HomeMy WebLinkAbout105 LEXINGTON LN - Building Permits " OdECTADDRESS: 105 LEXINGTON LN um CITY OF COSTA MESA — BUILDING PERMIT PERM NO: c069564
OWNER'S NAME: NELSON JEANNE L
nuns: 105 LEXINGTON LN PERMIT NO: B 069564 PLAN CHECK NO: N GOVT; N SUPP ; N
) COSTA MESA,CA 92626
CONSTRUCTION TYPE; V—N PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/O RESTH S. REROOF W/COMP & HOT MOP SQ FT: 2, 508
ADDRESS: UNIT:
CLAIM VALUE: 2, 508 . 00 CALL—VALUE: 2, 508 . 00 GROUP OCC ; R-1 /
PERMITTEE: STOUT ROOFING INC ( 310 ) 923-6775
ADDRESS: P 0 BOX 4309REQUIRED*O** **S *** * **O * SD* * *O*P **** * D* B*RS*O** D**
DOWNEY CA 90241 * ** ** * * * * * * *** * * * * * ** **********
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R EQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SETBACKS
circa.: 059 77 STATEuc.: 40253 CUB: C 39 EXP; 10/95
26 C��( �a� Signature:_ _ . MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: hereby affirm that I have a certificate of consent to sel4insure or a certificate of Workers' FRNT; FT I N REAR: FT I N FRNT; FT I N REAR; FT I N
Compensation 1Psg5,IDse.gc4Vilied copy thereof(Section 3800.Lab.p1.5/19/95 LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
POLICY NO.: ]O[L D D 7 EXP.DATE:
COMPANY: AIG Of
PARKING REQ: PROV; PARCEL: 41916318 ZNE: REF NO:
O Certified copy is hereby furnished. Lf Certified copy is filed with the city Building Division. PLANNING NOTES>
D e: ( l/ �V "1� Applicant: TU /�/Il/.(/L/L/ *if****itttieieititiEitiEi *****iti!**********itififitltiEiEieiEifielfiEiEiEitififiEit1E1f1fitiE****if****ititiEftlE******
REMPTION FR OM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQU 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 employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE: • '
Date: Signature: BUILDING APPROVED BY :
NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor DATE; r
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 B Y: • • DATE; D
which this permit is issued(Section 3097.Civ.C). ********'******************* tit *********************************** **
LENDER: ********************4444*** 4444*****4444******4444********4444***** *** 4444*
ADDRESS: LEGALIZATION:N F E E SUMMARY 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 54 . 00 , 50
repair any structure.prior to its issuance.also requires the applicant for such permit to lite a signed statement that he/she is licensed SMIP/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 ISSUE FEE
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 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sate(tection 7044,Business and Professional Code; The Contractors'State License Law TOTALS----> 54 , 50 0 . 00 0 . 00 54 . 50 54 . 50 , 00
does not apply to an owner 01 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: 54 . 50 OVER/SHORT: 00
for theepurpt is soldwithinone 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
far the purpose of sale).
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 , 00
50
❑ 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 e License )license pursuant to the Contractors'State License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL FEE BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: SFR 2508 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 508 . 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 Duality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant:
I hereby certify that I have read this application and stale 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 representatives of this city to enter upon the above-mentioned
props ty for inspection p poses
j ' / 01 00170603-00170604 TOT54.50
opfe: (_�(C7"- Oci: signature: OATS: 10/28/94 TII#L: 13:03
Driver's License or Social Security tt:
1641.46 Whne—Building',Green—Code Enlorcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
-.-t CDNSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement
• 9. Electrical Conduit UtilitytUndrgrna 54. Forms
. 4.Ejectrical Conduit-t4ndrgrnd. 55. Electrical Bonding
5.-Steel Reinforcement 56. Rough Plumbing & Pressure Test
b.':Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7."Footings 58. Electrical Conduit-Undrgrnd.
'FL._Foundation 59. Gas Pipe, D 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
t
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
20.7-Rough Factory Fireplace •c,1 •• - , .APPROVALS ' Permit # •
. _I_. r �' 'r _ •
•
21.:Ducts,in Structure' - _ - .. .r
- •70. Underground Hydro
22. Ducts, Ventilating - - •• • • 471. Product'Pfping 0 Gas DOTH
23.;Gas Pipe-Rough&Test - . 72. Underground Flush
24.;Roof Framing • - - - - - • -"Jr: Undergrnd.Storage Tank DGas 0 Oil
25. Roof Sheathing - . -2-147-: 62644: - 74.'Overhead Hydro-
26..T-Bar Ceiling (Structural) Sr Monocoat . _ .. • 75.-:Dry Chemical
27.•Frame and Flashing -
76. 'Dry Standpipe -.
nt
28. Lathing& Siding, s t _ r sr. 77.. FIXED SYSTEM FINAL
29. Insulation ; , _ 1 1 !' I 78r FIRE PREY. FINAL
-30. Drywall Nailing - " MI HEALTH:DEPT. REQUIREMENT
31. Piaster Brown Coat • . li • `'� ,.79. FINAL INSPECTION
-32.-Electrical Power Meter-Final I- :1: -. r80...FOOD CERTIFICATE ISSUED
•33._Finatl Electric . I ' , No• tes:
34. Final Heating & Air Conditionings � ,•
35.!Finai Gal Pipe-Test• - ,
,36. Hood ortanopy .. n t - I -
37..Final Factory Fireplace . :`- `_
. .
t
.38. Final Plumbing - - • , - ,
-39. Water Service•Final ' ' '
';40. Gas Service-EinaL;: , -
41. Solar Domestic-Final I .
`42, 'Backflow Preventer' I
43. Backflow Irrigation •
r: ._. - . -
.44. Landscape lr/igat,ion System n• r. -• -
45. Sound Attenuation -••r: i i • '
:46. Handicap'RegulatoPs - - • .
'47. FINAL STRUCTURE & BUILDING t0 _f! & 6L • .
48.!FINAL PLANNING. r; ,
49. ElecCric Release to Edison _...,._: -
50. Gas Release to Southern California Gas Co . -
.51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 12/04/87 �J a6V 1I'
. 0882
PE IT NO. TRACT NO. LOT NO. UNIT NO. 1
CITV,"oF COSTA MESA CONSTRUCTION PE MIT
Project Address O`�+ /c 7t /1L�%7,/L/y)7Y�j�• l 3/$57
•
HADD ❑ ALTERATION L EPA(R I
32 !/! ell) TYPE OF CONSTRUCTION H rl Ewr Applicant's Mailing dre 5/� 7 C�1 �! / � El CONVERSION ❑ DEMOLISH El OTHER - A,P,# ••
Zone
Owner's Name \: �Vl t-C./ PhoneOVODESCRIPTION OF WORK/USE OF BLDG.
.
Address S Main Building: 'Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT H GRADING LJ�F'OUNDATIOry STRUCTURAL E
❑ Front 0
Address q� /� / ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL BB Rear • N
Contractor's Nam- s114 /� 11.p�,.1 ' Phone tN 7 `5 ❑ OTHER C Right - . N
Address(mailing/ lC 3y/ ds '•/ I ens /+ e . , , PROJECT DESCRIPTION SQ. FT. OCCUPANCY K G
�j (/ 3 /• •CONSTRUCTION TYPE VALUATION $ S Left R
City License No. S ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parkin R¢q./Pr Ovi E
LICENSED CONTRACTOR DECLARATIONPr 0ed_
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: RECEIVED DEC _ 2 se, Q
with section 7000) of Division 3 of the Business and Professions Code, and T
my license is in'WI fo and effect. ,
Licens la Li dose . i� r • $
Date Signature A.SAA/. ./ oS IMPLA , PLUMBING FEES
WORKERS'COMPENSATION D C • •ATION Bar Sink Showers ELECTRICAL FEES
r\ 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
3800, Lab. C. //�/ys'7 p f,, Automatic Washer Transformer D 15-50 KW
•� Policy No.��/"I��'O1 company � �T rand Backflow Irrigation Sewer Cap Construction Pole Sub. ❑ 50+KW
I _ $artified copy is hereby furnished.
Cer l le fp p�(. filed with the city -r Itli) �' n /j / Bathtubs . Sewer Connection 1 Cooking Unit Meter Opp to 100 amps
Date /• 1. 'Q Applicant. /9 �i `�/
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers • Solar Collectors Dishwasher . Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100)or
less). Dishwasher Solar Piping si Dryers ❑Gas ❑Electric Sub Panel . -
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors❑0-1 HP 01'/x-8
Workers' Compensation Laws of California. - _
Date Signature Floor Drains Swimming Pool w/Spa F.A.U.
NOTICE: If,after making this declaration, you should become subject to the — — Inc.$Olay ❑g-15 HP ❑16-15+ .
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed, revoked. Microwave
CONSTRUCTION LENDING AGENCY ,1 Gas Service Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance - Pole Light
of the work for which this permit is issued (Section 3097,-Civ. C.) Interceptors Water Heater Outlets Range
Lender's Name
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 Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor
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 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
g natty of not more than five hundred dollars ($500).
LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee 1 $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 0
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date
prove the owner se nave the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By / Date
prove for he 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 00-100,000 BTU ❑100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con-
tractors) ucense pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ PERMIT
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. IC80# Fire Dampers PLUMBING $ S OD ISSUANCE $
Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,00067E 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 repre-
sentatives of this city to enter p•n the above-mentioned property for inspection I'ao=`os� „ // MECHANICAL $ TOTAL FEE $ (57•532
Signature '� I �� ��� Date it ar-a� Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
- 'Drivers' License or SS# - / (((/
-Applicant; Pink - Accounting; Goldenrod - Assessor
CONSTRUCTION AND•PLANNING POOL &SPA, ! `
APPROVALS Permit.# Date Inspector APPROVALS Permit# _ - Date Inspector
,
1:-Temporary ElectricarService 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
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test '
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNI:TE
7. Footings -, 58. Electrical Conduit-Undrgrnd.0 '
8. Foundation /., 59. Gas Pipe, Undrgrnd.,Test r
9. Water Pipe- ndrgrr d -`
U60. 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
. 1
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT •
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas 0 Oil t
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑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 '
l
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: 1 �.
34. Final Heating & Air Conditioning _ , ' - - _
35. Final Gas Pipe-Test -
36. Hood or Canopy
37. Final Factory Fireplace { '
38. Final Plumbing ZeZ-e0 LED .
39. Water Service-Final - L -
40. Gas Service-Final - .
41. Solar Domestic-Final ' - '
i
42. Backflow Preventer - , .
43. Backflow Irrigation • -
44. Landscape Irrigation System - - - - , -
45. Sound Attenuation - ,
46., Handicap Regulations - •;
47. FINAL STRUCTURE & BUILDING r -.
48. Special Requirements Completed -•
l "
49: Electric Release to Edison
50. Gas Release to Southern California Gas Co - - • I ,
51. CERTIFICATE OF OCCUPANCY - -
•
No. Date '
OWNER so VTRPA BUIT.DING COMPANY DATE 6_1_a
JOB ADDRESS 1O5_Lpgino nn Tana BUILDING PERMIT NO. 22200
GENERAL CONTRACTOR grana - VALUE $ 15,715.00
AP No. LOT 39 TRACT 51AO FIRE ZONE DESCRIPTION OF WORK reR p/yytt gar
INSPECTIONS Si nature A E GROUP Tt4,T TYPE V ZONE R3
Soil • /7, PERMITS�YSSUED
Gas Q S i. : Q DATE NUMBER
Water ✓ SUBCONTRACTOR
Rough Com. Re rig. " Air Cond. 0
Rough Heating/ 17://ay-4, 1
I/� / ',�',�++__��,,ff}}'' �•?IG0 1341419-e- k
Rough Plumbing 17:�� 1 vy.J� stir)
Miscellaneous J
Prop. S . Line i5 House Con..1,4 St. S . 0 V 1 a / (� f/irw . . _PEC 9 1963 4 0 6
Sprinkling System / 1,111/
Construction Pole it
Underground 0 Power 0
Rough Wiring - "e" / ,. i ,''-6a1 ,,1 /.9/
Trenches 0 Forms 0 Steel Rein!. 0 1%%C _— — _
Floor System -./ �,/
Bond Beam 0 Steel Reinforce 0
Sheathing 4 11 e 8 3;/-
Frame and Flashin `/ a.cear Q�
Lathing— In Out Li, r�'
Plaster, brown coat V- o - "e
Refrig. 0 Air Con. 0 Final
Heating, Final 1.1W�f•71/9 -nnin DEP,.
Plumbing Fixtures, Final /�� ��iar r i 'i�"}}_ f
Fir $al Gas Test .-W
� � -/,T
Electric Fixtures, Final 2- `be`
Building, Final
OCCUPANCY
Form HU4-5M-3-63—S-17 p vnr n vnD Cncrr A r nnnr.rnrnzrwrr^
22200 FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT in 1 9 1W
P.O.BOK 317 COSTA MESA.CALIFORNIA
1- / FINANCE DEPT.
For Applicant to Fill In Completely APEMPOWNUOTIAPMEM
TYPE OR PRINT BUILDING
BUILDING For Office Use Only
ADDRESS 105 Lexington Lane
RECEIPT NO. M T NO.
COSTA MESA. CALIFORNIA
i ,j,
• OY DATE RECEIVED DATE ISSUED
' OWNER San Vista Building Co.MA �� �• UN ,�
BUILDING
ADDRESS
ADDRESS 1166 E. 58th Street
— FIRE
CITY Los Angeles 11, Calif.NO. AD 37187 GROUP '
APPROVED
ARCHTECT DATE
OR ENIGINEER Raymond Levans NQ. OR 37010 BY
li
ADDRESS • • 0 t. 1 ' •O_t :each • • c arrf Nor
niiira
CONTRACTOR San Vista Building Co. ` ttat'l
LEGAL Tract 5160 - Lot IR 39'
ADDRESS 1166 58th Street DESCRIPTION --3 `{!. 3
CITY Los Angeles 11, California A.P.NO. 1 �I 1 r
NOTE: NO EAVE OVERHANG SHALL BE LES THAN
STATE
LIC..NO. 192782 NO' AD 37187 30"TO SIDE a REAR P.L.
EAVES 1
SIZE 20 x 70 1 NO.OF SLDGS. 0 ALLOWED (U. B.C.REQUIREMENT/
OF LOT NOW ON LOT I
YARDS APPROVED YARDS APPROVED E1b.
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. None • (FROM Cal/REET)...
FRONT
SETBACK LINE FROM t •�
'C)
R.SIDE FT. FT.
CENTER OF STREET 13 ' REAR YARD - //�� FT. FT.
SIDE YARD/ LEFT 0 RIGHT 0 '
DESCRIPTION OF WORK L.SIDE 0 FT. FT. F
Z
LLI
NEW X ALTERATION ADDITION REAR FT, FT.
DISTANCE BET. BET.MAIN A LLI
MAIN SLOGS. ACCESS.BLDOS.
REPAIR MOVING DEMOLISH cd
BUILDING.20
NO.O / •AD VAR. !/ / DATE /
SIZE .2D • 31/ ROOMS O STORIES 2 c.V.P • iy_�f� APPROVED ('7! 0 I. CY
EXTERIOR WALL I ROOF APPR•3 fi� l ` Ce
LJ
COVERING tucco COVERING Shin•les =r y � •ATE
/ S— C
USE OF BUILDING AND WORK TO BE PERFORMED • r �/
' V
Residence and /a,pc..t a �/ �/ 0.
I . ' i , 'y/ //Sag.FTd 9o ° ' N a
w .ode 3
I HEREBY ACKN• EDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE = DA
AND STATE THAT TN ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. G
PLY WITH ALL CITY O 'RANGES AND LAWS REGULATING VALUATION . . a
BUILDING CONSTRUCT/ PERMIT FEE 5 Sf 'D _
PERMITTER 6
SIGNATURE OF f..(.G(�LCiCiC'N ''JJ�� i _ G
`s/ 73i PLAN CHECK $ 23/SO e
AUTHORIZED AGE vi L--0 .
• TOTAL FEE • J