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Home My WebLink About527 WILSON ST - Building PermitsRICHARD �. DATE 11-4 (4 . Wilson St. BUILDING PERMI7 N0. ' " nn noero�or�nu_[wnov � n_____�_ A �.115-�3�ltf LOT Ih,_ LCTIONS SOIL cas W ATER ROUGM PWMBING PROP. SWR. LINE � MOUSE CON. SPRINKLING SYSTEM MISCELLRNEOUS ROUGH HEPTING ANO AIR CON�ITIONING TEMPORARV SERVICE OR POLE UNDEflGROUND � POWEH � ROUGH WIRING TRENCHES FOHMS STEEL REINF FLOOR SYSTEM ' BONO BEAM � STEEL FEINFORCE n SHEnTHING FRAME FNO FLRSHING LATNING — IN OUT PLASiER.BROWN CO�T ST HEn. ... PLUMBI Al, FINAL VENT., REFRIG. ANO A.C. , FINAL RN� G�5 TEST [ FINr1L BUIL�ING, FINRL F INAL ��'Z��%��1. SUBCONTRACTOR rN.�y �j ��__ VALUE ECTIONS SUBCONTRACTOR Sf ��ral, Final H�. ..�e. Vent.. ] LV V V PERMIT NO. (714) 754-5273 • Faz (714) 754-4856 • wv+w.ci.costa•mesa.��LDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 527 W WILSON ST Suite: Vicinity: 12-UNIT APT BLDG Parcel Number: 42219316 Applicant: GIRGUIS, MOUNIR Address: 18208 SANTA JOANANA FOUNTAIN VALLEY, CA Owner: GIRGUIS, MOUNIR Adtlress 18208 SANTA JOANANA - - �FOUNTAIN�VALLEY, CA Contractor: �OWNER-BUILDER Address: . , � Zip: Arch : Add�055: Phone: Zoning: Phone: 714-964-9689 Zip: 92708 Phone: Zip: 92708 Phone: License: 000000 Eng: Address: Status: ISSUED Applied: 12/08/2003 Issued: 12/OS/2003 ISSUED BY: Phone: Zip: � � license: � License: SCOPE OF PERMIT REROOF 12-UNIT APT BLDG: T/O EXISTING COMP ROOF, REPAIR/REPLACE SHTG AS NEEDED, 2 LAYERS 15i! FELT, APPLY'20-YEAR DOW-CORNING COMP SHINGLES. 65 SQUARES Plan Check: Permih SMIP Res: SMIP Com: Other: Inspection: Total: $0.00 $195.25 $1.10 $0.00 $0.00 $0.00 $196.35 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existina: o Rear 0- 0 Rear 0- 0 Required: 0 FEESUMMARY PLANNING 8 ZONING Left 0- 0 Lek 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0� � Right 0• 0 s»,000.00 3»,000.ao NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) 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 requlred inapeetlone and finel approvel musl be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 xaae-as �aroo� WORKERS' COMPENSATION DECLARA710N: I hereby eflirm untler penelry af perjury one of the following tleclarations: ❑ I heve end will meintain a certificata of consent to self-Insure for workers' compensatlon, es provitled for �y sectlon 3700 of the Lebor Code, for the pertortnanca ot Ihe work lor which this permit is issued. ❑ I heve arW wlll maintain woAcers' compensaUon insurence, es requiretl by sectlon 3700 oi the Labor Code, for Ihe peRortnance oi the work tor which this pertnit i5 issued. My workers' compensation Insurance cerner entl policy number ere: Carrier. Policy Number. (This ectlon neetl not be comp/eteG i! fhe Oermit is velued et one hundred dollars ($100) or IessJ �I cenity that in the performenca of the work for which ihis pertnit is issued, I shall not employ eny person in any menner so es to become su�jeq to Ihe workers' compensalion laws ot Calitomia, entl epree thet if I should 6ecome subject to the workers' compensation provisions ol Section 3700 of ihe Lebor Cotle, I shell fort�wit� camply with these Drovisions. ^ (� � , Z / � / 9 ? Appllcant Slgneiure:., N1/1 0--� �< u�+�r� oa�e: � WAfiNING: FAIIURE TO SECURE W ERS' COIAPENSATI COVEfiAGE I UNLAWFUL M!D SHALL SUBJEGT AN EMPLOYER TO CRIMINAL PEWILTIES AND CIVIL FlNES UP TOONE HUNDPED THOUSAND OOLURE ($100,000), IN A�DITION TO TNE COST OF COA9PENSATION, DAMAGES NS PROVIOED WR IN SECTION 3]O60F THE LABOR CODE, IMEFEST, AND ATTORNE'fS FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby aHirtn that I am licensea untler provlsions of Chapter 9(commencing with Sectlan 7000) of Division 3 0l Ihe Business and Professions Code, and my license Is in tull force antl eNect. Lic. N Cless q Contreaofs Signature: Data: CONSTRUCTION LENDING AGENCY: ❑ I here0y attirm that there is a construction lentling aqency for the pertormance ol ihe work lor which Ihis permit is Issued. (Sec. 3097, Civil Code). ' Lentlefs Nama: Lendefs Address: Signature: Dete: OWNER•BUILDER DECLARATIONS: I �ere6y ettirm that under penalty of perjury Ihet I em EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professions Code: Any city or counry w�ich requlres e permit to consiruct, alter, improve, demolish, or repair any structure, pnor to Its issuence, elso requires the epplicent for such pertnit b tlle e signetl statement that he or she is Ilcensed pursuent to the proWsions ot the Contrecrors License Law (C�apter 9(commendng wl�h Sectlon �000) of Dlvision 3 of Ihe Business end Profeuions Code) or that he or she is exempt iherefrom end Ihe basis for Ihe alleged ezemption. Any violetion of Section 7031.5 6y eny applicent tor e permit su Is Ihe applicant to e civil penalry ot not more ihan five hundred dollars ($500).�: I, as owner of t�e property, or my employees wlth weges as their sole compensetlon, WILL DO 7XE WORK, antl ihe siructura Is not in�entletl or offered tor sele (Sec. 7044, Business and Professions Cotle: The Contrectors License Law tloes noI apply to en owner ot property who builds or improves thereon, an0 who does such work �himself or herself or through his or her own employees, provitletl thet such impmvements are not intentlad or offeretl tor sale. If, however, the building or Impravemem is sold wilhin ane year of completion, ihe ownerbuilder will have the 6urden oi proving ihet he or she did not builtl or improve lor purpose ol sele.). � I, as owner of the properry, am EXCLUSIVELY CONTBACTNG WITH LICENSED CONTRACTORS to wnsiruct the project (Sec. 7044, Business and Professions `� Cotle: The contractors License Lew tloes not apD�Y �a en owner of p�operty who bullds or improves ihereon, antl who comracts tor such project with e contractor(s) license Dursuant to the Contractors License LewsJ. ❑ I am e:empt under sec. Signature: n/ �1/�� Owner ID verifietl by tlriver's license. Vedilcation ol Ownership by (rype oi �� Business ana Protessions Code for ihis reason: Dete: I Z Dnver's License No. �� -} Expires: 6�%T� i.e. - properry tax bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby cenlly Ihat na excevelion tive (5) or more feet in depth into which e person is requiretl to descend, will be mede in connection with work eutharized by Ihis permit, flntl ihat no building structura, scaHOlCing, falsework, or demolilion or dismanUing Ihereot, will be more then thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomia Adminisiretive Code). ❑ As owner-Dulltler, I will not employ anyone to tlo work which would require a permit irom the Oivision of Industnel Sefety, es noted above, unless such person has e permit �o tlo such work irom the tlivision. Signatura: Date: Division oi lntlusirial Satery Permit Number: CEHTIFlCATE OF COMPLIANCE ANO AUiHOROA710N OF ENTHY: I certity under penalry of perjury that I heve read this epplication and state t�at ihe information given is conect. I egree to comply with ell stete laws end ciry ordinances relating to buil0ing consWction, end authorize representatives of Ihe City of Cwta Mesa to enter upon the ebove-tlescribetl property tor inspection u I egree not to occupy or allow occupency of eny building authonzed by Ihis pertnit until final insDedion. [�nn �--- � �� l 2 ' � f �o Z Signature Of eg ner( ) Date � J Antl/Or Authadzed Applicant COUE 1. INSPECTIONTYPE 1616 Flned System Final Fire Pravention 1266 Pool Spe Final 200 Finel Re-Roof 201 Final BIacWRetaining Well 202 Finel Fectory Fire Place 203 Finel Sign 204 Final Demolition � —� i0 �$ �� INSPECTIONTYVE 206 Final Mec�anical 208 Final Plumbing 210 Finel Elecirlcel 212 Final Fire Prevention 220 Finel Planning Approvel 222 Final Site 250 Final Building/Occupency PAIE I[�EI� � �� 3894� COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSSA MESA, CALIFOANIA 92626 For Applicant to Fill in Completely �� BUILDING ��1 /� /�/ ' ADDRESS c( (C� � i J6N OWNER �/iL/n,-� �14�l�I—L�^ G • W W ,.__ .,.. -. " ._ "" TEL,/�' dU CITV �� ( {/✓�! NO.6�Io2� Z Q CONSTRUCTION /�� ON IENDER Vr.i` am J � BRANCH J V1 m J ADDRESS m ARCHITECT " TEL. J a OR ENGINEER �� </<<' N. U � Q W (t ADDFESS a W 7 WZ CONTRACTOR )�UL/� J Q m Z J � ADDFESS W W TEL. � CITV NO. ZF j� y� L C NO. � p�b I 0 `V J LICyNO. 7 � SIZE / % Y � � NO.OF BLDGS. OF LOT �j� /\ � 9(i NOW ON LOT W SFP -5-7�tvQ�,UQO 243's **'x 180.37 A PL'�ATION FOH BUILDING PERMIT R ev TE FECEIVED DATE ISSUBD L �-s-�� /--y-� p/ PER IT NO. A.P. N�. � �O `/VJ� BUILDING ADDRESS ��-� � F/k R.0 � . p,�, o /- TRACT /J� ' LOT BLOCK aO-6 OWNER 1G,1.� �y�vFl� I VC 1 Gr' .L BDW rl VAW$ N(p�'� N . FIRE Y 20NE TYPE GROUP 'T APPROVED N NO.OF PlP.NS VARDSAPPqOVED EXISTING BLDG. F— SIZE OF NO. OF Z NEW BLDG. O O ROOMS STORIES L. SID FT. �% CO E ROINGALL COVOERING RE�+R FT. J USE OF BUILDING AND yVORK TO BE PEfiFORMED DISTANCE BET. a MAIN BLDGS. a Q � T /� VAR.qW � . �'\ C.U.P.3W F APPFOVED N Z O UI hereby acknowlatlBe thet I heva reatl this applicallon antl siata � thet t�e abO�e into�mation is cor�ect entl eprae to comply with � all laws .eguleting buildin8 connruction, antl I shall not employ r any parsan in vio�etion of the workman's compensation laws ot y the Smte of Calitomia. n ? 1 hereby cerilfy that I em properly licensatl as a contractor ontler v SQ. FT. the State of Celifornie Business antl Proteaions Cotle, Divisicn 3, THE AMOUNT SI Chapter 9, entl that auch licenses ere in full torca antl effect, or I THE PVRPOSE OF am exempt from t�e Provlsio�s of the Stata ot California Business VALUATION and Profassions Cotle, Division 3, Chapter 9. Sipnature of /�A7 � ,�/}- /�� Permittee - ��'— �"\ �'�"`�--- SoC/G � Authorizatl, peni � USE OR NEW BUILDING/`1� � �Q/�� YARDS APPfiOVED ACCESSORV BUIIDING BET. MAIN & ACCFSS. BlU DATE APPROVED FEE / '� � � i � TAX � m O WATION IS FOR ' =RMIT FEE ONLV: � ¢ n 2 7 m � E LL ` 3� L ' COSTA MESA BUILDING-SAFETY DEPARTMENT Z � Q U Z Z� am J � J� Q w � J Jm Q U� � a W � aW J Q � Z J¢ a= z� w� N � 70 ��OV-�-7�i��,;°00 121 ��T�*347_.50 P.O. BOX 1200 COSTA MESA, CALIFORNIA 9T626 ForAppficant io Fi!{in Comptetely AP LI ATION FOR BUILDING PERMIT R C I ED V DATE RECEIVED TE I SUED BUILDING 2 IL � � ADDRESS P R IT O. OWNER �j� �L� A.P. NO. /� MAIL AODR1E SSL� W VvILSv�a/ "/ AODRESS TEL. 7RACT LOT BLOCK CITV NO. CONSTRUC710N �+ LENDEP BRANCH I OWNER RIG EW��-•(+ G AODflE55 AFCHITECT TEL. 2 ��'r VALU$^/ '�,1�' �C �vu OR ENGINEER N FIRE ADDRESS 20NE T PE GROUP APPROVED CONTRACTOR BV DAT — ADDRESS ZON£ NO.OF USE OF NEW TEL. p�qry$ BUILDING CITV NO. STATE CITY VARDS APPROVED YARDS APPROVED LIG. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING 512E NO.OF BLIX'.S. (FROM C/L STREET) OF LOT NOW ON LO'r ROM FT. FT. USE OF EXISTING BLDG. F 512E OF - NO. OF NEW BLDG. ROOMS STORIES L. SIDE FT. FT. EMERIOP WALL ROOF COVERING COVERING ftEAR FT. FT. USE OF 9UILDING ANO WORK TO BE PERFOFiMED p15fANCE BET. BET. MAIN & MAIN BLDGS. ACCF�, BLOGS. VAR.9W DATE C.U.P.� APPROVED APPROVED I hereby ecknowletlpa thet I heve read this epplicetion entl rtete [hat the Bbove informetion is corract and aprae to comPly with all laws rBgulatlnB buildinp construc[ion, antl I shell no[ employ any person in violetion of the workmen'z companaation lews of the State of Calitprnia. I hereby certify Mat I am properly Iicensetl as a contractor under S�. FT. the State af California Business a�tl Protasslo�s Cotle, Divisicn 3, THE AMOUNT SHOWN VNDER VAIUATION IS FOR Cheptar 9, antl that suc� licenses ere {n full force entl effect, o� 1 THE PURPpSE OF ESTA8lI5HING A 7ERMIT FEE ONLY: am exempt from the provisfons of Me Stete of California Businesz VALUATION antl Profaisions Cotl Division 3, Chepmr 9. �� ) PERMR FEE 4 SiBnatura of //�/j/ Permlttae �/�—��/�� $ � PI,AN GMECK �� Authori tl ABant ��— TOTAL FEE $� � I, � 3a�G�� COSTA MESA BUILDING•SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 Gor Applicant to Fill in Completely BUILDING J—'1 � //. �/ f�`1 �' AODFESS `1 "� C� OWNEfl Z . "_ — a U c17v f OZ CONSTRUCTION �/,�/ N LENDER [/ /IE am J � BRANCH J N m J AODAESS m ARCHITECT J a OR ENGWEER L/ t U Q W � ADDRESS aw w Z ,CONTRACTOR J Q m Z J � ADD:�ESS W w Z F CITV w O STATE � (j�/ // (; LIC. NO. 0 b 6 �O SIZE /r ` f OF LOT (.� �l �� .. � TEL. NO. i TEI. TEL. NO. CITV LIC. NO. NO.OF BLDGS. NOW ON LOT G � SEP -5-74�a��OO 241�"� **�*2'-!.23 FOR BUILDING,PERMIT 7 BUILDING ADORESS IRE ZON NO.OF PWNS VARD$ APPROVED DATE USE OF BUILDIN YAR H SIZE OF NO.OF Z NEWBLDG. ROOMS STORIES L SIDE FT. a EXTERIOR WALL ROOF �% COVEFING COVERING REAR FT. �l U aF BUII_DING ANO WOFK TQ 0E PERFORMED DISTANCE BET. BI a � C� MAIN BLDGS. AI a � Q VAR. qW Di O C.U.P.qW qi � APPROVE / %7 ��C/ z O UI hereby ecknowletlpa thet I have reatl this applicotion entl state � that the ebove informecion is corract antl apree to comply with � ell lews regulatin8 builtlin8 eonsttuction, and 1 shall not employ F anY Oerson in vloletlon of the workman's compensation laws af y Me Stata of Californle. � ? I hereby certify that I em properly licansatl as a contractor untler � SQ. FT. Ma Siate ot Celifornia Businass antl Professions CoGe, Divisicn 3, THE AMOUNT SHOWN UN[ Chapter 9, end that sucfi ticenses ara in tull foree antl effect, or I THE PVRVOSE OF E5TA8LISM am exempt from tha provlsions of the State of CatHornla Business VALUATION antl Protessionf Cotle, Dlvision 3, Chaptar 9. / PERMI' stenatura or / — / I� C � / — $ /D �� I Permlttee �jfi��.� A2 ./-..[i .c.�. vVyN c AuthoritaG/Apant T�A� MAIN & � SS. BLDGS. � OVED � �� ^tATE � c � 'v 1 � 0 i VALUATION IS FOR ^ i A PERMIT FEE ONLY; Q N EE $ ] �) m �K $ �3 E 0 LL E $ ; �;:. 3 gQf�s" COSTA MESA BUILDING-SAFETY DEI P.O. BOX 1200 COSTA MESA, CALIFOR �; y � 7yvai�oO 12'l_ v*-`r:�47.C� 0' —+ uasn APPLICATION FOH BUILDING PERMIT ForApplicantroFillinCompletety RECEIVEOBV DATERECEIVED ..,.r��..�„ BUILD�NG � ADDRESS � OWNEA G SS / M(� A.P. NO. S MAIL /� BUILDING S� ADDRESS G � v ADDRESS W W TEL. ��' 1 U CITV '� �s NO.� TRACT r, Z CONSTRUCTION W A O m LENDER J � BRANCH J � OWNER m J ADDRESS �+ m ARCHITECT TEL. QCQ /' J a OR ENGINEEP Q� r N =� N FIRE � Q W Q ADDRESS ZONE a w APPROVED JO CONTRACTOR �L(/y{Y 6V mz � a ADDRESS W µ� TE� 20N {/ NO.OF USE OF N Zz CITV NO. �/ PLANS z BUILDING r W� STATE Q� CITV VARDSAPPROVED VARD; LIC. NO. (�/6 ! Q LIC. NO. MAIN BUILDING ACCESS 7 O (FROM C/L STREET) SI2E ��j ^ D NO.OF BLDG.S. RQNT FT. OF LOT J 0�( NOW ON LOT Q USE OF EXISTING BLDG. F— SIZE OF NO. OF '� NEWBLDG. ROOMS STORIES L SIDE FT. � EMERIOP WALL ROOF U COVERING COVERING REAR FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCEBET. � n— MAIN BLOGS. p V /' �i 1� I�i C URP.31E r APPROVED N Z O UI hereby acknowletlge that I have reatl this application antl stata � that the ebove information is correct and aprae to comply with � all lews �egulating buildinp construction, antl I shall not employ r any person in violatiOn Ot the workmen's compenwtion lews of y the Stata ot Calitornia. � I hereby certify that I am properly licenutl as a contractor undar a SQ. FT. the Siate of Califarnia Bus(ness antl Professions Cotle, Dlvisicn 3, THE AMOUNT SH Chapter 9, and that such licenses are In full forca and effect, or I THE PURPp$E OF I am ezampt trom t�e provisions of the Stete of California Business VALUATION antl Professlons Code, Divicion 3, Chapter 9. SIB^eture oT h ' � Permlttee ��/j�� $ J LOT ' BLOCK �.1"C�f1<J/�LN L' VALUE '1 $ � � GROUP F I DATE �I— �—f — / TOTAL a" � � � MAIN 8i �� , / � 0 VALUATION IS FOR � A PERMIT FEE ONLV: Q G''rj m E $ � j K S E � o LL $ � ` � ��y�6 . .�. COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applican[ to Fill in Completely ADDFESS S� T/� `(// 'SG OWNER /7 / S � y� ADDRESS �C/�AC �U.f �Tfs7 d2 � 1 J ,� /// /' U CITV � , /Cf /V(rJ'! NO`C�IoZ�/T' ZZ Q CONSTFUCTION O N I.ENDER � am J � BRANCH J � m J ADDRESS m ARCHITECT TEL. J a OR ENGtNEER CU f'L�h N UQ w Q AD�RESS a �! /I J O CONTPACTOR )'G[% G/ f I' �,Y�IGO� m Z J � ADDRESS w W TEL. � = CITV NO. ZH w � STATE n�/ �/ G CITV y� LI0. NO. O� O LIQ NO. � � SI2E � NO.OF BLDGS. iy OF �OT � a 9 D NOW ON LOT V PAiU �EP -5-74cr;s'�� 2�+Zx TM��25.78 FOR BUILDING PERMIT BUILDING ADDRESS OWNER FIRE NE NO.OF PLAN$ VARDS APPqOVED MAIN BUILDING USE OF • EXISTING 8L .� F SIZE OF NO. OF `� NEWBLOG.�OX ROOMS STORIES I L.SID FT. EXTERIOR WALL ROOF //,� � COVERING GCQ COVEqING �i�'vEL' REAR FT. J USE OF BUILOING AND WOF7K TO BE PERFORMED OISTANCE BET. 0. MAIN BIOCS. Q / / �.{� L / VAR. qW � /\�I ��, ! nn a,, / rnrl scia. tf- c.u.P. vw r y C(ar nr �G' PPPROVEO � � 2 O � � �oreby aeknowlatlBe thet i hava reetl this epplication entl nete .� ihai iha abova iniormntion is corract antl e0ree to �omp�y with a ell lews ragulatinB buildinp construction, enC I zhall not amploy r eny parmn in violatio� of the workman's compensetion laws ot N tha Stam ot Calitornia. � � � 1 �ereby cerHfy ffiat I am D�ope�ly Iicensetl as a conbactor untler SQ. FT. ' the Staxe of Celifornla 8usinesa antl Professions Coda, Divisicn 3, THE AMOUNT SH( Cheptar 9, antl t�et such licansas are fn Sull Sorca entl eSiact, or f THE PURP(SE OF E am azempt irom the provisions ot the State ot Californie Business VALUATION antl Professions Code Div(sion 3, Chapter 9. 5;a�a��,eof �---- �� //I� -. Permlttae /��%%Z�/.� �(-� $ Authorized,AOant ' VALU�r$ .-.,....e f _ USE OF N BUILDING vARD: BET. MAIN & � �' � � LNoRy M /ia o UNDER VAIUATION IS FOR ^ fLISHING A PERMIT FEE ONLV: Q m :PMIT FEE $ � � m AN CHECK $ E LL 7TAL FEE $ I r J+ c� v// V COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely BUIlO1NG s'f � // /� tON �/ Af]f]RESS 06 /!/ U OWNER MAIL ADDPESS CITV CONSTRUCTI( IENDER BRANCH ADDPESS ARCHITECT OR ENGINEEF ADDRESS �:��i—ll'l�iLK5fV4 �Z3 tJf4k�RitSU.V� APPLICATION FOR BUILDING PERMIT RECEIVED BV DATE RECEIVED nerc �ue�� AD'DflIE S �� / � � TRACT W � OWNER � G � M N f' S I FIRE ZONE APPROVED / _ ADORESS TEL. GTV NO. STATE CITV LIC. NO. LIC. NO. SIZE NO.OF BLDGS. OF LOT I NOW ON LOT VSE OF EXISfING BLOG. SIZE OF NO. OF NEWBLDG. ROOMS STORIE: EXTEFIOR WALL ROOF COVERING COVEflING USE OF BUILOING AND WORK TO BE PERFOPMED I herebV acknowletlge that I have reetl this applltation entl rtete that Me ebove informetion is eorrect and apree to comply with ell lews regulatlnB builtling construcHon, anE I shall not employ eny Derson in violation of tha workmen's compBnsati0� laws oi the State of Californ(a. I hareOVi certifY �hat I am proOarlY licensatl as e contractor under tha Staie ot Calitornie Business and Protessionz Cotla, Dlvisicn 3, Chepte� 9, and that such licenses ara in �ull force antl effect, or I am exampt from the provisions of the Stata of California Business and Professions C/ytla, Divislon 3, CMap[er 9. SIB^etureot /'V�Glltifs ./( / �!/ � Permittae / ZONE NO. OF PLAry$ VAROSAPPROVED MAIN BUIL iOM C/L STR DISTANCE BET MAIN eLDGS. VAR. # QU.P. *,S� P.PPROVED h VALUE USE OF NEW BUILOING VARDSAPPROVED ACCESSORY BUILDING BET.I ACCE: OATE f SHOWN UNDER V OF ESTABLISHING A VALUATION � m � 0 IS FOF ^ ONLV: � ¢ � ry 7 m E � o` LL