HomeMy WebLinkAbout175 22ND ST - Building PermitsF
CA
42263
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
IUI 13-76crP'001393: **,r, * -I.97
For Applicant to Fill in Completely — Use Ink Only
APPLICATION FOR STRUCTURAL PERMIT
RECE7M
I D R
DATE ISSUED
_
BUILDING
ADOR ESS
OWNER =
�/�
A.P. NO. V —
PE
MAIL —
ADDRESS
ADrZo
DLDING a
RESS QS 22�'—° �
EL.
CITY NO. )
N TR CT H�fS.
,p
r �OT BLOCK
CONSTRUCTION
1 -ENDER
W
X1
PMOVING
x
BRANCH
OWNER
ADDRESS
E w
S
ARCHITECT TEL.
R ENGINEER ii
FIRE
ZONE TYP5 GROti
ADDRESS ys/
-
CONTRACTOR /
APPROVED /
BY DAT
ADDRESS }
TEL.-p1y/E�)
CITY _ NO =�j
I� v
NO. OF
PLAN$ Z
USE OF NEW
BUILDING
STATE CITY
LIC. NO. LIC. NO.
YARDS APPROVED
MAIN BUILDING
YARDS APPROVED
ACCESSORY BUILDING
SIZE / ♦
OF LOT �%%
NOWBLDGS.
NOW ON LOT
(FROM C/L STREET)
FRONT Alf FT.
FT.
USE OF
BXISTING BLDG. -C
+2
R. SIDEJFT,
FT
Separate permits are required for
electric, plumbing and heating work.
L SIDE
FT.
��//,�FT.
REAR Zi'FT6
FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
MAIN BLOCS.
BET. MAIN &
ACCESS, BLDGS.
VAR. aW
C.U.P. qW
DATE
APPROVED
APPROVE2 J t
�W
DATE' /
10
I hereby acknowledge that I have read this application and state
that the above Information Is correct and agree to comply with
all laws regulating building construction, and 1 shall not employ
any Person In violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed as a contractor under
the State of California Business and Professions Cod., Division 3,
Chapter 9, and that such licenses are In full force and effect, or I
am exempt from the provisions of the State of California Business
antl Professio ce, Division 3, Chep W
Signature f f b�- o
Permltcea ^i� �—�
SO. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VALUATION
E / PAM
PERMIT FEE E
PLAN CHECK $ DO
TAX E
Authorized Agent
TOTAL PAID E
q
C.
N1 If, 11-764fi�t7Q01014 d***`41`.CO
y I COSTA MESA BUILDING -SAFETY
P.D. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Appli � Fill in Completely — Use nk Only
RECEI
DATE RECEIVED
rMpE IC�
BUILDING
�l
ADDRESS
(�
OWNER O,^f-Soy-- ��
A.P. NO. Ile_0
PERMIT NO.
MAIL
ADDRESS
BUILDING
ADDRESS
TEL.
CITY NO.
TRACT
LOT
BLOCK
CONSTRUCTION
NEW
ADO ALTER
REPAIR
LENDER
BRANCH
OWNER
ADDRESS
VALUE
USE E
ARCHITECT TEL.
OR EN (NEER
FIRE
ADDRESS
ZONE TYPE GROUP
APPROVED
CONTRACTOR
8Y DATE
ADDRESS
TEL.
CITY NO.
ZONE
NO.OF
PLANS
USE OF NEW
BUILDING
STATE CITY
LIC. NO. LIC. NO.
YARDS APPROVED
MAIN BUILDING
YARDS APPROVED
ACCESSORY BUILDING
SIZE NO. OF BLOGS.
(FROM C/LSTREET)
OF LOT NOW ON LOT
FRONT FT.
FT.
USE OF
EXISTING BLDG.
111F FT
FT
Separate permits are required for
L. SIDE FT.
FT.
REAR FT.
FT.
electric, plumbing and heating work.
USE oP BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
MAIN BLOCS.
ACCESS. BLDGS.
VAR.+
DATE
C.U.P.#
APPROVED
APPROVED
By
nATP
I hereby acknowledge that I have read this application and state
that the above information Is correct and agree to comply with
all laws regulating building construction, and 1 shell not employ
any person in violation of the workman's compensation laws of
the State of California.
1 hereby certify that I am properly licensed as a contractor under
SQ. FT.
THE AMOUNT SHOWN UNDER VALUATION 19 F R
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FE Y:
em exempt from the provisions of the State of California Business
and Professions Code, Division 3, Chapter 9.
VALUATION
PERMIT FEE
PLAN CHECK E �^
Signature of
TAX E
Permittee
E
TOTAL PAID E OQ
Authorized Agent
G
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant.ttoo Fill in Completely — Use Ink Only
BUILDING
ADDRESS
OWNER cla A S%�eIlm�Lj!
MAIL
ADDRESS €, ad!6-
NW
CITY G�/%I NOL67
CONSTRUCTION
LENDER `-
BRANCH
ADDRESSARCHITECT �♦�''7'- /
ORENC•INE R ///i�/mss '[IOIY�`> NO hY/J T�7
CITY
STATE
LIC. NO.
SIZE
OF LOT
USE OF
USE
TEL
NO.
CITY
LIC. NO.
NO. OF SLOGS,
NOW ON LOT
Separate permits are required for
electric, plumbing and heating work.
0
I hereby acknowledge that 1 have read this application and state
that the above information Is correct and agree to comply with
all laws regulating building construction, and 1 shall not employ
any person In violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed as a contractor under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force and affect, or I
sm exempt from the provisions of the State of California Business
antl Professi ode, Division 3, Chap e 9
Signature
Permittee
Authorized Agent
P *** -'-25.25
'=P 13-7Fc.—xASJ.00 5t17.•x
A41t PION FOR STRUCTURAL PERMIT
RE V
DATE RECEIVED O TE ISSUED
A.P. NO.I� -074 -ZC� PERMIT NO.
BUILDING I� .l ��� �-
ADDR�ES�S
7�5
w TR AC'Is - -
py`
I LOT
BLOCK
W
P
MOVING
I-RIJ
p
OWNER Az
S C VALUE rn
F
F� PNO. OFLANS USE I NEW /�'pf� PLANS zBUILDING
ARDS APPROVED YARDS APPROVED
MAIN BUILDING I ACCESSORY BUILDING
IF
VAR. aW
02:7 FT. toe
BET. MAIN &
ACCESS. BLDGS.
DATE Q I/ `7/
APPROVE V' CJ
REQU
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VALUATION PERMIT FEE E
5SPLAN CHECK E
S TAX E
TOTAL PAID E
_ 4264
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING J_ -SMI'. 'r a _ .,A , �slil'i
OWNER
BUILDINGS ADDRES
___9
CITY -" NO. Z
CONSTRUCTION
LENDER
BRANCH
ADDRESS
ARCHITECT TEL.s,, ism
CONTRACTOR
ADDRESS
TEL.
CITY NO.
I STATE CITV
LIC. NO. LIC. NO.
SIZE NO. OF SLOGS.
G OF LOT 0 NOW ON LOT
USE OF
EXISTING BLDG. 7
HSeparate permits are required for
A electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
O
}
.a
W
p1 hereby acknowledge that I have read this application and state
19 that the above Information Is correct and agree to comply with
L all laws regulating building construction, and I shell not employ
.Z any person in violation of the workman's compensation laws of
the State of California.
= I hereby certify that I am properly licensed as a contractor under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that Such licenses are In full force and affect, or I
am exam pt from the provisions of the State of California Business
and Professions$CClod., Division 3,
Chap r 9.
Signature cf� J /
Permittee tAAA/// Cr
Authorized Agent
crP 1�-7hPr.:a:° **t,
r. 00 5 R1 40.10
FOR STRUCTURAL PERMIT
2
Z
NO. OF
PLANS Z
USE OF NEW AW (210E.%
BUILDING U1a
YARDS APPROVED
MAIN BUILDING
YARDS APPROVED
ACCESSORY BUILDING
/Js��Jr
;FROM C/L STREET)
FRONT FT.
FT.
�{
SIQEFT.
FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
���•
L. SIDE vW FT.
FT.
REAR � FT.
FY.
v
DISTANCE BET.
MAIN SLOGS.
BET. MAIN &
ACCESS. SLOGS.
-
VAR.
C.U.P, / O
DATE
APPROVEO8' _ �jiAl
$ a �
LL
�
TAX $
n
m
i
/Js��Jr
w
IIV SO. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
NO
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VALUATION
PERMIT FEE $
v
PLAN CHECK $
o
$ a �
LL
�
TAX $
U
TOTALPAID $
OWNER COAST APARTMENTS DATE 10-26-
J'" ADDRESS 175 East 22nd Street BUILDING PERMIT
AP No. 118-074-26 LOT TRACT FIRE ZONE VALUES R00.0(1
INSPECTIONS
Si nature
Date
TYPE V GROUP
I ZONE
SOIL
SUBCONTRACTOR
i PEP
GAS
Data Number Si notare
WATER
Pi bin
ROUGH PLUMBING
AD 503,
PROP. SWR. LINE Lj HOUSE CON.
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND POWER
ROUGH WIRING
Heatina and Vent.
TRENCHES Lj FORMS STEEL REINF.
FLOOR SYSTEM
BOND BEAM STEEL REINFORCE
SHEATHING
FP -ME AND FLASHING
Q7
It a
'NG — IN M OUT
PL.•aTER, BROWN COAT
STRUCTURAL, FINAL
HEATING. VENT., REFRIG. AND A.C., FINAL
1,�
(/ T/
PLUMBING. FINAL AND GAS TEST
�I
ELECTRIC, FINAL
RL
-1
BUILDING, FINAL
/�'/
BRANCH
D
CONTRACTOR �
COSTA MESA BUILDING -SAFETY DEPARTMENT
•"
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
ARCHITECT A�D�/ TEL.
OR ENGINEER /' NO.
US
PL 'A I
in Completely —Use In yR!7�`1,Q�J
FIRE
ZONE
G /
APPROVED
PLA BUILDING ffj
F.
STATE CITY
YARDS APPROVED YARDS 'APP ROVED
LIC. NO. LIC. NO.
7ApplicantFill
A.P, NOQ -�
SIZE
No. OF SLOGS.
BUILDING
Il
OF LOT
NOW ON LOT
FRONT FT. FT. I All"
QAODRESS
w
- e� NO BV
�T
T
CONSTRUCTION w/e 4, tf
cnincc �{r
W !ADD A
BRANCH
D
CONTRACTOR �
ADDRESS
OWNER
ARCHITECT A�D�/ TEL.
OR ENGINEER /' NO.
US
Z
ADDRESS
FIRE
ZONE
G /
APPROVED
IPT
75 7�cr
FOR STRUCTURAL PERMIT
If
BLOCK
CONTRACTOR �
BY DAT
/Vlf4e��
ADDRESS �v
TEL.
Z
NO. OF USE OF NEW
CITY NO.
PLA BUILDING ffj
F.
STATE CITY
YARDS APPROVED YARDS 'APP ROVED
LIC. NO. LIC. NO.
MAIN BUILDING ACCESSORY BUILDING
w
SIZE
No. OF SLOGS.
(FROM C/L STREET)
Il
OF LOT
NOW ON LOT
FRONT FT. FT. I All"
<
USE OF
l G
4
EXISTING BLDG. r.-
T
N
A
V/
FSeparate
permits are required for
L. FT
electric, plumbing and heating work.
REAR FT
F
t:
U E OF BUILDING AND WORK TO PERF RMED
�.dp 11
DISTANCE BET. BET AIN &
G`
4 ! r C'
MAIN SLOGS. ACCESS. BLOCS.
e
��-clluv"Biel
VAR.
T B L/
.�
C.U.P. APPROVED
//-Oe'r y.Atel"e. IV;,V/O
ROVE /J
6•
}a
DATE/0
a
�T � Mvc R /fdGi9
w
0
1 hereby acknowledge that I have reed this application end state
N
IX
that the above Information is correct and agree to comply with
:11
all laws regulating building construction, and I shall not employ
person in violation of the workman's compensation laws of
o
Wany
.y.
the State of California.
m
3
I hereby certify that 1 am properly licensed as a contractor under
SQ. FT.
N
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Division 3,
m
Chapter 9, and that such licenses are in full force and affect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from t e provisions of the S to of California Business
'r
and P, I,a, Divisio , Chap r9
VALUATION
PERMIT FEE E
�/
LAN CHECK E
G
SlBnoture of
G
TAX E
Permlttoe -
$
i
Authorized Agent A
-A,--s-�`� /
U
TOTAL PAID E
OWNER WALKER Otis 7
"'BATE 1rZ $1sa,
]OB ADDRESS 175 E. 22nd St. MAR
ENERAL CONTRACTOR OHner-Builder tJ IgsS
BUILDING PERNUT NO. 6116
VALUE $ 4,608.00
11 P o LOT 282 TRAC A. FIRE ZON o D]n�C,{2IPTION OF WORK Addition to Garage
IUP 1 & d TYPE v ZONE R a„
PLAN NO. 6116
INSPECTIONS DATE SUBCONTRACTOR
PERMITS ISSUED
DATE NUMBER
Trenches Uukorms Steel .Z '
Floor System
Steel Reinforce Chimney Re -Rod
Bond Ream
Frame and Flashing
Lathing, In Out
Plaster, brown coat
Underground soil W/G Pipe Test
Top Out
Furnace
✓
Gas Vmts
Rough Plumbing
- -,5
Cesspool Sepde Tank
Prop. Swr. Li6e, 110 Con. St. Swr. 3 a
Sprinkling System
P 'ig Final
E_ ,ing Fixtures, Final
Final Gas Test . Q
Construction Pole
Underground Power L.�.-K EtE.d C
.Sc. e rim
Rough Wiring /
Fixtures, Final
VaA.urn1\l,aI 11/--,, J p
Form 210-5M-1-67' - i _ -
I eV,F, FOR SPECIAL REOUIRFMFNT9
11'�2I- S'7 ' `(u
'lF I:TIA P. `tii
APPLICATION FOR PERMIT
BUILDING (I
COSTA MESA. CALIFORNIA
FOR OFFICE USE ONLY
..
OWNER
6116
RECEIPT NO.%I%Nq
. 40
MAI
MAI L
ADDRESS/�
'R IVEO
COSTA MESA BUILDING DEPARTMENT
D E IS IyED
P. O. BOX 317
CITY7L(,/� /�(.p. ✓�,,, NO.
COSTA MESA. CALIFORNIA
FOR APPLICANT- TO FILL IN
COSTA MESA. CALIFORNIA
11'�2I- S'7 ' `(u
'lF I:TIA P. `tii
APPLICATION FOR PERMIT
BUILDING (I
COSTA MESA. CALIFORNIA
FOR OFFICE USE ONLY
OWNER
RECEIPT NO.%I%Nq
MAI
MAI L
ADDRESS/�
'R IVEO
PA/ RECE
D E IS IyED
CITY7L(,/� /�(.p. ✓�,,, NO.
ADDRESS
ARCHITECT LC.
ORF NEER NO.
COSTA MESA. CALIFORNIA
FIRE
ADDRESS
ZONE
//y���� �/ JyC'�ITV LIC.
CONTRACTOR I!/ -W`14 NO.
ZONE
NO.OjFF��
/✓rr�t
TYPE
/ �E - TRO.
APPROVE . 7� p 10
di 4 V ` J16A �•wr rl
_ADDRESS
LEGALLOT
DESCRIPTION
q
NO.. 0
BLOCK
TR CT
CORRECTIONS // Z/ 5
A, P. NO.SIZE / I
vO
OF LOT (% A 5'
No. of aLDcs.
naw oN LOT
ti Ly
USE OF
CITY OF TA MESA
EXISTING BLDG.
SETBACK LINE FROM
CENTER OF STREET /E� r�_Y�APWARDI?lrSUDJEC(
TO
G. DEPT. REG}
SIDE YARD RIGHT -7A LEFT
DESCRIPTION OF WORK
t;Y H iyyL -
NEW
ALTERATION
ADDITION
REPAIR
MOVING
DEMOLISHs—
BUILDING NO. OF
SIZE ROOMS �� STORIES
7 a
nn,�-�
EXTERIOR WALL �l Y+/1.0
COVERING •�L-I-L�
ROOF
COVERRn IING��/
OF (/
r"a-rim'
8W WILDINUSE
G T Li %
� „ Z
1NEREBV ACKNOWLEDGE T TRIS APPLICATION AKD
OR T AN AGR
STATE THAT THE ADOVE IB CORRECT ANO
TO COMPLY WITR ALLCITT
4-7:�
ATIN
ORDINANCES ANO STATE LAWS REGULATING BUILDING CONRTRUC�
VALUATION
PERMIT FEE $
TION.
SIGNATURE OF /y/ �L
PLAN CHECK S
PERMITTEE _ v✓c
/o�`
AUTHORIZED AGENT
/
TOTAL FEE 5 3�
r
;Z V Al=d
DAT2 I ,
'BAR. No APPRol co.
S I -W e 7`0 1 -ie-
OWNER WALKER, Otis DATE 1-24x58 _
JOB ADDRESS 175 E. 22nd St. BUILDING PERMIT NO. 6338
11-Gk?jERU CONTRACTOR Owner -Builder VALUE $ 57.00
We. LOT TRACT FIRE ZONE DESCRIPTION OF WORK Fence
IUP TYPE ZONE PLAN NO.
INSPECTIONS DATE SUBCONTRACTOR
PERMITS ISSUED
DATE NUMBER
Trenches Forms Steel .
Floor System
Steel Reinforce Chimney Re -Rod
Bond Beam
Frame and Flashing
Lathing, In Out
Plaster, brown coat
Underground soil W/G Pipe Test
Top Out
Furnace
Gas Vents
Rough Plumbing
Cesspool Septic Tank
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
N ig Final
E_ ,in Fixtures, Fiaal i.
Final Gas Test
Construction Pole
Underground Power
Rough Wiring
ix[ures. —Final
OCCUPANCY
Form =10.-vzrt_1_57 338
COSTA MESA BUILDING DEPARTMENT
PO. BOX 317
COSTA MESA CALIFORNIA
C.L. OF STREET
___iPROP TINE—
r 10 FT. FOR 60 FT. STREET
I
I
I
I
LLEY OR PROP. LIN
I
0
m
I�yc
&33�
N
Date Received
Date Issued
!U
CD
INS
VALUATION'
� C.
I
Permit Fee
$
Plan Check
F
TOTAL FEE
�^• t7 0
10
FT
L a
I
7
6IIN.
�!
0
��
I
IW
Fn'W z
I
FT
I
IZ
J
El
U M a
I
a
to
�-
m
I
I
I
la
I
F
1 I
i
II50
FT.
ST.
I
C.L. OF STREE
MAXIMUM 4 FT. FENCE MAY BE PLACED ON DOTTED LINES
MAXIMUM6 FT. FENCE MAY BE PLACED ON SOLID LINES
v
I
40
FT
60 F71 ST.
6338
FOR APPLICANT TOrFII.I- ���•
BUILDING ADD 173
5 x I�`I
,-
Mail Address�= / ys %+ R`
City- i Ph. No./+
ContractorPh. No.
City_ Lic._No._Sta_te_Li_c. No. _ _ _ _ _
Size of Lot 5G -k/,B AP No.I � � F 0 `1 /
j//
Setbacks: C/L Street—Z-490Rear /
i
Side Yard - Right Left
Type of Fence '*-"A 4L 44 /
I hereby acknowledge that I have read this application and state
that the above is correct and agree to comply with all City Ord-
inances and State Laws regulating building construction.
Signature
of Permittee _
FOR OFFICE USE ONLY
Permit No.
&33�
Received by
Date Received
Date Issued
VALUATION'
Permit Fee
$
Plan Check
$
TOTAL FEE
USE REVERSE SIDE FOR DETAILS
OWNER AWREY, Maude K. DATE 5-10-72
JOB ADDRESS 175 EaRt 22nd Street BUILDING PERMIT N0. 34690
LOT TRACT FIRE ZONE VALUE
INSPECTION
� uSOIL
�IGAS
WATER
ROUGH PLUM91
PROP. SWR. LI
SPRINKLING S)
ING AND AIR CONDITIONING
UNDERGROUND " POWER
F
SHEATHING
FRAME AND FLASHING
o
^TER, BROWN COAT
,...UCTURAL, FINAL
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST
ELECTRIC, FINAL 75 11
SUBCONTRACTOR
F_
Z
Q
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Q
O
F
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- 34690
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BUILDING 6941 / , )_. _ _ / _
OWNER
MAIL
BRANCH
ADDRESS
ARCHITECT
OR ENGINEEI
ADDRESS
ADDRESS
'N 10_17r,, 00 554' ****18.13
APPLICATION FOR BUILDING PERMIT
R E C;6 D 8 DATE RECEIVE
DATE ISS ED
-5--le-2A��%%
/fiADDRESS
TELNO
TEL. S
NO
FIRE
ZONE
s, r APPROVED
VALUE
1 hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation taws of
the State of California.
I hereby certify that I am properly licensed a cont ctor under
the State of Californ(a sinass and Profe tons Cotle, ivisicn 3,
Chapter 9, and t t eh licenses are in f II force antl ffect, or I
am exempt fro t pr Isions of the Ste a of California Business
and Professions e, vision 3 hapter
Signature of
Permittee
Authorized Agen
TEL.
W
ZONE `�
NO. OF
,Lq
USE OF NE�
BUILDING
CIT Y
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
NO.
VALUATION C"'o��•
d�
v
N
STATE
D
CITY
fD
YARDS APPROVED
YARDS APPROVED
LIC. NO.
E
LIC. NO.
MAIN BUILDING
ACCESSORY BUILDING
(/
LL
TOTAL FEE $ VJ
/
(FROM C/L STREET)
SIZE
NO. OF BLIX'.S.
OF LOT
NOW ON LOT
NT FT.
FT.
USE OF
•
s
EXISTING BLDG.
FT
SIZE OF
NO. OF
NEW BLDG.
ROOMS
STO
S
L. SIDE
FT.
EXTERIOR WALL
ROOF
COVERING
COVERING
REAR FT.
FT.
USE OF BUILDING
AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
MAIN BLDGS.
ACCESS. BLDGS.
rf
VAR. iW
DATE
�(
C.U.P. 46
APPROVED
C v
APPROVED
-S5 14— 7-7/
1 hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation taws of
the State of California.
I hereby certify that I am properly licensed a cont ctor under
the State of Californ(a sinass and Profe tons Cotle, ivisicn 3,
Chapter 9, and t t eh licenses are in f II force antl ffect, or I
am exempt fro t pr Isions of the Ste a of California Business
and Professions e, vision 3 hapter
Signature of
Permittee
Authorized Agen
W
SD. FT.
o
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
2
VALUATION C"'o��•
N
PERMIT FEE $
D
fD
S/ /
PLAN CHECK $ live
E
����
0
(/
LL
TOTAL FEE $ VJ
/