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Home My WebLink About246 22ND ST - Building Permits CITY OF COSTA MESA -) r BUILDING DIVISION FI4 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us ..SbTMow� FOR INSPECTIONS CALL: (714)754-5626 PERMIT NUMBER P07-00404 PERMIT TYPE PLUM STATUS: ISSUED DATE ISSUED: 06/12/2007 ISSUED BY: BJK JOB ADDRESS: 246 22ND ST`CM _ - • Suite/Unit: Vicinity: . .. SCOPE OF WORK: WATER'HEATER CHANGE-OUT AT AN EXISTING SFD. NO OTHER WORK AUTHORIZED WITH THIS PERMIT. . OWNER: MATTHEWS', MARGARET E . Address:• 246 E 22ND ST - PHONE: - . City/State/Zip: COSTA MESA,CA APPLICANT: ARENAS;ERIK Address: 9911 LARSON AVE : PHONE: 800-842-2637 . City/State/zZip: GARDEN GROVE,CA CONTRACTOR: A AMES PLUMBING, HEAT,AC License No. 250307 Address: 9911 LARSON AVE" . PHONE: 800-842-2637 City/State: GARDEN GROVE,CA ZipCode: 92644 CELL: 714-5304440 PLUMBING PERMIT FEE SUMMARY ' - PLAN CHECK FEE: $0.00' PERMIT FEE: $35.80 TOTAL FEES: $35.80 - - - - •• NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28, §1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODER INSPECTION TYPE pAft IN'I11AL$ COOP INSPECTION TVP$ DATE IN1ITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical [� 1266 Pool Spa Final 208 Final Plumbing 8--q -C -7 = 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 204 Final Demolition 250 Final Building/Occupancy WORKERS'COMPENSATION DECLARATION: Owner ID verified by drive Ise. 0 Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' ,.'Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. • Se I have and will maintain workers'compen„ation insurance, as required by section 3700 of the Labor Code,for the performance of the work for which this DIVISION'OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized Carrier'- - ei�til`��- (fit 1) by this permit,and that no building structure,scaffolding,falsework,or demolition `f V or dismantling thereof,will be more than thirty-six(36)feet high,(Chap.3.2,Gm (This section need not be completed if the permit is valued at one hundred� dollars($100)or less.) 2,Art 2Sec.341,Title B,California Administrative Code). Policy:Number 000O •Z-66 9 —z Qv 1Y� 0 As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to t.- workers' compensation provisions of Section 3700 of the La.•r ode,I - all forthwith comply with these provisions. Applicant's Signature Date ( —O'7 Division of Industrial Safety Permit Number: i Appl�nt'sSignatLre r-oatei HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: W' -NING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and : UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑ No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. /I C 2 a registration form for acutely hazardous materials? ❑Yes ❑No LL-ic..# / s:# OS 0-7 [Clas 'a2 C J La (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by —_ ll� I each business which at any One time has on hand a quantity of acutely /77 Con dors' - tore- f oate--2 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 CO RUCTION LENDING AGENCY: temperature and pressure). O l hereby affirm that there is a construction lending agency for the 3, Does or will the applicant or present or future building occupant need to performance of the work for which this permit is igsued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑ No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications far non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, es owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK. and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by Califomia License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No thereon,and who does such work himself or herself or through his or her own 8 (If"yes",attach certificate of compliance from the appropriate air'pollutionemployees, provided that such improvements are ffot intended or offered for sale. If, however, the building or improvement is sold within one year of control officer), completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I:certify that under penalty of.perjury the did not build or improve for purpose of sale.). • information given above is correct. I agree to comply with all state laws and 1:1I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Dale properly who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ,$ign`ti eflegal,Owner(s)a- Date Signature Date 3057-06(3/07) L And/ Aulhonzed-7:10DateL) I i. r CITY OF COSTA MESA t, 0 "cy' "�'� BUILDING DIVISION PERMI UMBER r ^ j' ' DEVELOPMENT SERVICES DEPARTMENT k PERMIT ttbmPokatspe 99-01523 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 246 22ND ST Status: ISSUED Suite: Applied: 09/22/1999 Vicinity: HOUSE&GARAGE Issued: 09/22/1999 Parcel Number: 42607117 Zoning: Applicant: CAMERON ROOFING CO ISSUED BY: S 772 Address: 10762 MC VINE AVE Phone( (818)353-1067;. SUNLAND,CA . i % _ Zip: 91040 • Owner: KONE, SANDRA MATHEWS _ Address 246E 22ND ST ' - ' Phone: . '' ",: 'COSTA MESA,CA .- - Zip: 92627 ' '-'-„ , Contractor: /CAMERON ROOFING CO Address: ' ,10762'MC VINE AVE :/ Phone: (818)353-1067 - - SUNLAND;CA . ' - ' • Zip: 910401 License: 734769 Arch : • : • • Eng: 1 Address: - Address: ,Phone: - _ - Phone: I - , , • . ` Zip: f i 1 - License: '' License: . SCOPE OF PERMIT ' REROOF-PRE-ROOF INSPECTION REQUIRED. INSTALL NEW 20 YEAR ASPHALT SHINGLE ROOF OVER EXISTING COMPOSITION SHINGLE ROOF. - ' FEE SUMMARY ' • Plan Check: $0.00 Calc Valuation: $2,900.00Permit:' ', $83.25 Claim Valuation: $2s00.00 SMIP Res: ' $0.50 % ' ' SMIP Com: ' $0.00 Other $0.00 -- - Inspection: $0.00 • Total: $83.75 , 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 DECLARATIONS WORKERS'COMPENSATION DECLARATION: 1 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 carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at 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 Califomia,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 provision� /1 r Applicant Signature: G. w 4t Kms' //L9-- Date: 7 '22 7y WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST 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 licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Pr essions Code,and my license is in full force and effect.Lic.N2'-A?5/ >6 / Class# li --7 p Contractor's Signature: Date: F-22- 99' CONSTRUCTION LENDING AGENCY: O 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: Lender's 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 and 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 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 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.). O 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 property 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 under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. _ Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 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,California 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 Safety 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? ❑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 ic 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? ❑Yes ❑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 aggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .— boundaries _.._._ _. __— 6 Will any part of the facility to be constructed under this permit be within_1000 feet from the outer ountlarieo s of a school? ❑Vas 0 Na (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ---"'--- .. it.. th..... ua.i- r 7 If a tiofromn the South Coast los Air Quality Management is at or other t pollution controln 0district 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? ❑Yes ❑No ._._---- _...._ e..of.. .. from .. .. tion... cer). 8 (If yes',attach certificate of compliance othe 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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. � v Signature Of gal Owner(s) �l�te And/Or Authorized Applicant Date CODE N IN5PECTION TYPE DATE, fNTRIALS CODE INSPECTION TYPE PATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final d 208 Final Plumbing 200 Final Re-Roof 9-2.q-en a##- 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 204 Final Demolition 250 Final Building/Occupancy 2446-46 (` yi , �9'i' E. 22'w v= 3b4b5 � � 7 ;.P14..1.-k. - , 00 rs :.1 :.51.52 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 P I ATION FOR BUILDING PERMIT For Applicant to Fill in Completely A I E BY RqtE ECE ED ' D TE ISSUED QUI LDI Ny, g rj c� -73 �"" ADDRES `1 0 /� �] c- r� ^ A.P. NO./7,-/..22---3 P'/VM7 ,7 OWNER N��\�sCeR, �C4MAIL ,�PR \ 1 ` \ /^� ` \ (' J BUILDING - , yn /J e-.72 �� ADDRESS rk�� l'r QttYtQ. `�� -� &cf. 'C ADDRESS;YfY/y_ j 0- U CITY ` rsc \ tetal t.fi \`v INOL G91 - TRACT��j/(,•/r-s LOt.29V BLOCK Z Z Q CONSTRUCTION NEW ADO ALTER REPAIR MOVING DEMOLISH r / O N LENDER 0- 03 ‘..,>< / ` J D BRANCH /{�, (� J to OWNER ti RI -4o {.c_,+i CO J ADDRESS T/ c.(��. r — VALUE 9 ryY(j -m ARCHITECT TEL. USE 1✓co a='M•�+.� $ ,��/I/(v J < OR ENGINEER N . 1 U< FIRE CT W IL ADDRESS l/ ZONE TYPE GROUP J� X11 J aw .//"-j-L/ APPROVED J O CONTRACTOR BY DATE CO Z J cr ADDRESS W w TEL. ZONE NO.OF USE OF NEW SF'ter 0.,,,/ 0= CITY NO. �-/ PLANSZ� BUILDINGA7J K..4,,Z F w 0 STATE CITY YARDS APPROVED YARDS APPROVED to CC LIC.NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING D 0 (FROM C/L STREET) SIZE 1 NO.OF BLOCS. C^ OF LOT NOW ON LOT FRONT �7 fJ FT. FT. USE OF C EXISTING BLDG. R.SIDE J FT. FT. . I- SIZE OF NO.OF 2 NEW BLDG. ROOMS STORIES L.SIDE •5 FT. FT. UEXTERIOR WALL ROOF '^ _ COVERING I COVERING REAR 2 bFT. FT. -I .y USE OF BUILDING AND WORK 708E PERFORMED DISTANCE BET. BET.MAIN& a. S \cCry.-F \t` , 1�_.1 c 0]\.pa:.L A-. r\_.t. C MAIN BLDGS. ACCESS. BLOCS. a Q VAR.* DATE 0 _C.U.P.* APPROVED 1- - APPROVE ll I' U) ,..._J3_1DATE Q / 3 Z *OLD FOR C • •• t;.i:iITS,. VI hereby acknowledge that I have read this application and state ee O LtO that the above information is correct and agree to comply with ��V CCall laws regulating building construction, and I shall not employ 5 ,?n,,. i..L H any person in violation of the workman's compensation laws of J W y the State of California. ��/f �) yi �� 6 Ok-v f`/I g to Z I hereby certify that I am properly licensed as a contractor under SO. FT, r O the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5 Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: a am exempt from the provisions of the State of California Business and Professions Cnoe, Division 3,Chapter 9. VALUATION td PERMIT FEE $ CV D 7 Signature of.. ^ P/f �n 57) m Perm e�r-R.-��mac•. .� r•.� $ - LO t�//// PLAN CHECK $ 9.e E \� / V Authorized Agent u. TOTAL FEE $ ��jj //Q'y(// c� S /f sPAID JUN —5-73c se,OU 186 x99.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ''11 Ay► C• ION FOR BUILDING PERMIT For Applicant to Fill in Completely REc D = DATE RECEIVED • E ISSUED BUILDING �J �- -- ADDRESS �'¢�j 4 E22� sr--- / �„5-- 5' pp �) y, �1n igRMI ' OWNER 4ef 1/Ot�fi- J7 �WARX) A.P.NO. , �1 MAIL BUILDINGDRS n /('7 l2 Al✓ -TT Z ADDRESS ADDRESS �L '!YC'y /' I 0-W TEL d U CITY NO. TRACT I LOT BLOCK Z Q CONSTRUCTION NEW ADD I ALTER REPAIR (MOVING DEMOLISH O LENDER ><0• v ,J D BRANCH 1� y� J N OWNER IZ7T-,Darr1-yf�;L�/4/�,// m J ADDRESS m ale h / VALUE ARCHITECT TEL. USE hale/Inc $ J Q OR ENGINEER NO. U FIRE J. / WQ CC ADDRESS ZONE VPE _- GROUP , '"r— aw W Z APPROVED �/y O CONTRACTOR BY .....9DATE '+5 -z;3 • Z Ir ADDRESS W W W TEL. ZONE NO.OF USE OF NEW 0= CITY NO. PLANS BUILDING Z W O STATE CITY YARDS APPROVED YARDS APPROVED to cc LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING D O (FROM C/L STREET) SIZE INO.OF BLDGS. OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. R.SIDE FT FT. I— SIZE OF NO.OF Z NEW BLDG. ROOMS STORIES L.SIDE FT. FT. /— Q EXTERIOR WALL ROOF C.1 COVERING COVERING REAR FT. FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& a a MAIN BLOCS. ACCESS.BLDGS. Q ;N 4 -e VAR.# DATE O lf'�fLr unit—.(( R„- C.U.P.# APPROVED / APPROVED CO HY , DATE Z 0 UI hereby acknowledge that I have read this application and state D that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ F any person in violation of the workman's compensation laws of (n m the State of California. to zI hereby certify that I am properly licensed as a contractor under SO. FT. o the State of California Business and Professions Code, Divislcn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5 Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; • CC am exempt from d e provisions of the State of California Business q and Professions Cnue, Division 3,Chapter 9. VALUATION fie to PERMIT FEE $ 1�J n' Signature of O D co Permittee $ PLAN CHECK $ E �� 9 LL Authorized Agent TOTAL FEE $ , '/