HomeMy WebLinkAbout371 WILSON ST - Building PermitsGTY OF COSTA MESA
BUILDING DIVISION
F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-.3856 • ewiw.ci.wsta-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754-5626
�ro �
PERMIT NUMBER: P09-00017
PERMIT TYPE PLUM STATUS: ISSUED
APN: 41906102 DATE ISSUED: 01/23/2009
ISSUED BY: KJB
JOB ADDRESS: 371 W WILSON ST CM
Vicinity:
Suite/Unit:
a
SCOPE OF WORK: EXCAVATION AND REPAIR OF ON-SITE SEW ER LATERAL. NO OFF SITE WORK AUTHORIZED BY THIS
PERMIT. NO WORK IN THE PUBLIC RIGHT OF WAY.
OWNER: VASILJEVIC, FREDRAG AND DINKA
PHONE:
APPLICANT; ALLEN, THOMAS
PHONE:
Address: 371 W WILSON
Cily/State/Zip: COSTA MESA, CA
Address:
Ciry/Slate/zZp:
CONTRAC70R: POWER PRO PLUMBING License No. 766254
Address: PO BOX 6970 PHONE: 310-324-3661
Ciry/State: TORR4NCE, CA ZipCode: 90504 CELL:
ARCHITECT; License No. PHONE:
ENGINEER: License No. PHONE:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
$0.00
$48.15
$48.15
�"' 7
"NIS
NOTICE: 7he work authorized by this permit shall comply with all applicable handicap access requiremenLs under Califomia statutes and related
regulations, (Ord. No. 92•28. § 1, 72-21A2)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order tor the work authorized under Ihis pertnit to 6e considered legal, such work must comply vrith all applicable cotles, and all
required inspections and final approval must be obUined. Failure to obtain inspeclions and final approval will result in the expiraUon of this permit.
COpE1, INSPE�T�pNTYVE Q�jF INiRIRLS C�DE/ INSPECTIONTYPE U� � INTRI�lS
1616 Fized System Final Fire Prevention 208 Final Mechanical
7186 Pool Spa Final 20a Final Plumbing 1�.=,�R - 09 _��
200 Final Re-Root 210 Flnal Electrical
201 Final Blak/Retaining Wall 212 Final Fire Prevemion
202 Final Factory Fire Place 220 Final Planning ApDroval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/OccuDancy
WORKERS'COMPENSAnONDECLARAnON:
1 �ereCy aftirtn under penalty of perjury one of Ihe followirg tleUa2tions:
❑ I have and will maintain a certificate of wnsent to sel(-Insure for v.orkers'
compensation, as provided for by section 3700 of the LaDor Code, for the
peAormance of the v.nrk /or whiU t�is permit is issued.
❑ I �ave antl will maintain workers' canpensation insurance, as requiretl by
secibn 3700 of the Labor Code, fw the pedortnance ol the vmrk !or which this
pertnil is issued. My workers' compensalion Insurance carrier and policy
numDer are:
Cartier.
(T/ns seeon rieetlnot De cornpefM (Ure pem4 B vaMeO ar aro fru�dM aobrslS�00) «buJ
Policy Number:
❑ I certify Ihat in the pertormance of the vrork for which this Dermit is
issued, I shall not employ any person in any manner so as lo become subject
to Ihe workers' compensation laws ot Cali(omia, ana agree thal if I should
become subjecl to the wo cers' compensation provisions o( Section 3700 of
the Labor C�,1e iall f hvnth wmply vnth these provisions.
� L3—u7
diwm's SignaWre Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES ANO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000�, IN ADDITION TO THE CAST 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 licensetl under provisions o( Chapter 9(commencing
with Section 7000) of Division 3 01 [he Business anC Prolessions Code, antl
my license is in full force and eHect.
Lic. # .� t�' `� Class It C,?(o
// o �—
//.� �'J /-23—u1
' CM12tlor's Signalure Oale
CONSTRUCTION LENDING AGENCY:
❑ I hareby affvm that there is a constructbn lending agency fa the
perfortnance of Ihe Hork ta wfiich this pertnit is issued. (Sec. 3097, Civil Cotle).
Lender's Name:
Lender's Address:
Sigrulure
OWNER-BUILDER DECLARATIONS:
I here�y aNirm that under penalry of perjury thal I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5.
Business and Professions Code: Any city or county which requires a pertnii to
construct, alter, impmve, demolish, or repair any structure, prior to its
i55uance, also requires Ihe applicanl tor such permit to fle a 5igned statement
thal he or she is licensed pursuant to Ihe provisions of lhe Contraclors
License Law (C�apter 9(commencing with Seclion 7000) of Division 3 of the
Busine55 and ProfeSsionS Code) or Ihat he or 5h8 is exempl IherOfrOm and
the basis (or Ihe alleged exemption. Any violation of Section 7031.5 by any
appliwn� br a Dertnil subjects the applicaN to a civil penalry of not more than
fve huntlred dollars ($500).):
❑ I, as owner o( the D�operty, or my employees with wages as their sole
wmpensation, WILL DO THE WORK, and Ihe struclure is not intended or
o%ered far sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not appy to an ovmer of properry who builds or improves
thereon, antl who dces such work himsell or herself or through his or her own
employees, pravided that such improvements are not intended or offeretl for
sale. If, however, the building or improvement is sold within one year ot
completion, the ovmer-builder vrill have the burden o( proving ihat �e or she
did not build or improve for purpose of sale.).
❑ I, as ovmer o! the property, am EXCLUSIVELY CONTRACTING WI7H
LICENSED CONTRACTORS to construct the prqect (Sec. 7044, Business and
Professions Code: The contractors License Law tices not apply to an owner of
property who builds or impmves thereon, and who contracts fa suc� prqect with
a cmtracta�s) license pursuant ro Ihe Cont2clors License Laws.).
❑ I am exempt under sec.
Business antl Protessions Cotle for Ihis reason:
SignaWre Date
305Pa6 (]/0])
Ovmer ID verified by drive� _...xnse. ❑ Yes 0 No
Driver's License No. Erzpires:
Venfication of Ownership by (type of tlocument, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N: -
❑ I hereby cetlify Ihat no encavation five (5) w more leet in depth inro v.fiich a
person is required to descentl, will be made in connection with �wrk author¢etl
by ihis permit, an0 that no building slructure, scaffdding, falsework, or demolitbn
or dismantling Ihereo(, will be more Ihan thi�y-su (36) feet hgh. (Chap. 32, Grp
2. Art 2. Sec. 341. Ti�le 8. Cali(omia P.dminist2�ive Code).
❑ As ovmer-builtler, I will not employ anyone to Oo work which wouid
require a permil lrom the Division ot IndusMal Safely, as noted above, unless
such person has a permit to do such work from lhe division.
Apdiwm's SiB��ure
Division o( Intlustrial Safaly Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
7. Will the applicant oi present or future builtling occupant need to file and
certi(y a Business Plan for emergency response to release or mreatened
release ol a hazardous material? ❑ Yes � No
(Section 25505 of the Califomia Health and Salety Cotle requires, with some
exceptions, that a Business Plan be filed with the Cosla Mesa Fire
Depanment by every Dusiness which has at any one time dunng a reported
year a quantiry of hazardous materials equal to or greater t�an a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic (eet of wmpressetl gas
at slandar0 tempereture antl pressure).
2. Dces or will Ihe applicant or present or (uture builAing occupant need to file
a registration form for acutety hazardous materials4 ❑ Ves ❑ No
(Section 25533 of the Califomia Health and Satery Code, with some
exceplions, requires registration with the Cosla Mesa Fire Department by
each business which at any one [ime has on hand a quantity of acutely
hazardous mateiials equal to or greater ihan a weighl o( 500 pounds. or a
volume of 55 gallons, or 200 cuDic feet of compressetl gas at slantlartl
temperature antl pressure).
3. Does or will lhe applicant or present or (uNre building occupant need to
prepare an RMPP (Risk Management antl Prevention Program (or acutely
hazardous malerials)? ❑ Yes ❑ No
(Section 25534 of Ihe Califomia Health and Safety Code provides Nat the
Costa Mesa Fire Department may require the preparetion, certification antl
�ling wilh Ihe Fire Depahment of an RMPP by Dusinesses which are requiretl
to register acutely hazardous materials with Ihe Fire Departmen�.
4. If an RMPP is presentty required, has Section 25534 of the Califomia
Health and Safely Code been fully complied wilh? � Yes ❑ No
5. Dces or will the applicant or presenl or future builCing occuDanl require tor
the .wrk which is the subject o( Ihis application a p¢rmit for such wnsWction
or modifcation from the South Coast Air Oualily Managemen� DiS�rit[ or from
any other air pollution control dislrict or agency7 ❑ Yes ❑ No
(Seclion 658502 of the Califomia Govemment Code raquires that me requested
infortnation be lumishea on applications lor non-residential building pertniis).
6. Will any part o( tha lacilily lo be constructetl untler Ihis permit be wilhin
1000 (eel IfOm Ihe outer boUndaries o( a SChool? ❑ Ves ❑ No
Qf yas', the lacility must meet the requirement ol Sections 25534 and 42303
ol Ihe California Heallh antl Safery Cotle).
7. If a permit from Ihe South Coasl Air Ouality Managemenl District or other
air pollution wntrol dislnct or agency is requiretl for Ihe work which is the
subjecl o( this application, have all of the tlisclosures prescribeC by Califwnia
Health antl Safety Code Section 42303 been matlel ❑ Yes � No
8. Qf'yes', auach certificate of wmpliance from Ihe appropriate air polWtion
controioKcep.
CERTIFICA7E OF COMPLIANCE: I certify thal under penalry o( peryury the
information given above is wrrecL I agree to comply wiN all slate laws antl
city ordinances regarding Hazartlous Materials and Emissions.
S�gnature Da�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certi(y untler penalty of perjury that I have reatl lhis application and state that
lhe in(ortnation given is covect I agree lo comply with all state laws and ciry
ordinances relating lo building construction, and authorize representatives of
the City of Costa Mesa lo enter upon the a6ove-describetl property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this pertnit until final inspeclion.
SiB�d�u al s) Date
/-�3 �
AnE/pAul�OnzMAOd��n1 Ddl!
3
Applicant to fill in all soaces withln heavy Doraer lines ana sign all appropriate tleclantions. r
CITY OF C_f�,LA MESA PER IT NO. TRACT NO. LOT NO. ' BLOG. NO. '
CONSTRUCTION PERMIT -,3'%� �748 10/ � 3/81 �5.00
Project Address W � � TYPE OF CONSTRUCTION � � �
OWnef hone ❑ NEW ❑ ADD ❑ ALTERATION
Addf2ss � ❑ REPAIR ❑ CONVERSION ❑DEMOLISH
❑ o7HER ZONING REGULATIONS
Arch/Eng. License ND. A p �
Addf255 . OESCRIPTION OF WORK
ZONE PLNG. REF. �
Contractor 0 Pho — TVPEOFPERMIT TpgU i�oING
SETBACK C ST. V0.0PERTY LINE
Addf255 , / Q ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL 1❑E VARD
LICENSE� CO TRACTOR OECLARATION ❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHANICA 5EpPE V
I hereby affirm thal 1 am Iitensetl untler provlsions of Charter 9(tom- RIGHT
mencing wlth sectlon 7000) of Divlslon 3 of the Business antl ❑ OTHER
Pro(essions Cotle, ntl my Iitense I in tull torce antl eHect. REAR VAR� (TO P/L)
PROJECT DESCRIPTION
LitenseClass �� i nze � GKG.SPACEREQ. oROVIDED
Dat¢ �� � Si9na[u� $Q. FT.
WORKERS' COMPENSATION D LARATI OCCUPANCV_CONSTRUCTION TVPE STREET WIDTH PARK FEE $
I hereby aiFlrm that I have a<ertiflwte o onsent to self-Insure or a VAIVATION ZONE ZONING APPHOVED ov DATE
certlfiwte o( Workers' CompensdtlOn In ance, or a certifietl copy
t�nreot (Settion 3800, Lab. C.). GRADING CV. VDS. ACRES SPECIAL CONDITIONS:
:y No. Company
:e�tifietl copy I5 herGby fu�nlshetl. REMARKS:
❑ Certifietl copy Is tilea with the tlty Builtling Divlslon.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION '
(This section neetl nat be wmpl¢t¢tl if tha permit is fo� one nuntlrea .
(5100) or lezs).
I cerLfy that in [he performance of the work for which this permit is
issuetl, I shall not employ any person in any manner so as to Cecome PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK
Subj¢ct t0 [he WOrk¢rs' Gompensation LawS of Call(ornia.
Date Signature BATHTUBS SHOWERS
NOTICE: If after making tM1is tleclaration, you shoultl become subject TOILETS VRINALS GENERATOR 0-1 KW_ I-30 KW
to the Wotke�s' Compen5ation prOvisions ot the LaDo� Code, you must TRANSFORMER
tOrlhwith comply with sucn p�ovl5lon5 0� thl5 permit shall be tle¢metl LAVATORIE$ �OVBIE LAV$ APPLIANCE 30-50 KW_50 t KW
revakatl. � .
CONSTRUCTION LENDING AGENCV KIT. SINKS DISHWASHERS MOTORS 0-1 HP_1-30 HP
I hereby affirm that tbere Is a cons[ruction lentling agenty for Ihe per- SERVICE SINKS SUMPS (�NC. SOLAR) �0-50 HP 50 + HP
formance of tha-work for whith thls'permit'Is� inuetl (Sectlon 3097
Civ. C.). ' FLOOR SINKS FLOOR DRAINS FI%TURES OUTLETS SWITCHES
Lentler's Na'ine
Lentler's Atltlresz '� DRINKING FOVNTAINS • GASTUBESIGNS " '
OWNER BUIIDER DECIARATION �'• `. �. ' ' INTERCEPTORS, � �` CLARIFIERS POLE LIGHTS '
1 her¢by attlrm that I am exempt from.tM1¢'Contracrocs LlcGnse•LawMor � .
the tollowing rea5on (SecHon ]031.5 Bu5ine55 antl Profes510n5 Cotle: SWIMMING POOL P TRAP
Any tlty or county whlch reqWres a permit to construct, alteq POLES METERED SUB
Improve, tlemolish or repair any structure, prior to its issuance, alzo re- yyqTER SERV ICE ALTERATION PANELS MAIN � SVB
quires the aOPllwnt for such permit to tile a siqnetl statement tnai he
Is Ilcensetl pur5uant to the provisions of [he Contractor'S License Law GAS SERVICE OUTl.ETS _� SERVICE AMP
(Chapter 9(tommencing with Section 7000) of Division 3 of Ihe
�.,en�¢ss and Professions Cotle) or that he i5 exempt Iherefrort� antl [he yyqTER HEATERS BTU OVTPUT
'"'�$ppliCantdlfo9ea permPt� ubjecti Lhelappllcantstota ci il�pe albly SEWER CONNECTIONS �
o'v�'::F'fot more tnan tive huntlretl tlollars (5500�.
❑ I, as owner of the property, or my employees wiih wa9e5 as their � SOLAR TANK COLLECTORS
5ole compensalion, will tlo Ihe work, antl the structure is-no[ intentletl
or offeretl for sale. (Section ]044, Business antl Profe55ionz Cotle: The SOIHR PIPING SVS. ISSUE FEE '
Coniraclor's License 11w tloes not appry to an owner of a property - - - qPPLICATION APPROVE� BV DATE -
who builtls o� imOroves thereon, antl who tloes such wo�k nimself or ISSUE FEE �
through hi5 own ¢mployee5, provitletl that such improvements ar¢ not
intentletl or of/eretl for sale. It, noweveq the building or improvement MECHANICAL P�AN CHECK SUMMARV OF FEES
is Soltl within one year of compl¢lion, the owner will have tM1e burtlen
of proving he tlitl not builtl or Improw (or Me purpose of sale). HEATING SVSTEM 0-300,000 BTV BUILDING
❑ I, a5 Owne� ot the p�operty, am ¢xclusively cont�actinq with PERMIT $ SMIP . E
AND DUCTI NC
II<ensetl coniraciors to consVuct lhe projec[ (Sectlon ]044, Business 300,000 + BTU PLAN CHECK S PERMIT
antl Profe5510ns Cotle: The Contractor's LiGense Law tl0¢s not apply t0 - ISSUANCE E
dn owner of property wh0 bulltls or ImprOv¢s [hereOn, antl who Con- REFRIGERATION 0-100,000 BTV PLUMBING § �
Vatts f�om Sutb p�o�ec[5 wllh a Contrattor(s) Ilcesnetl pu�suant lo SVSTEM GRADING S
ihe ConVaclor's Licenso Law). 100,000 + BTU PLAN CHECK S
❑ I am exempt untler $ection B. & P. C. fOr [his ELECTRICAL $ s
BOILERS BTV
reason _ MICROFILM $
Date pw�er SVSTEM REPAIR, ALTERATION PLAN CHECK S TOTAL FEE S
I hereby <ertify[hat I �ave reatl this application antl ztate that the above EXHAUST SVSTEM MULTIPIE MECHANICAL E
informafion is cor ecL I a9ree to compl wi[h all <ity antl county PLAN CHECK g LE55 AD-
VANCE PC $ _�
ortlinances antl s e laws relating to cons cUon, antl M1ere�y authorize
wpresen[ativCs t0is ci to Er lpon the above menlionetl �
prOperty fa� ' e tl rp �
Slgnature " a[e FINAL FEE 3
Drivers' Li nse or 55 $ _ �SSUE FEE
cmr unoo-wo wmce-ewiaing; wnary-qppucanc; wnH-!accouncmg; moiaenroaaasaeaw�
�.4
CONSTRUCTION ANDPLANNING POOL&SPA -
��� Date Inspector Date Inspector
APPROVALS 'Permit # APPROVALS Permit #
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location
. Soil ipe-Undrgrn � 44. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding
. tee ein orce 47. Rough Plumbin & Pressure Test
6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE
7. Footings 49. Electrical Conduit-Undr rn
8. Foundation 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn � 51. Backwash Lines P-Tra ❑ ndr rn
10. Structural Floor System 52. APPROVALTO DECK
11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connection 54. Heater & Vent-Final
13. Rough Plumbing �
14. Rough Electric-Conduit �56. Electrical-Final
15. Rough Electric-Wiring 57. Solar System-Final
� 16. Rough Heating & Air Cpnditioning � encing & Access Approval
17. Ducts in Structure APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL •
20. Roof Framing �
21, Roof Sheathin �
22. Frame and Flashin NOTES: .-� S/- F/ �„ w '
23. Insulation '
24. Lathing & Siding
25. Drywall Nailing
26. Plaster Brown Coat �
27. Electrical Power Meter-Final �
28. Final Electric
29. Final Heating & Air Conditioning
30. Final Gas Pipe-Test
31. Final Plumbing
32. Water Service-Final �
33. Gas Service-Final
34. Solar pomestic-Final
35. landsca e S rinklin S stem
36. Sound Attenuation
37. Handicap Regulations
38. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed
40. Electric Release to Edison
41 . Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY �
No Date
COSTA MESA BUILOING—SAFETY DEPARTMENT �
. P.O. BOX 1200
Costa Mesa, CaliMrnia
CONTRACTOR ' �-' p� �
Address '],� �� � � N '
Ciry G r I iU l7� �•Tel. No. g� �
Stafe Licensa No.Z) I g Class. a—
�w City License No. $q 1,13
H
Q NUbII3F:R TYPE OF FI%TURf? OH ITG.1 FGE
�
' N'ater Closet (Toilet)
Qyath Tub
� snow«
T Lavarory (N'ash Basin)
J K�tchen Sink
� L�undry Tub or Tray
w service sink
� Floor sink
O
� ploor Drain � ?
a pishwashcr �.
Z prinkin Fountain i �
W Urinal � �.
3 Garb.�ge Disposal '���.J �..1-
pummatic Nushin 61zcFi. �.
~ \4'a[er Softener. I�� 1' _
� 1 N'ater Heatei &`VertL (
WRece to�b � �
d 5�+'�m�Eool Filter Sys[em
� GAs System . . . Outless
� Lau�n Sprinklers
� Mstallation or Altera[ion
N'ater Pi in
y Back Flow Prevcnter
y Pm . Scwer_ ft.
= Cess ool S< tic Tank
H
t
-
1'01'AL FEE
,I 1
-' �,AY i2-75c��.,—S�OO 949 o***t*�.0�
PERMR,NO.
TfUCT No. RE�o. a� � 67369 �
LOT NO. DATE IB6U6D
BUILOING USE ' /� �
iw�
BUILDING ? / <OI,
ADDqE55 L/ v '�/ �
COSTA MESA. CALIFORNIA
AODFE55 /�/j GCl• � � I' � �YO) // _n
GITY �[�j�Xi- //(` �i�._ � TEI. NO. O�I /��jl
I hereby acktiowledge that I have read this application
and state.ttiaf the'.above is correc[ and agree to comply
with. all' Cify Ordinances and State Laws reguL�ting
plumbing., '
a'� I eectify that I possess the above valid state of Cali-
'fornia dassification or I am the legal owner of the resi-
-Aential property described above.
Signatwe of
Permittee
INSPECTION RECORD
APPROVAL
1� � �- u .,�....�r w. ,
l .w /� �u.
IOwM OU.3a BWV. riRI�YT
�
O N�� COUNTY BUILDING DEPARTMENT APPLICATION FOR PERMIT ,
� � 636 North Broadwar . -. . - � � � � �' � �, .
SANTA ANA, CALIFORNIA
FOR APPLICANT TO FILI IN FGR OFFICE USE ONLY �
RECEIPT NO. PERMIT NO.
BUILDING ��/ I.I. w1LS'ON cJ� � i��[� �7�%�� �
ADORE55 W
RHTOWN 'ST �� J f// ��C S� [RECnEIVED BV DATE REG'D. DATE ISSIiED
NEAREST �//��� /�L.'/ /! /. Il O'' —/��� �� �5� �a -� - � 3
CRO55 ST. ,/�. //
OWNERf�AUI � � V�KM � ^Y /"� ADD E'S5' ✓71 '/ /��—KY-'U%'L- . __
MAIL �`� q �?o� HG�tfi6R L� � OR TOWN �� V�c"-d�
AOpRE55 SCHOOL OIST.
cin �O.S'�A M�C A No �E %�s� CROSSS T. �, 1L. .
ARCHITECT OR LIC. ZONE NO.OF 1 TYPE GROUP
ENGINEER NO. � I PLAlIS i ^'�7� f
�Vi �!
_DRE55 APPROVED {�7
BV DATE/O�I —�
CONTRACTOR I� V_FRM/L'%A NoJ�1/y'7 CORRECTION$
AOORE55
<"
LEGAL I LOT I F�
DESCRIPTION NO. , BLOCK TRACT S ,
(ATTACH METES B BOUND51 � � �
SIZE OF LOT a X 3 0 I NO, OF BLOGS. J. . /'
NOW ON LOT
USE OF I NO, pF I NO. OF ��-t �� -
EXISTING BLOG. FnMiuea ROOMS r ' " �
SETBACK LINE FROM; .( � REAR YARO ��
CENTER OF STREET cl S SIpE YARD ,�
DESCRIPTION OF WORK � �-�� �� � �
NEW I I ALTERATION I I qO�IT10N I ' � � - Z
/
D
REPAIR I I MOVINCa I /'' I OEMOLISH I �y? r
BlIILDING 3 X 2 1 ROOMS X STORIES /
SIZE 4 � 1-+ • � . • "`�
TERIOR WALl.� q I` ROOF �J q r � � � �� � �� �
ERING �)fUt�LO I COVERING /�QCSI\
EOFNEW �u�)C/IX y
BUILDING C � .^:9 C�•�.. ;. ..�\-�,•� \ ; .�. '' �
F.;n � 1 �iA�� •a� � �._ ��a.
* APPROVALS•
FOUNOATIOI: LOCATION INSPECTOR DATE •
I HEREBV ACKNOWLEDGE TMAT 1 HAVE READ THIS FORMS, ATEpIALS.' �
APPLICATION ANO STATE THAT THE ABOVE IS CORRECT UNOER� NNING 'i
AND AGREE TO COMPLY WITM ALL COUNTV ORDINANCES FRAME: FIR STOPS, Jw� z. -�.�
BRACIN BOLTS It
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