HomeMy WebLinkAbout3065 TAYLOR WAY - Building Permits T PROJECT ADDRESS: 3065 TAYLOR WY UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 061196
OWNER'S NAME:RAUS, MICHELE G
j ADDREss: 3065 TAYLOR WAY PERMIT NO: B 061196 PLAN CHECK NO: 00684-93 S GOVT: N SUPP ; N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: ALT
( 714 ) 641-9464
ARCH/ENGINEER:L- P. LEAVITT & ASSO. REG.N0.:11792 JOB DESCRIPTION : REROUTE DRIVEWAY, MOVE DOOR OPENING SQ FT: 1 , 600
ADDRESS: 9724 BLANDWOOD RD UNIT:
DOWNEY CA 90240 CLAIM VALUE: 1 , 600 . 00 CALL-VALUE: 1, 600. 00 GROUP OCC: R-3 /
PERMITTEE:A.C. WHITE CONSTRUCTION ( 310 ) 437-5770
ADDRESS: 1605 E . 2ND ST 302 COMMENTS; PROVIDE SMOKE DETECTORS IN HOME PER THE 1991 ED. OF THE UBC.
LONG BEACH CA 90802 +r*******4 x***** **x**** *************>EyPTEFB>F******:E* (-**LE*+E*>E*y8*******TBy6********
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
70001 of Division 3 of the Business and Professions Code.and my license is in full force and feet. SETBACKS
CITY LIC.: STATE uc.4 9 4 01 1
—11Dale:3/ 3 Signature:_ A MAIN BUILDING ACCESSORY BUILDING
WORKERS'CON DECLARATION: I hereby affirm that have a certificate of consent to self-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
- ICY NO.: EXP.DATE:
'-IMPANY: PARKING REOQ- PROV: PARCEL: 14160439 ZNE: R1 REF NO:
( :3j Certi ied copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> RELOCATE GARAGE DOOR FROM SIDE TO FRONT - MIN 19 ' LONG DRIVE
> TO BX PROV, ENG OK NEEDED TO CLOSE OLD/BUILD NEW APPROACH ,
Dale: Applican). - *****************!E*iE********iP***************1l******:Y-***************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(31001 or less). DEVELOYPMENT -- SERVICES REQUIREMENTS
I cerily that in the performance of the work for which this permit is issued.I shall not empl y y person in any manner so as to become /���
subject to the Workers'Compensation Laws of California. ��,(� ZONING APPROVED BY '-r ; DATE:
Data: J/a� JnJ yhru: /Jrii BUILDING APPROVED BY : S�/)--:` /1 % DATE: •2 ,3
NOTICE:y:lf, ter making this declaration.you shout ec this rt torte deerempensation provisions of the Labor
Code.you must lonhwitn comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm the(there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; DATE; `/f3
which this permit is issued(Section 3097.Civ.Cl. • ********************** -* **** ****- . • ** **** *****************1K' **kk*****
LENDER: ************************** *************** *********************************it
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that 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 37. 00 • 50
repair any structure,prior to its issuance,also requires the applicant for such permit to file 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
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation 01 Section 7031.5 by PLAN 24 . 05
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($5001. ISSUE FEE
I, as owner of the properly 01 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 tor sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 37. 50 0 • 00 24 . 05 61 • 55 61 . 55 . 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 REVENUEDIVISION TOTALS--> COLLECTED : 61 . 5 5 OVER/SHORT: 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
for lhe purpose al sale), BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I.as owner al the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 37. 00
50 24 . 05
❑ 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 contractors)license pursuant to the Contractors'Slate license Law). l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
i❑ I am exempt under Section: B.&P.C.
1 tor this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
I
Date: Owner: SFR 1600 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 1 , 600 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Salety 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. 4 EXPIRED
• Dale: _ _ 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 representatives of this city to enter upon theabove-mentioned
property tor purposes. ( ��� DATE L( I Iii 74
�` Dale3/ati93 Signature: `itr
Driver's License or Social Security
1641.46 White—Budding:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
-
CONSTRUCTION AND PLANNING. I & SPA
Date Inspector APPROVALS Permit 52,1-- Date Inspector
APPROVALS Permit m
1. Temporary 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
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. '/ ' 57. APPROVAL TO COVE R-GUNITE
7. Footings $/Q9 58. Electrical Conduit-Undrgrnd.
8. Foundation 7 7 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,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 3 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 3/j,/p�, 79. FINAL INSPECTION
32. Electrical Power Meter-Final �J � 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes;
34. Final Heating&Air Conditioning liltg'V
35. Final Gas Pipe-Test ± t�
36. Hood or Canopy
37. Final Factory Fireplace I
38, Final Plumbing
39. Water Service-Final I l
ff 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. FINAL PLANNING
•
49. Electric 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 tines and sign all appropriate declarations.
CITY O,TP, MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO.
7059 3/IBIT' o V T.
3o ,5 Tfvi R B 32`SS"
0 f2 W `i C 7058 3/I B/0" 37,f1 : IL
Project Address rr II u
Applicant's Mailing Address
5'-1 E.)\t4 A S}. ' Ct..t1 TYPE OF CONSTRUCTION U.NEW a ADD U ALTERATION LI REPAIR
rib+ Or ClISI 'C ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone
Owner's Name Tn vt VSA11 Phone 1 DESCRIPTION OF WORK/USE OF BLDG.
Address 30.51 iaNn `C- Co., TQ �-- 'n y S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT U GRADING ❑ FOUNDATION 1E STRUCTURAL E Front 0
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N
Contractor's Name • I j Phone CI OTHER �9 A - I
Address(mailing) // PROJECT DESCRIPTION SQ. FT. X2,10 0 OCCUPANCY J C Right — G
City License No. CONSTRUCTION TYPE V N - _ VALUATION$ I, La Oa oo S Left
R
ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided E
LICENSED CONTRACTOR DECLARATION Q
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: T7�--.� _.G-. r/_ Planning Notes: AA
with section 7000) of Division 3 of the Business and Professions Code, and 2-e ..Sir-fP1/1�5`n T
my license is in full force and effect.
License Class License No. S
Date Signature PLUMBING FEES
WORKERS'COMPENSATION DECLARATION Bar Sink Showers
I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
3800, Lab. C.) Automatic Washer Transformer 0 15-50 KW
Policy No. _ • Company Backflow irrigation 0 50+KW
8 Certified copy is hereby furnished. g Sewer Cap Construction Pole Sub.
Certified copy is filed with the city Building Division. Bathtubs - Sewer Connection Cooking Unit Meter Duo to 100 amps
Date - • Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(Thissection need not be completed If the permit is for one hundred($100)or .
less). Dishwasher Solar Piping 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 sas to subject tothe Drinking Fountains Solar Tank Fan Motors 00.1 HP 01%-8.
Wor keM'' 1 i np en tion Leyet of Cali nla.
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP 016-15+
NOTICE:If,after making this declaration, you s Id become subject to the
Workers' Compensation provisions of the Labor ode, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet •
I hereby affirm that there is a construction lending agency for the performance Device Boxes Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.)
Interceptors Water Heater Outlets
Lender's Name Range
Lender's Address Kitchen Sink Water Service Switches
OWNER BUILDER DECLARATION Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or 9 P Standing Sections
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 P
'o file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains
•e Contractor's License Law(Chapter 9(commencing with Section 7000)of
ivision 3 of the Business and Professions Code) or that he/she is exempt
.nerefrom 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 _ _
enalty of not more than five hundred dollars($500).
I, as owner of the property or my employees with wages as their sole Reinspection Fee 1 $15 Issue Fee $ 3
mpensation will do the work,and the structure is not intended or offered 1 - 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 com- Canopy Type II ❑ Zoning Approved By Date
prove the owner se have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By ( „ Date ,t..ss
Prove for the purpose of Sale). Ja•L\ B�CyIY-�1
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By C� Date
v
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- —
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ ., SMIP $ ll .—
, proof o// their Worker's Compensation Insurance should be provided to me. _ PLAN CHECK $ PERMIT
'''❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $
Date l4'-4+I*-4. caner _ Heating System& Ducting Registers ENERGY P.C. $
PLAN CHECK 25% $
I hereby certify that I have read this applica on and state that the above El 0-100,000 BTU 0100,000 BTL GRADING $
information is correct. I agree to comply II city and county ordinances ELECTRICAL $
and state laws relating building construct on and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of this city enter upon the above-mentioned property for
inspection p sesMECHANICAL S
Signaturei �C7L -Date TOTAL FEE $
Drivers' License or Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
J1fl
CMF 0865.46,rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod -Assessor
CONSTRUCTION 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
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 Grr d. 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, 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
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, Ventilating 71. Product Piping ❑Gas 0 Oil
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
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 Domestic-Final
42. Backflow Preventer •
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations /
47. FINAL STRUCTURE & BUILDING 061,33i •- e P,ee AS / 1t U13C 303Qd)
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY,
No. • • t. Date
OWNER Seaview Homes, Inc. DATE 6-19-62
3OB ADDRESS 3065 Taylor Way BUILDING PERMIT NO. 17320
GENERAL CONTRACTOR S. V. Hunsaker & Sons VALUE $ 14,471.00
AP No. LOT 29 TRACT 14565 FIRE ZONE DESCRIPTION OF WORK res watt gar
IN4 ;tECTIONS Signature DATE GROUP I&J TYPE V ZONE Rl
AZ 7 -/-6 L PERMITS ISSUED
GasSUBCONTRACTOR
^ (-/-(Z DATE NUMBER
Wntcr n _
Rough Com. Re rig. I Air Cond. ❑ y /�
Rough Heating F �7'G-s—, _ -_v g�7'1�y .l_13"-
Rough Plumbing frO2- ' • / A/i�y •-j �j c_ c" i
Miscellaneous __
Prop.Swr.Line El-House Con. QSt:Swr. ❑ )c r4 Z_ _fl.4 4 t• ':i4? S (4/:..I ? C/J Z!/
Sprinkling System III'
Constructiol'ole
Underground 0 Power 0 /
/qq/
Rough Wiring ;r'7, 12 S' t9.-1-Ci 4 , •147 � '7--Ts-X i i/7 )
Trenches ❑ Forms ❑ Steel Reinf. 0 J7" 7s Co 7..-----' 7
Floor System
Bond Beam 0 Steel Reinforce ❑ _-y�
Sheathing . t 1 'j--272.1, �
Frame and Flashing / a e-90-6y
Lathing — In fa Out 12-- inf. •k-IL-_6 -
'+ _
Plaster, brown coat „,'/.J'. 9
;
n,,w . ❑ Air Cond. ❑ Final
I-i;. ng, Final Lk/ 7d-S`'61
Plumbing Fixtures, Final
Final Gas Test/5 �' � •�
ElectricuildiFixtures, Final
Building, Final S----A/ 9
OCCUPANCY 17320
FORM 81.14•5M - 7-61
17320
kLL i„.. li &&)
COSTA MESA BUILDING-SAFETY DEPARTMENT ! JUN 15 198i
P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE DEPT.
Applicant to Fill In Completely CITY OF COSTA MESA
For
P Y APPLICATION FOR PERMIT
TYPE OR PRINT Vi
BUILDING 306--,--- AI /0� �A/ J BUILDING
ADDRESS COSTA MESA. CALIFORNIA 7 For Office Use Only
I RECEIPT NO. ` PERMIIT•!I3n
OWNER Seaview Homes, I. . I �V!en
MAIL RECEIV O BY RECEIVED
ADDRESS 1602 W. Almond IfGr ,I •DJTE B
6L
TEL. BUILDING
CITY Orange NO. ADDRESS
ORCHITECTER Ramberg & Lowery NE 1.76131 COSTA MESA. CALIFORNIA
ADDRESS 21 27 N. Main St. Santa Ana FIRE `/ a��/
ZONE TYPEY GROUP.�Y J/l//
CONTRACTOR S. V. Hunsaker & Sons APPROVED
BY DATE
ADDRESS 15855 E Edna P1 ZONING
ZONE NO.OF USE OF NEW S/a� T�.Ac
CITY Irwindale I(_/ I PLANS Z+ I BUILDING W/
ed
In-
STATE TEL. ED. 87361 LEGAL 1 10-Y- 1 TZ y,�-�1
LIC.No. 164929 /-� NO. DESCRIPTION
SIZE Cal •/ 9S' I NO. OF BLDGS.O -�
OF LO7 JC NOW ON LOT A.P.NO.
USE OF YARDS EVES
EXISTING :LOG. - APPROVED ALLOWED
SETBACK LINE FROMcep / / (CENTER LINE ST.)
CENTER OF STREET • REAR YARD 3, FRONT 6'S`FT. —
IN.
SIDE YARD I LEFT 9 / I RIGHT S / R.SIDE `S FT. ---_ IN.
DESCRIPTION OF WORK L.SIDE / FT. IN.
NEW IX I ALTERATION I I ADDITION REAR 30 FT. �_ IN.
REPAIR I D MOVING I II DEMOLISH I BYPROVEDz ✓�e4q DATE 6/2% \
SIZE DINrO x SZ /NO. OF / L7 •
ROOMS STORIES 1
EXTERIOR WALL}},�stucco I ROOF comp.
COVERING CU,nQ COVERING ssnigles /1:91)SLc = /300 1
USE OF BUILDING AND WORK TO BE PERFORMED
_ ' 1. .a famil dwellin. with A ' , -t- u `20 4
attached garage r, ._ _ J/
. : L
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT ANO AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION 4r
`�,/'
SIGNATURE OF V �� A.E. - SONSPERMIT FEE $ �//Y
cd
PERMITTE AT P
�j� $ /t/4/2/--- PLAN CHECK $ �1— �'
AUTHORIZED AGENT �� • Atejil -f E
TOTAL FEE $ �7 s6 �' W