HomeMy WebLinkAbout3160 KILLYBROOKE LN - Building Permits PROJECT ADDRESS: 3160 KILLYBROOKE LN UNIT: CITY OF COSTA -MESA — BUILDING PERMIT PERM NO: B 052958
OWNER'S NAME: HUNSAKER DAVID R
ADDRESS: 3160 KILLYBROOKE LN PERMIT NO: B 052958 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION RE—SHEATH 6 RE—ROOF W/ASPHALT COMP SQFT: 5, 200
ADDRESS: UNIT:
CLAIM VALUE: 5, 200. 00 CALC—VALUE: 5, 200.00 GROUP OCC: R-3 /M 1
PERMITTEE: CONSUMER SERVICES ( 714 ) 754-1533
ADDRESS: 17450 MT HERMAN B COMMENTS: SMOKE DETECTOR(S) REQUIRED IN HOME.
` FTN VLY CA 92708 ****************************** ****+ *************************** ***************
LICENSED CONTRACTOR DECLARATION: hereby affirm Thal am licensed antler pro inions of Chapter 9(commencing with Section Z O N I N G R E Q U I R E M E N T S
7000)of Division 3 of the Business and Professions Code,and my resin lull t. antl effect. SETBACKS
CITY IIC.: 044683 STATELIC.:424349 0 , .Ss' g ,
Date:_7— i -14 Signature:___,____ _ _ ` MAIN BUILDING ACCESSORY BUILDING:
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR
WORKERS'COMPENSATION DECLARATION: I hereby at firm t . have a c ificate of a`nt to self-insure or a certificate of Workers' FT IN
Compo Ntin Insur0509certiliedd copy thereof(Section
3600,DALab 1)0/O1 /.`� LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
7 CDMPANY: STATE PARKING REQ: PROV: PARCEL: 14102216 ZNE: REF NO:
'] Certified copy is hereby furnished. 2 Certified copy is fa, e city:/ife g Division. PLANNING NOTES>
Date: �� ���� Applicant: _�, _ Y_ — ^ ********************************************************************.*:*.*********
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section m•• of be co the permit is for one hundred(5700)or less). DEVELOPMENT SERVICES 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: pl. .n .'rson in any manner so as to become •_
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE:
Date: Signature:
NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : /a DATE
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. 11,
CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• ' w / DATE
which this permit is issued(Section 3097.Civ.C). *************************.t ' r *** . • . * . * * *******{E{E*{F.{(-*.)(..**; r %�.Sf lr 3e **
LENDER: ******************************* ' *-******* '* .f, ********************************* •
ADDRESS: LEGALIZATION:N F E E S U M A R Y STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 81 . 00 • 5 2
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SMI P/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
•
any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). ISSUE FEE L.
1, as owner of Ise property or my employees with wages as their sole compensation, will do the work, antl the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS—---> 81 . 52 0 . 00 0 . 00 81 . 52 81 . 52 . 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 or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 81 . 52 OVER/SHORT: . 00
for theemepose of sold le)hin one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
• for roe minis sf dale).
I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 81 00 . 52
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
1 and who contracts for such projects with a contractor(s)license pursuant to the ContractorsState License Law).I am aware ***************if******************it*************If*****X******if******if**I.E.ifW') **)4-**
that proof o1 their Worker's Compensation insurance should be provided to me. IND I V I D U A t, F E E BR EAKD OWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY ,..S C R I P T TiO N UNIT COST TOTAL COST
Date: Owner: SFR 5200 REROOF BY VALUE RESIDENIAL_ NOZONE 1 . 00 5, 200 .00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from +, /
these provisions +•V///
Dale: Applicant: '
I hereby certify that I have read this application and state that the ahoy i orma ,n is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and.* It.Re r•es. lathes oTthis city to enter upon the above-mentioned ; i
property for inspection purposes.
01 090T.723—(41192.534 TOT
Date:? l q=7j signature: =�i— •_ DATE: 97/19/91 TIiiE: 1:42i •- -�
Driver's License or Social Security n:
1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Hetenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING POl SPA
APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service.67- Pole i 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. . " 53. Steel Reinforcement3. 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.
i .
8. Foundation 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
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. Duds,in Structure 70. Underground Hydro
22,,Ducts,Ventilating - - ,71. Product'Piping 0 Gas 0Oil
23. Gas PipeiRough & 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 Flaship9 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL '
-29. Insulatign . 1 I , 781 FIRE PREY. FINAL
30. Drywall Jai Iing :: II, :1 • HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat ' ( 79. FINAL INSPECTION • .
32. Electrical Power Meter-Final - I� -- 80.. FOOD CERTIFICATE ISSUED
33. Final Electric - - , ••1' •; Notes: ..- J
34. Final Heating & Air.Conditioning,
35. Final Gas Pipe-Test / 2 - ' ' '
36. Hood or,Canopy. / : -
•
37. Final FaEtory Fireplace /yqy - -,,-
,4 -
-38. Final Plumbing -
39. Water Service-Final ' I`^
40. Gas Service-Final -'
.41. Solar Domestic-Final - - - •
Li t• -
' 42. Backflow Preventer - I '
43. Backflow Irrigation
44. Landscape Irrigation System i , - -
45. Sound Attenuation - ' • '
I
'46.,Handicap Regulations -
47..FINAL STRUCTURE & BUILDING Illt t
48. FINAL PLANNING ..-i
49.-Electric Release to Edison i�'' r •
1..? •
_
: 50.,Gas Release to Southern California Gas Co _ i ' .A,
51. CERTIFICATE OF OCCUPANCY .
No. Date
J
PROJECT ADDRESS: 3160 KILLYBROOKE LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 052959
OWNER'S NAME: HUNSAKER DAVID R
ADDRESS: 3160 KILLYBROOKE LN PERMIT NO: B 052959 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA, CA 92626
CONSTRUCTION TYPE; 5—N PERMIT TYPE: STR PURPOSE: ALT
ARCHIENGINEER: REG.NO.: JOB DESCRIPTION : INSTALL THREE ( 3 ) SKYLIGHTS ( ICBO#3609 ) SQ FT: 2, 000
iii
Pr, ADDRESS: UNIT:
CLAIM VALUE; 2, 000 . 00 CALL—VALUE: 2,000 . 00 GROUP OCC: R-3 /M-1
PERMITTEE: CONSUMER SERVICES ( 714 )754-1533
µ ADDRESS: 17450 MT HERMAN B COMMENTS: RE: B52958/RE—ROOF PERMIT.
FTN VLY CA 92708 *********-*********4E*********************M*-***********N•*********** *******X-**-***
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisi S Of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is' .N tore and effect. SETBACKS
CITY LIC.: 044683 STATELIC.:424349 4•s '
Date:=7-- _I 7— _ signature: /r -. MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a cenirate of consent 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 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: 110 5 0 91-90 EXP.DATE: 10/0 1 /-`,
COMPANY: STATE PARKING REQ• PROV: PARCEL: 14102216 ZNE: REF NO:
•❑ Cen tied copy is
hereby furrnnished. II Cendied copy is e..l ' ding Division. PLANNING NOTES>
Date: —I—/ C - Applicant: '/�� ••� *********fF******IE** ****iE*!E************1E*****3E***lE**7f******If*3E*****IE*,*T******)f**
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: his sectio need A tet if the permit is Ion one hundred(Ston)or less). D E V E L O 'P M E'•N T SERVICES R E Q U I R E M E N- C S
I certify that in the performance of the work for which this permit is issued.I shalt deemploy any person in any manner so as to become ',
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY S•. : DATE: -
Date: Signature:
NOTICE:If,atter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : e i DATE: ec
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. ��� �
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED 'Y: `.�_ /�,� DATE
which this permit is issued(Section 3097.Civ.C). ******************3t�E**• • -• 17 ' ' •• • " • ' ********** **
LENDER: SMOKE DETECTOR(S ) *******************i6************ **** **, *************************************
ADDRESS: REQUIRED IN HOME. LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT;Y
OWNER BUILDER DECLARATION: I hereby at firm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 45. 00
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 of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the BusinessSMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN . 50
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE ' PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 45 . 50 0. 00 0 . 00 4 5 . 50 45 . 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 or offered for sate.If,however the building or
improvement is sold within one year of completion,the owner wit have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED • 45. 50 'OVER/SHORT• 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMTP/TOT GRADING PLAN—CHECK
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 45. 00 th •e . 50
❑ and Professions Cade: The Contractors'State License Law does not apply to an owner of progeny who bmlds or improves thereon •
and who Contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).lam aware ***.***************************************.*************.***.*******************.**.
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTION UNIT COST TOTAL COST
Date: owner: SFC 2000 ALTER BY VALUE COMMERCIAL NOZONE 1 . 00 2, 000 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES /
25534 and that I or any future building occupant win/will not(circle one)need to comply with said state codes and the requirements for a `//
permit for construction or modification from theAu Duatlty Management District.Residential construction applications are exempt from
these provisions.
•
Date: — Applicant: •
I hereby certify that I have read this application and state that the e of rtmati, is correct.I agree to comply with all City and county .
ordinances and state laws relating to buidulg construction and he e rear 'nl tii s WHAM dry to enter upon the above-mentioned :
property for inspeceon purposes. ' 01 0009'e5:1—GG0925Se Toy • F
Date.7-1 —Ll _ Signature: % �%. • DATE: 07/19/91 TIDE: 13t23
Driver's License or Social Security 559850775
1641.46 While—Building:Green—Cote Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL PA
APPROVALS Permit#r- Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement -
3. Electrical Conduit Utility-Un13rgrnd. 54. Forms /.
• 4. Electrical Conduit%Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement . '56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. • 57. APPROVAL TO COVER•GUNITE
•7. Footings 58. Electrical Conduit-Undrgrnd.
.8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test .
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
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, Ventilating71. Product Piping ❑Gas 0 03
23. Gas Pipe%Rough & Test .. • 72. Underground Flush- '
24. Rooi Framing - - 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing - 74, Overhead Hydro
26.'T-Bar Ceiling (Structural) & Monocoat • 75.•D?y Chemical -
27. Frame and Flashing 17_22- ( 4C.41.' 76. Dry Standpipe
28. Lathing& Siding Js - 77. FIXED SYSTEM FINAL
29. Insulation 7.224/ 641i$ 78. FIRE PREY. FINAL
C•
'30. Drywall Nailing - l 1 ;t_ HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat - • I ! '1 . 79. FINAL INSPECTION • L
-
I32. Electrical Power Metei•Final `•r 7_ •80.-FOOD CERTIFICATE ISSUED
33. Final Electric I . - Notes:
77.74A1
i
34. Final Heating& Air Conditioning I ••
,35. Final Gas Pipe-Test ( /.. 1/' r
36. Hood or Canopy - ;'".:7, •J •
37. Final Factory Fireplace 7
e{
38. Final Plumbing •✓ -
39. Water Service:Final _ -
.40. Gas Service-Final , , - `t
'41. Solar Domestic-Final - { 4_. I
42. Backflow Preventer. I .
43. Backflow Irrigation
44. Landscape Irrigation System -
45. Sound Attenuation
'46. Handicap Regulations
I J
47. FINAL STRUCTURE & BUILDING 7�/qf ' - .
48. FINAL PLANNING /V • . -
49. Electric Release to EdisonI I
Yt'(. - -
50. Gas Release to Southern California Gas Co ; / -
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER HARBOR HALL OF FAME HOMES, INC. DATE DEC 1 1 1962
JOB ADDRESS 316U K111ybrooKe Lane BUILDING PERMIT NO. '9 Sill 1
GENERAL CONTRACTOR bit eti a Cory. VALUE $ 1970,5.00 -
AP No. LOT9 TRACT 14355 FIRE ZONE DESCRIPTION OF WORK
INSPECTIONS Signature DATE GROUP ridThim TYPE V ZONE R1
Soil f. ) PERMITS ISSUED
Gas Gf/ ��f SUBCONTRACTOR DATE I NUMBER
Water 14.--,—*
/Jj /_ r/.G)
Rough Corn. Refrig. 0 Air Cond. ❑
Rough Heating ] .� q� lc_i. /S
Rough Plumbing 1' u'p -2$ er/.2-2t-IA .9 75r - •Q
Miscellaneous _ ll'�y
/
Prop.Swr.Line 0 House Con.�j St.Swr. 0 /yam S /-'G t ? " "_s . ? . i a,c._ .2-& 3 35 2 > -P`- i
Sprinkling System g'/7 '
Construction Pole
Underground 0 Power 5 �r�P -y7�"_ /]_-$-/5-4.3
Rough Wiring i /Y(/.1 3/4-(7 C:st///ci eJaj e. .$-/.S 4.3 / —
Trenches (7;1- Forms lid Steel Reinf. 0 �l� /1.2,9 62
—
Floor System k! / I'M-A)
Bond Beam 0 Steel Reinforce 0
Sheathing p ��a 3.<-4-%Frame and Flashing P� if 3-. 7.. J
Lathing — In Sr Out ®- 44 qq .�
Plaster, brown coat /r ,g`-ice
Refrig. ❑ Air Cond. 0 Final
Heating, Final _/JJ ir/2--4
Plumbing Fixtures, Final r -'3-(`3
i.:-.a r.,‘, m. ,.- ,c--44.
cmi f RECEIVED
' DEC 1 198
COSTA MESA BUILDING-SAFETY DEPARTMENT Lot 29, Trac ' 43Fj AI4CiII I-AP. O. BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPEOR PRINT '/ BUILDING
ADDRESSBUILDING j/3/6-0 /((1/%/ybYOIIl�e LI-,pi
COSTA MESA CALIFORNIA For Office Use Only
I RECEIPT NO.
OWNER Harbor Hall of Fame Homes, Inc. • ES4TL
MAIL [[ RECEIVED BY DATE /ppEECE/Iy�ED I DATE ISSUED
ADDRESS P.O. Box 2000 1, _ -77,�b /pi//, A-7�DEC 1 1 1962
city Santa Ana NO`Q 9-229 ' BUILDING
ADDRESS
ARCHITECT Jamison TEL.544-00 • COSTA MESA. CALIFORNIA
OR ENGINEER NO./ADDRESS 225 "0" St• Tustin FIRE
ZONE TYPE GROUP LQTr
CONTRACTOR Lifetime Residential Bldg Co I APPROVED JJ�'
Y DATE
ADDRESS 2131 So. Artesia ZONING
Santa Ana ZONE NO.OF USE OF NEW -04 .v...AO
CITY p - /{--i I PLANS BUILDING W/OTro{-L
LIC.STAENO.208676 No.KI 9-2204 LEGAL
EG DESCRIPTION
La t a 9 T� L/;. s- '
SIZE60001 . I ND. OF BLDGS°
OF LOT NOW ON LOT A.P.NO.
USE OF None YARDS EVES
EXISTING BLDG APPROVED ALLOWED
SETBACK LINE FROM COI 261011 (CENTER LINE ST.) COTER OF STREET �T l REAR YARD FRONT '/I FT. IN.
SIDE YARD ( LEFT !( I RIGHT 71 R.SIDE 7 FT. IN.
DESCRIPTION OF WORK L.SIDE 7 FT. IN.
NEW I XI ALTERATION I II ADDITION I REAR 2_ 6 FT. —
/ IN.
REPAIR I II MOVING I II DEMOLISH APPROVED I.IIF3/� DATE /04,1/42_
2_
BUILDING NO. OF ���
BIZE 1790 ROOMS 10 STORIES 1
COVERIING WALY1as ter I COVERING Shake
USE OF BUILDING AND WORK TO BE PERFORMED
Single family residence
7�-- .. Aga JF g o
-,1 - /7196 "/ /J" 1/4�0 D
I HEREBY ACKNOWLEDGE T T I HAVE READ THIS APPLICATION HIDER(
AND STATE THAT THE A004 IS CORRECT AND AGREE O COM- PUH ASOF BNOWN VALUATIONMIIS FOR THE
PLY WITH ALL CITY O'• CES AN STA LAWS ULATIND PURPOSE OF ESTABLISHING A PERMIT PEE ONLY.
BUILDING CONSTRUCT —. 1((``// VALUATION
SIGNATURE OF / PERMIT FEE $ 3- N
PERMITTEE .�V. 4 �� $ /1 D53J PLAN CHECK $ 3/^3 G E
AUTHORIZED AGENT A. L e Q,
TOTAL FEE i-/