HomeMy WebLinkAbout271 16TH PL - Building Permits CITY OF COSTA MESA •
4es) BUILDING DIVISION
> „ � DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
F t renal A : PERMIT
do B04- 005
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 271 16TH PL Status: ISSUED
Suite: Applied: 11/29/2004
Vicinity: Issued: 11/30/2004
Parcel Number: 42522106 Zoning:
Applicant: TOD RIDGEWAY ISSUED BY:
Address: 2804 LAFAYETTE AV
Phone: 949-723-5854
NEWPORT BEACH,CA Zip: 92663
Owner: RIDGEWAY, TOD W TR
Address 1400 W BAY AVE
Phone: 949-723-5854
NEWPORT BEACH,CA Zip: 92661-1023
Contractor:
Address:
Phone:
Zip: License:
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REPAIR DAMAGED STAIR CASE LANDING
FEE SUMMARY
Plan Check: $45.01 Calc Valuation: $2,000.00
Permit: $69.25 Claim Valuation: $2,000.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $114.76
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
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
244648(8/00)
DECLARATIONS
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.
❑ I have 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.
My workers'compensation Insurance carder and policy number are:
Carrier: Policy Number:
(This section need not be completed It the permit is valued et 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 of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.,
Applicant Signature: - . Loa: • _ Date: //- -3 0 --r)
WARNING:FAILURE TO SECURE WORKERS'•• - NSATIO •• ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES D CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION T• I. COS •F COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37Ce 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 and Professions Code,and my license Is in full
force and effect.Lic.# Class#
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
In 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: Lenders 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 end 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�rthe applicant to a civil penalty of not more than five hundred dollars($500).):
L•. 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 properly 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 un•- ec. Business and Professions Code for this reason:
Signature: F /
232Expires:
Verification of Ownership by(type of docu /.nt,i.e.-properly 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,Callfomia 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 Safely 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? ❑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 application a ppermit for such construction or modification
from the South Coast Alr Quality Management District or from any other air pollution control district or agency? Yes u 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? 0 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 Duality 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 0 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 prope ins action purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Je*-1' //- 3 0 - o7
nature Of wner(s) Date
And/Or Aut rized Applicant Date
;ODE f INSPECTION TYPE DATE INTITIALS PDF k INSPECTION TYPE PAIS 1
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
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 Y
204 Final Demolition -. 250 Final Building/Occupancy 2--23-1342.. �,\
ADDRESSOR IwlLDINO: BARRINGTON, WILLIAM B MT: CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: B 07184",
°""ERSNA"EI`Iorom: BARRINGTON BONNIE A
ADDRE' 1506 KEEL DRIVE PERMIT NO: B 071847 PLAN CHECK NO: N GOVT: N SUPP : N
CORONA DEL MAR,CA 92625
i♦♦APPPL.MAIUIIO ADDRESS:
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE : OTH
?NCNRECT OR ENGINEER: LIG. DESCRIPTION T/OFF & REROOF W/COMP SHINGLES SQ FT; 2 , 674
ARCH.OR EMI ADDRESS: WIT: CLAIM VALUE: 2, 674 . 00 CALC—VALUE; 2, 674 .00 GROUP OCC; R-1 /M-1
BEST ROOFING ( 714 ) 557-4040
CDIRRACTORSNAVE: 765 ST CLAIR COMMENTS : SMOKE DET. REQ PER 91UBC, REROOF 2000SF 4—UNIT APARTMENT W/COMP
CONTNACTORSYAIIWO COSTA MESA CA 603323 *+t*+E*********+r+c******+t_****************roc*********************+6***************ac*
ADDRESS: 92626 uc'ta.: B ZONING R EQUIR EMENTS
WMT: SETBACKS
LICENSED CONTRACTORS DECLARATION:I hereby dfim mint penalty of perjury that I am I' under provisions of Chapter 9
(commencing wi d D'nisidn 3 d the Professions 0`SY°"9P°b "°°3 � "'° en°° /95 MAIN BUILDING ACCESSORY BUILDING
CITYDale NO.: Cuc.cuss: UC.NO FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dale: �VO -9fj Contractor: / LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER B ILDER DECLARATION:I hereby affirm under penally of jay that I an from the Contractors License Law to the
following reason(Semon7031.5 Buenesa and PMessions Code:AnY city or coney whidy dre.e permit to Cosmos,eher,improve, PARKING AEQ• PROV: PARCEL: 42522106 ZNE: REF NO;
R demolish.or repair any structure.prior to As issuance.a"o requires the applicant for such permit b file a signed statement that he or she PLANNING NOTES>
l r?;)licensed pursuant to the provisions d the Contractors License Law(Chapter 9(cornmeni g with Section 7000)of Dia"ion 3 d the >
:-,,03-1,5
-�udrromard professions reCabla that Ms the a aids thereboeand iMom"tathe alleged exemption. (S500]).
5oy 0)L liondSection *******************************************************************************
`3031 S by any rofessi for o permit subjects heo she
applicant ex m rot del penalty of not more ththe free hundred dollars iry viol.
❑ I.ea owner of the propeny or MY employees veth wages as Illei sole compensation,will do the work,and the structure irs 1101 intended DEVELOPMENT SERV ICES REQU IR EMEN TS
or offered for sale(Section 7044,Business and Professions Code:T a Contractors License Law does not apply to an owner of property
who bolds or inprovea thereon,and who does such work tinned or hem/or trough his or her own employees,provided that such
improvements are not intended or offered for.ele.I,however,the building or improvement is sold within an yew d completion.the ZONING APPROVED BY DATE:
owner binder wit have the burden d proving he or the did not meld or improve for the purpose of sale).
❑ I.as owner ol the properly.am exclusively contractiig with Warned contractors to constnxt the MOWCI MedliOn 7044.Business end BUILDING APPROVEDBY
ProfessioCode:The Contractors License Law does notapply a
to en owner properly who builds or improves thereon end who DATE :
ns ` 1
projectsCCntrod°mr.,vctrwith ror
a .mdorla)Iaand.e pursuantto
tM rctda �
coml, ts.law). APPLICATION ISSUED BY; DATE: �1' tUb �l.t�
❑ I am exempt under Section: B.8 P.C.,b this reason: ********************************************** ************************* *****
Date: owner LEGALIZATION:N F E E SUMMARY STRUCTURAL ' SEGMENT:Y
I do hereby certify that I am aware of and understand the requirements of CdUmua health end Safety Code Sections 25505.'neat end
25534.and thatt o anyhure building Pavpent nil not an)need to comply with saki tate codes andthe requirementsler BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit foe construction or modification from theAi uwty anglmrd Diurkt.Residential mmmeun appicndias are exempt from these PERMIT 54 . 00 . 50
provisions.
Date: ApplicantPLAN SMIP/NON AES
WORKERS COMPENSATION DECLARATION:I hereby affirm under penalty d perjury the of the blowing declarations: ISSUE FEE
❑ Ihaveendwim°imenacejraudcawmlo°ed'nwuebworkricompemety,mproidedforbySedion3700othLaba BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Code,for the performance ofthe work for with this permit oissued. TOTALS----> 54 . 50 0 . 00 0 . 00 54 . 50 54 . 50 . 00
❑ I have and will maintain workers*compensation insurenoe,es required by Section 3700 d the Labor Code,ler the performance of the
""I° vhichihaPemil"""ad'Myworh°rrS'Ilti u'710111756"''Kiel mint'''": EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 54 . 50 OVER/SHORT: . 00
Center: 11375:2 DS 06/01 /95 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
Policy Number.
54 . 00 . 50
This section need not 6e completed I the print u b are hundred dollars(51001 or Nes)
❑ I coney that in the performance of the work for which this permit I issued,I deg not" ploy any• • in any manner Do as to
become mbject to the workers ornperaatipnlaws of Cafdanfe.and agree that !I should,r.. subject to the workers' *******************************************************************************
Cor ion provisions d 3700 d the Labor Code,I shell fond ;it .dv .. , • • INDIVIDUAL F E E BREAKDOWN
Date: '40 . 5 4 Applicant: a . /
TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Warning:Faun to secure workers'compensation coverageIs un I.and Nall aub/eef •employer to criminal penalties and
civil tines wbm.hundredthousand and ttrgfl teas Off•• mm.nett of dors damages.s provided rot In SFR 2674 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 674 . 00
Section 3705 0l on Labor Cods,Interest,and a(5l Oil/Ma
CONSTRUCTION LENDING AGENCY:I hereby affirm under panels a Perjure tett there'. a cenmmcion lending agency for the END OF FEES
performance piths work for which this pantS is issued(Sedan 3097.Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I ham read this application and date that the above information is correct.I agree to comply with all city and county ordinances
and state laws relatkg to buiidkg.• .. .•• and hereby authorize repreaenuative.of this city to enter upon the above'mentioned properly
for inspection purposes.
yinspectionIr. ISL.-1%. / 01 001'79644-00179645 TOT 54.50
Nam. �/ / DATE: 04/10/95 TIDE: 13:24
p der i///A Date: 9 /
—1 sely. no- /AgentfAppfunUCmiraea
(5151'46.WP) While-Bul. •8 Safely;Green-Ale:Canary-Appicent:Pink-Revenue;Goldenrod-Assessor
•
•
tit
CONSTRUCTION AND PLANNING POOL ?A
APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pale 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-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 1
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. POOUSPA 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 O Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing - n. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing ,, ql &W 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 PREY. 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 Li.29_95-6-14.4
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
JOB ADDRESS th Place ' 7len..� BUILDING PERMIT NO. 111526
GENERAL CONTRACTOR Owner-bldr. '� c - - C.( VALUE $ 27.1131.00
AP. No. 117-191-13 LOT TRACT FIRE ZONE DESCRIPTION OF WORK —kali ales. ---7sy_ "--
INSPECTIONS
INSPECTIONS A44/ DATE GROUP H & J TYPE V ZONE R-h 44P4
I,!;ykrground Soil U.G. Water _ SUBCONTRACTOR PERMITS ISSUED
Ls` ground Gas DATE NUMBER
Overhead Water and Gas !' _9-2 -C_f
Rough Heating , -2-C/ Q Cv�t� _
_Kit v�,,.a�,.. qac - 6 -1Y�— ?Io1ga° v
Rough Plumbin .A9^� 7cM,,� $-r -' +- '• _ 3al? .'- •Ig3l( �+)
MiscellaneousP/i 1;741'Yr fv7i'�f % :}l',r7 " '+ N- 8'�v� 3ZS ' O
Prop. Swr. Line House Con. St. Swr. ��-1.?y�yl+ >� /fer-ZS'i/" , ¢-4i 3/703
Sprinkling System —�/ +(f
Heating, Final (4,3_
Plumbing Fixtures /�yi
Final Gas Test /5` �� i
Construction Pole
Underground Power •y, _ _
Rough Wiring y ,2 } .' " , 2. 'Qoc�..
tt: ( it- 1?-7-4 1 U'62, - '''I
Trenches Forms Steel Edi£ fa,-2-2--64.4 _ _
Floor System `� Lei -2-y' -o ' /
Steel Reinforce Chimney Re-Rod
Bond Beam gr
Sheathing fesdr + _ ,
Frame and Flashing - . ' Z — -
lia ;3, In Out �j}ter? a Yr— ' 3-el — el //
Plumb/ brown coat QtF/ 9-f5(-(S/ /
Plumbing Fixtures, Final /1411,- //-/L -Gi /y/
Electric Fixtures, Fina-/-(40/6 (/--7n/
• .. 14526FEE RECEIVED
sr MAI 17tail
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P. O. BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT)
RESS 2-2/ '�8'
ADD ��zi/ ',gce BUILDING
COSTA MESA.
CALIFORNIA
/J� /\'`//�J For Office Use Only
OWNER /`/-'///[// (J LJ�RIV C �.1/\' I RECEIPT NO. I PZRMI�NO�/
MAIL •�� I/ Iy, w� J RECEIVED BY DATE RECEIVED DATE,ISSUED
ADDRESS ace) ,VJ',__AO, i. y /7.$may- ^-Cf- I •S '/7-G! 7 /57.2..6n
CITY�� J]Ijj.O{ 1/q TEL.
NO.U41 fiat ADDRESS
ARCHITECT /II 1 /1� #.S No:G i'�ary9 COSTA MESA. CALIFORNIA
OR ENGINEER l(S14 ( IK {�
ADDRESS N�r,4'LE y JT. FIRE ,�J l:.l
/'// p ZONE TYPE (� GROUP 1(
CONTRACTOR &4/7//,,E1?—LAY �/PER, a. i
APPROV 41
JJBY DATE C-
ADDRESS �7j�/15 ZONING ,i7/2/___ .,-4,4._ a
ZON 1 / NO.OF �) � USE OF NEW ,47 w
CITY I PLANE 2 BUILDIHet
STATE TEL. LEGAL N�"� D ll�/"�-I�!!n , (,2 5-j` U
LIC.NO. NO. DESCRIPTIO ;fir" 67 (2
SIZE NO. OF BLDOB. �7la
OF LOT /".C./{//,3JF .O r NOW ON LOT A.P.NO. I/ / -/97- ( O.
U)
USE OF YARDS EVES
EXISTING BLDG. T Q<r .0�AICL/.SN E` n APPROVED ALLOWED (.'/
LINK FROM / //// / <D8NT8R LINE 8T.) �/� IO
SETBACKCENTER OP STREET 92 REAR YARD ler FRONT t&FT. IN.
SIDE YARD I LEFT JO /
I RIGHT ,./
e, R.SIDE /�'Li FT. 4. IN.
0 .
DESCRIPTION OF WORK
L.SIDE /0 FT. IN.
NEW I ,
j Iptl'{I{-ALTERATION I ' II ADDITION I REAR 9c`FT. I c3
REPAIR I U MOVING I II
DEMOLISH I APP4,,,,,_,,,,x,
ROVEI�/I 7 i0 I DATE �� /
BUILDINGy�, �/ NO. OF ROOMS �[J STORIES2 V �/ lCP ^'SIZE713 COVERING RIOR WALLROOF {j yJ� ( — r e' eg-k • AI
.LL / O I COVERING//G�//L4 TRe ...(((��� 4..32 ,Y-i
USE OF BUILDING AND WORK TO BE PERFORME
d /� y� C- a- Y c. --ice...:
//Pi�'7///* / r- y / J�#// - / ' i.g 3-7 2.`0 >/-tie' Q t
y c�/-? Po RT- t— on' CA
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ADOVE IS CORRECT AND AGREE TO COM• PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. (•�0
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING `N
BUILDING CONBTRUCDO VALUATION ''//�77
SIGNATURE OF/// r `� ,' ��//y"�j'!,( PERMIT FEE $ *C �D
PERMITTEE (�'�L�'�iiPV r(�/"� '��� �j [� S-17
n �'v
VV IL $ // Si'v PLAN CHECK $ a 3• S O % `\
AUTHORIZED AGENT }O. S 6j c\• �
TOTAL FEE / E��l