l G420 3:'70 (�ic0
34. Final Heating & Air Conditioning 7- 23-g(� roo ON� ��� L�
35. Final Gas Pipe-Test
36. Hood or Canopy G�,(,EL /�,g �J�Q j�0.3 V�.�- L�c+O
37. Final Factory Fireplace
38. Final Plumbing .._
39. Water Service-Final �
40. Gas Service-Final
41 . Solar pomestic-Final
42. Backflow Preventer .
43. Backflow Irrigation .
44. Landscape Irriqation System �
45. Sound Attenuation
46. Handicap Regulations �`.'
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Cv
51. CERTIFICATE OF OCCUPANCY
�n. Date "
AOp���ant to /ill in all Tpac¢s eacept ihose y.�ithin neavy emEer lines antl sign all approo�iate eeelarations.
PE IT N TRACT NO. LOT NO. UfV1T N0.
C�TY oF enS7A MESA CONSTRUCTION PERMIT A.P. �
� -i � a�N �,FQa AP - 0 33/ -
Pro�ct Address � /��/ /G� . E Main Build�
s` TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
Applicant's Mailing Add�fss —L�- Ij'j y� ❑ CONVERS70N ❑ OEMOLISH ❑ OTHER �'� Front
Owner'sName/7�Qli�.�� E � G�/SERphonesS7-�
i 91 DESCRIPTION OF WORKNSE OF BLDG. 2 ✓—YLi�-� A Rear
Address --=� ��
Arch/Eng. License No. TVP^E OF PERMIT GRADING FOUNDATION STRUCTVRAL �� K Right
Address � 4J TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL g� Left
Comractqr'S Name Phone ss7 9/4Z � �THER ' Ping, Ref. #
� PROJECT DESCRIPTION Sq. FT. OCCVPANCV Plannin Notes:
Addresslmailing) ' 9
CONSTRUCTIONTVPE VALUATION$ �ZOO
CityLicen52No. 20NE GRADINGCU.VDS. ACRES
LICENSQD CONTRACTOR DECLARATION
1 nereby aHi�m Ihat I am licensetl untler provi5ions ot Cha�t¢� 9(comm¢ncing
with section �000) of Di�ision 3 of the Business antl Professions Cotla, antl
my license is in full force antl eftect.
License Class License No.
Date Signa[ute
WORKERS' COMPENSATION DECLARATION
1 hereby aftirm that I have a certificate of consent fo selt-Insure or a certlflcate
of Workers' Compensation Inzurance, or a certitietl <opy thereot (Settion
�0, Lab. CJ
cy Nb. Corhpany
�Certifiea copy is hereby furnisned.
Certifietl copy is filed Wifh the city BUiltling Division.
Date AOP���ant
EXEMPT�pry FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be completetl i! the permit is for one huntlretl (5300) or
Iess).
I certify that in the petfo�mance of the Wark fo� which (his pe�mit is i55uetl 1
shall not e ploy ny person in any mdnne� so as to become subje t to t�e
Worke�C � Laws of Califomia. '
Date 99nature
NOTIC �f, aft mak ng [his declaration, you shoultl l�y ome subject to the
Workers' Comp nsation provisions of the Labor CotleV ou mus[ forthwith
comply wi[h such provi5ion5 or tM1is permit shall be tleemetl revoketl.
CONSTRUCTION LEN�ING AGENCY
i hereby aifirm thai there is a consiruction lentling agency for tlte performance
ot the work tor which this permit is issuetl (Section 309] Civ. C.)
Lentler'S Name
I..entler's Atltlress
OWNER gU1LDER DECLARATION
I hereby atfirm iha[ 1 am ezempt trom fhe Contractor's License Law For [he
following reason (Seccion ]031.5 Business antl Professional Cotle: Hny aty or
[ounty Whicb requires a petmit lo con5[ruct, al[eq improve, Eemolish O� �epair
any strutture, prio� to its i55uance, dlso �equires the applican[ fo� Such pe�mi[
to tile a signetl statement that he/she is liwnsetl pu�sudnt to the provi5ion5 of
[he Con�iactor's Licenze Law (Chapter 9(rommencing wrth Section 7000) ot
Divisian 3 ot tne Business antl Professions Cotle) or that he/she is ezemo�
therefro�n antl the basis tor the allegetl ezemptlon. Any violation of Section
_=T,}1.5 by any ap0�ican[ tor a permi[ Subjects thC applicaM to a civil
-,.4,r_",„.xlty uf not more than five huntlretl tlollars (y500).
P%37 as owner of lhe property or my employees with wages as their sole
r�edmpengation, will tlo the work, ana the structure is not intentletl or offeretl
for sale (5ection ]044, Busine55 antl Prof¢Ssional Cotle: The Con[ractor'S
License �aw tloes not apply to an owner of a property who bulltls or improves
tnereon, anC who tloes such wo�k bimself/hers¢If o� through his o� b¢r own
emoloyees, provitletl that such improvements are not intentled or otiered Por
saie. Ii, however, the builtlin9 or improvement is soltl within one year of com-
pletion, tM1e owner will have the bu�tle� ot proving hE/She tlltl nOt builtl or iT-
prove tor the purpose oi sale).
❑ I, as owner of the o�operty, am exclusively contracting with licensetl con-
' tracto�s �o construtt tM1e project (Sec[ion ]044, Bu5ine55 antl Profes5ion5 Cotle:
. The CobVactor's LicenSe Law does nOt apply to an Owne� of p�ope�ty who
I builtls qr im0/oves thereon. antl who contracis for such oroiects with a r.on-
tractor(5) Imense pursuanc m rne ConVactor•s License Law). 1 am aware that
prooi oi their Worker's eompensation insurance shoultl be provltlea to me.
I❑ I am exemot under Section B. & P. C. for tM1is reason
Date Owner —
I hereby ertify that I have reaE this application a@ s4ate that the above
information is co�rect. I agree to comply wiih all clty antl county ortlinanCes
antl state laws relating to builtling construction, antl hereby authorize repre-
sentativ�s ot this city to en[er upon the abov,e-mentionetl pr erty (or
in5pecti�n purpo e . .L
Signatwe Date
Drivers' License or 55 �f � �
Remarks:
Sink
Preventer
Irrigation
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Roof Drains
Reinspection Fee � $15
Duct - Under Ground
Duct - Structural
Duct � Ventilating 1
Exhaust System ❑ Muftiple ❑
Firepl/Fact. Blt. iCBO #
Heating System & Ducting
❑ a i oo,000 sru O i oo,000 aT�
Reinspection Fee I $15
0865-46, rev. 5/88 White - Builtling; Ganary - APPlicant; Pink - Atcounting; Goltlenrotl - Assassor
Shawers
Service Sink
Sewer Cap
Sewer Connection
Solac Collectors
Solar Piping
Solar Tank
Swimining Pool w/Spa
Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fae
Hood o Typel ❑
Can y Type I I ❑
iefrigeretion System
❑a-ioo,000eru ❑ioo,000
Sysrem Repair/Afteration
Fire Dampers
Registers
Issue Fee
FEES /automatic Washer
Construction Pole Sub.
Cooking Uni[
Dishwasher
Oryers �Gas ❑Electric
$ 3
FEES
$ 3
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
$witch¢S
Garbage Disposal
Generator �0.5 KW C
N
I
N
G
R
E
Q
M
T
S.
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+ KW
Meter ❑up to 100 amps
Meter ❑over100amps-
Sub Panel
Motors OO-1 HP �1'fi - 8
"Inc.Solar �9-15 HP �16-15+
Microwave
Pole light
Range
Standin9 Sections
5-15 KW Trash Compactor
� Reinspection Fee I$75 I I Issue Fee
DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved 6y
Building Approved By
APpliration Issued BY .—_ .
� SUMMARY O F�F E ES
BUILDING PERMIT $ 7/2�. 00 SMIP
PLAN CHECK $ '1�fO • 80 pERMIT. -
PLUMBING $ � �SSUliNCE
PLAN CHECK 25% $ ENERGY P.C.
ELECTRICAL $ GRADING
PLANCHECK 50% $ MICROFILM
MECHANICAL $ TOTAL FEE
PLAN CHECK 25% $ _ .. �
FEES
$ 3
g �:S'C�
n' L'Oii43?;3-��nYi7r� ; � ",- - -
c��T�a eG���::�� -?�:. i_ _. — � -
' CONSTRUCTION AND PLANNING POOL R \
Uate Inspector Date Inspector
A'PPROVALS Permit # APPROVALS Permit #
n.
. Temporary Electrical Service or Pole . 52. Pool & Equipment Location `'
2. Soil Pipe-Undrgrnd. �� 53. Steel Reinforcement •
3. ElectricabConduit•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, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwasfi Lines, P-Trap, O 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 `
74. Rough Plumbingv. 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
i
22. Ducts, Ventilating �.�� 71., Product Piping 0 Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush .
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing � 74. Overhead Hydro �
26. T-Ba�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
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final ,
42. Backflow Preventer ��•r+
43. Backflow Irrigation
44. Landscape Irrigation SYstem
45. Sound Attenuation
46. Handicap Regulations ' .
47. FINAL STRUCTURE & BUILDING �/ � ,
48. Special Requirements Completed
49. Electric Release to Edison �,
�0. Gas Release to Southern California Gas Co �' �
n:
57. CERTIFICATE OF OCCUPANCY , � �
No. Date •
OWNER MESA DII, MAR DEVELOPMENT COMPANY
aoa nnDxE5s 1 Junipero rive
GEN�RAL CONTRACTOR �,Cco CO�._
AP No. LOT 5 TRACT 4p
I `ECTIONS � Signatuce
r�a� zov�
DATE �GROUP
-62
BUILDING PERMIT NO.
VALU� 3 18,768.00
DE5CRIPTION OF WORK res
TYPE V 7,ONE
SUBCONTRACTOR
: • 16603
' C057A MFSA BUILDINGSAFETY DEPARTMENT
P. O. BOX 917 COHiA MEBA. CALIPORNIA
�
For Applicanf fo Fill In Complefely
TYPE OR PRINT
BUILDING
ADDRE68 'I Dr' P
COSTA MESA GALIFORNIA
FEE! �CEIVED
�t 5 - �'��E�E�'T.
r� 450�
APPLICATION F�RT�EI�IIYOSTA MESA
BUILDING
For ON1ce Use OnIY
cin a Del Mar Calif NOV R 3= IBUILDING
w��Ress
ARCHITEGT C1i�f Olsten & TEL.T COSTA MESA. CALIFORNIA
OR ENGINEER 5 NO. PFi: ��.2
ADDRESS OZ 1 E, Florence Ave, Doi�ne =ONE TYPE GROU i�
Ca_ii • AppROVED
CONTRAGTOR r }� BY DATE
AODRESS 8OO E� CQ3Sti H1 t1S•T ZONING
ZON6 NO. OF U86 OP NCW Siqy �ym /�v
c�n Coxrona Del Mar Calif• %�—r vuxe � eui�.o�No w�Qy Q�
LIC. NO. 8 U�B�Z NO. �R. —�2� oBeCRlrTion L O� -S TR N 2 6 0
size 6$10 S.F. "'. °" "�`a.No
OF LOT now ox tAr A p NQ
USE OP NOne ' YARDS EVE6' '
EXISTING BLD . APPROVED ALLOWED
BHTBAGK LIN6 PROM �f [GCMlR LIN6 6TJ
caHiea O� aiweET SO� REAR YARD 22 �<�� FRONT —tD FT. IN.
SIOE YARD I LHFi � I RIGHT � p, SIDE -s~ FT. —^ IN.
DESCRIPTION OF WORK �
L.SIDE s FT. IN.
NEW A I IIALTERATION I IIADDITION REAR 2 2 PT. z' IN.
REPAIR I II MOVING I II DEMOLISM I BYPROVED W��. DATE� 2��� /�^ Z
SIZE�V•�0' ���, ROOMS 72 STORIES 1
EXTERIORµ(q LL ROOF
COVERING NI OVERING W
USE OF HUILDING AND WORK TO 9E PERFORMED
S' ' v .a • o Living area 1739 S.F.
VI attached Crara e Garage �� 460 S.F.
Covered Porch !�2 S.F.
I HEP6lY ACKNOWLEDGE THAT I XAYE R6AD TMI6 APPIJGTION 1NH AMOUM /XOWN UNO6p VALUATION I! �OR THe
AND 8TAT8 THAr THE ABOVE IB GORqHCT ANO AONlC TO COM- pURP086 OP 6BTABLIBHINo q PHRMIT PeE ONI.Y.
PLY WITH ALL G�1'V OROINANCe9 AND BTATe I�W! R86ULATING
BUILOINO CONB�UCTION. VALUATION o�yj/�-�
SIGNATURE OF - �'ERMIT FEE $ �/lJ. �
PERMI'RE T T' - �/� , _ n �
p qL C % /l"1
EY $ lU)IVB�OO PLAN CHHCK $ i ci[/
AUTFIORIZE� p
TOTAL FEE C�O n