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Home My WebLink About265 LILAC LN - Building Permits `,5TO 9 CITY OF COSTA MESA 4 BUILDING DIVISION I. .lie.P, `I - DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �6. PERMIT PO4-00462 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,C STA MESA,CA 92626 PLUMBING PERMIT Job Address: 265 LILAC LN Status: ISSUED Suite No Applied: 06/30/2004 Issued: 06/30/2004 Vicinity: ISSUED BY: A. Parcel Nunmber: 42615114 - Applicant: STEVEN SCHNIERER - - Address: , - . - . Phone: Zip: - " - Owner: 'KENCHEL, GARNET E TR Address `265 LILAC LN/ , - '- Phone: ' " COSTA MESA,CA Zip: 92627 - Contractor: ALL PRO COPPER REPIPES - Address: 14175 TELEPHONE AV ` SUITE C -• ' - - Phone: 909-517-2994 ; , ' • CHINO,CA Zip: 91710 - • License: 626884 ' ` ' Arch/ Eng.:- - . f -_ . .. . � . Address: . Phone: - • .. . Zip: • .- y.__ ,_License: - - ._- 4 - - -, SCOPE OF PERMIT INTERIOR WATER RE-PIPE TO 12 EXISTING FIXTURES. - .;FEE'SUMMARY ; - AMT.'`, QTY AMT 'QTY j"� , AMT QTY ISSUE FEE ' , $23.50 Laundry Tub/Washer $0.00 0 -=. `;' Sump-Pump '$0.00 0 Backflow irrigation $0.00 0- Landscape Irrigation $0.00 0 . Swimming Pool $0.00 0 Backlow Preventer $0.00 '0 P-Trap ' - • . $0.00 0 , Trap Pruneri/ $0.00 0 Bathtub $0.00 0 .Pressure Regulator ' $0.00 0 _ -- ,- Urinal _ - /' / $0.00 0 Clarifier System \` , $0.00 0 ' - Process Piping(per10 ft), $0.00- . 0 - ".- ` Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) '-' $0.00 . 0 Receptors' - 1 - $0:00 0' - Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 ' 0 ' Septic Tank . _ $0.00 0 - ',\Wash'Basin! $0.00 0 Dishwasher $0.00 0 - Sewer Cap for Demo _ $0.00-- 110 ,\ Wash,BasinSet $0.00 0 Drain, Floor $0:00 _ 0 _ ,' 'Sewer Connect . ' ' $0.00 --0 Waste"and Vent System $0.00 0 Drain,Rainwater $0.00 , 0 Sewer Private Line ,- -- $0.00 ._ '0. ' - Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0-_ci _ Shower` - . :>'_. - .$0.00 0 . p -,Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 ,'Sink,bar - $0.00- „0,,-'_ - Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial.Tic:: : -$0.00'' A - - Water Re-pipe $9.80 1 ' Gas Earthquake Valve $0.00 0 Sink, Floor • - - . . . $0.00 0 Water Service $0.00 0 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 2446-46(6/00) • ECLAR ' • A O .---t 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. ❑ 1'¢ave 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. `M workers compensation Insurance carrier and policy number are: �! / oar: �'-'}-c.—*C_ C"'V T(\!\ -oily Number: OCz� 4 yp --Z�/ I y his section need not be completed if 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• alifornia,and a•ree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith mply with the yAppint Signature: - u - ��7� Da 6p/3��- ( ti., FAILURE T••SECURE WORK -S'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPCOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDI ION 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 andoProfessions Code,and my license is in full �foorce d effect.Lic.k • ._ . /,.Cos;# C�C,o (c tractor's Signature: �.-.—.are F.:;,-,:h7atis: l.ol?ln((�r-F 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 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 driver's license. 0 Yes ❑No Driver's 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(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: 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? 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 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? 0 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 a plication aEEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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? ❑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 ❑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: 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. in .. •wner(s) D.tei e • Om V+ Anted Applicantlate CODE I INSPECTION TYPE ON INTITI4 S CODE I INSPECTION TYPE DATE INTIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical +� Q,,, 1266 Pool Spa Final 208 Final Plumbing 7-i•Qy f]'_ 200 Final Re-Roof 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 I I PR07`tT_ADDRESS: 265 LILAC LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 064217 oWtWR. is NAME: KENCHEL, GARNET E ADDRESS: 265 LILAC LN PERMIT NO: B 064217 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA,CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: SIR PURPOSE: ALT 646-6112 ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : T/OFF SHEATH REROOF W/COMP SHINGLES SQ FT: 6, 200 ADDRESS: UNIT: CLAIM VALUE: 6, 200 , 00 CALC—VALUE: 6, 200, 00 GROUP OCC : R-3 /M-1 PERMITTEE: CALTON ROOFING ( 714 ) 549-2725 ADDRESS: 3124 MCKINLEY COMMENTS : REROOF 2700SF W/COMP SHINGLES, SMOKE DET REQUIRED j gig l UBC COSTA MESA CA 92626 ******************************rE*******EE*a<-****vE*sES****vr***** �C LJ �+�•�•'��W-�(- LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R E Q U I R E M E N T S E I L CTO R 7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. S E T B A C K S CITY uc.: 051149 STATE uc.:587704A ¢� REQUIRED c litre .0 G MAIN BUILDING ACCESSORY UILDING Date: 2`9 hj Signature: rtG _ _ FRNT; FT IN REAR; FT IN FRNT; FT IN REAR: FT IN WORKERS'COMPENSATION DECLARATION: thereby affirm that)have a certificate of consent to self-insure oracemficate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN Compensation Insurance.ora certified copy thereof(Section 3800.Lab.C). 'OLICY NO.: EXP. DATE: COMPANY: PARKING REQ: PROV: PARCEL: 42615114 ZNE: REF NO: • ❑ Certified copy is hereby furnished. ❑ Certified copy is tiled with the city Building Division. PLANNING NOTES> Date'. Applicant: ************ ******************************************************1********** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). D E V E!:.L O P M E N T 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 issueq.I sh of a ploy any perso any manner so as to become subject qm thee Workers'Compensation Laws of California. �� ZONING APPROVED BY DATE: Date: Il.-Y^—9-5 Signature: k' "" NOTICE:If.alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE: - 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 IS SUED B Y: C, tw DATE. 1��-l'gJ[ which this permit is issued(Section 3097.Civ.C). ********************************************Ri�,`********************* * *.1 ***. LENDER: ********************************************************************* ********* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL' SEGMENT:Y t OWNER BUILDER DECLARATION: I hereby affirm that lam exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SM IP/RES • GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 90 . 00 6 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 SM I 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 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 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 property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID v DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 90 . 62 0 . 00 0 . 00 90 • 62 90 . 62 , 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.It, however the building or REVENUE DIVISION TOTALS--> COLLECTED• 90 , 62 OVER/SHORT improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improvet , 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 90 • 00 . 6 2 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon '" . and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *************************************************.***.****.)f**.)f*****.7{.**.******{p****. that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN (T ❑ I am exempt under Section: B.&P.C. for this TYPE QTY DESCRIPTIO N UNIT COST 'i TOTAL COST Date: owner: SFR 6200 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 1. 6, 200 . 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 0 0 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 c- permit for construction or modification from the Air Quality 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 above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize repress tatives o this city to ent up the above-mentioned property tot inspection purposes. p - '. Date:2 2!t'43 Signature: / . /a/- : 01 00147888-00147889 TCET 90.62 Driver'sC/.Lcense or Social Security a: DATE: 04/28,!! TIME: 11:40 1641-46 White—Building:Green—Code enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor _a _. . CONSTRUCTION AND PLANNING r � & SPA Illh APPROVALS Permit # Date Inspector Date Inspector APPROVALS Permit# 1: Temporary Electrical Service or Pole - ' 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. , . 53. Steel Reinforcement .3. Electrical Conduit,Utility-Undrgrnd. 54..Forms r_ • 4. 'Etectrical Conduit•Undrgrnd. 55. Electrical Bonding 5. S:eeLReinforcen'erit 56. Rough Plumbing & Pressure Test rc =,6: 'ElectricalUFERLGrnd. 57. APPROVAL TO COVER-GUNITE -7,_-Footings � 58. Electrical Conduit-Undrgrnd. • .8. Foundation ; 59. Gas Pipe, O Unclrgrnd.,'Test it Water Pipe-Undrgrnd. 60. Backwash Lines,P•Trap, 0 Undrgrnd. ' 10. Structural Floor System 7 , 61. APPROVAL TO DECK ,- 11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final , . 12. Sawer Cap63. Heater & Vent-Final / 13. Roof Drains / 64. Plumbing System - Final . C 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 i DPermit# .. -r ' . - r. . 21:;Ducts,in Stractdre: . ... _ '1 ;.;t = -'70. Underground Hyciro 22. Cutts, Ventilating - r i 71. ProductPiping 0Gas OOiI 23:,GakPip4'Ro gh &Test ii. ,-1 • , : 72, Underground Flush, - .. 24.,,Roaf Framing - ,732-i Undergrn i Storage Tank'0 Gas 9 Oil 25. Rauf Sheathing ""`"' _ .-•r . ,9 : " 74,:.Overhead'Hydro� 26.LT-Bar Ceiling (Structural; &,Monocoat' I�0'' ' .i>. • 75-24Dry Chemical = -I -.L' 1. 27: Framlhi e andFlashing ;tr, r , - 76. Dry Stagi4e . _428. Lathing& Siding - t •• ••-. : 77;' FIXED SYSTEM FINAL. "29. Insulation •",. :, a I j I; 1,L. TB,: FIRE PREY. FINAL .v. at • • n 30. Drywall.Nailing x I b !' MM - LHEALT -DEPT . REQUIREENT • 31. Plaster Brown Clot, '• ,.792FINAL INSPECTLON � ' -.32-.Electrical Povver,Meter-Final I j -- + '80:nFOOD CERTIFICATE ISSUED 33_FinAl Electrie * f I I' "Notes: y n,n in fix .' �" .� ` -y ,. , 1;34. Final Heating&'Ai ir C"bnditioning- c ,,:t: ; !35.•Ficial Gas Pioe-Test- , `` t- r;:_ 1.' 'T _ ;,3&i-lo'od or Canopy ., i r .4-• n - Y � ; ', - X37:Final Factory Fireplace , -- - r 1 • it .. _. s .. .. .� I _ -fir r _ ,J,. t.. . _ 38. Final Plumbing S39. Water Service=Final. - i.:‘ 4 r Cr. . 1 * . 7. ,40. Gas Service Final. ` - 7- .c . `...-41. Solar Doinestic•Einal , •- r �' m If R • 'V: - ' 42::-Backflow Preventers F y • ;i , a: d•r, _ , 43. Backflow Irrigation _ - 44. Landscape Irrigation System -1 • L: .ar,, r .9 ,i - ,;, p m, _, x.45. Sound Attenuation - ,1.- - - -' r r. o ,It ,. _ . .. ,t Lr - _ a, . $-1t3 -46.';Handicap Regulations ••�• - '• ' r -'•r„ •• -, -. - 1 •C . .+ r 47:_FINAL STRUCTURE &'UILDING'• !V,•�`_s13 �W�, -"._`So 1442- 7. r O _/� `� 48:.FINAL PLANNIF,IG E_ t„ - 49. -Electric Release to`Edison„ ` •r.' 50. Gas Release to Southern California Gas Co - 1 - 51. CERTIFICATE OFO000PANCY - 'i , , OR. OCCUPANCY No. • ' 'Date 1436 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT APR 26 t3SI P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE DEPT. For Applicant to Fill In Completely APPLICATION1FQRPERMIT MESA SA • TYPE OR PRINT � BUILDING NG - ADDRESS 265 Lilac Lane COSTA MESA. CALIFORNIA - For Office Use Only OWNER Irving. C. Jordan 1 RECEIPT NO. I .TNO. MAILDRESS 3700 Newport Blvd. . RHC81 BY DA EOE VCO DATE ISSUED AD CITY Newport Beach ELOR38811 BUILDING / ✓ "•R C 1961 C ADDRESS HI ARCTECTER ' D. Southwor th NoLI85161 COSTA MESA. CALIFORNIA ADDRESS Costa Mesa FIRE ZONE TYPE )� GROUP'( 27 CONTRACTOR 0.0„ jt_. APPROVED BY DATE ADDRESS Same ZONING pp CITY p ZONE I P0.LANE BUILDINGS /. Wi �l / STATE B1-82547 No: 0R3 8811 LEGAL yA I/ DESCRIPTION SIZE - - 11 NO. OP BLOGB. ��'-'��`'��Q/'� OF LOT e S - _ — ,5..., C NOW ON LOT 0 A.P.NO. /i '�/S' .-4'9. -�/�/I USE OF YARDS EVES EXISTING BLDG. APPROVED ALLOWED SETBACK LINE FROM (CENTER LINE ST.) / CENTER OF STREET REAR YARD FRONT (0OFT. IN. SIDE YARD I LEFT 5 , 0" - I RIGHT 5 I 0" R.SIDE SFT. IN. DESCRIPTION OF WORK L.SIDE SFT. IN. NEW - I X II ALTERATION I II ADDITION I REAR 7� FT. N. I H MOVING I °I DEMOLISH I 11,12/PROVED /• L 0( i �'/ f_/ REPAIR ! 11( .1.2/ 1 DATE BUILDING NO. OF ) ., ST SIZE ROOMSSTORIES _ 4-2 � . Tr EXTERIOR WALL,' ROOF 4-2-s--..(7r--.4-2-s--.4-2-s--..(7r--. COVERING 0 LUCO I COVERING Shingles _ ►s.,- , USE OF BUILDING AND W•RK TO BE PERFORMED - Res . w att. _araee Plan #1508A I 1675 sq. ft. J 421 sq. ft. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION '1 THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- fr\ PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. I PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING �] BUILDING CONSTRUCTION. ._—__ - I- SIGNATURE OF `/+I Il I� LY V1 - I�rPERMIT FEE $ 37.00 PERMITTEF ` v � ,Q C,' No ,p.,,, $ i7,i33 PLAN CHECK $ 18.50 4 AUTHORIZED AGEN 'L�/ TOTAL FEE $ 55.50 O v