HomeMy WebLinkAbout1873 Tahiti Dr - Building Permits •
4`,gtH Mac 9 CITY OF COSTA MESA
UILDING DIVISION gllIl
fi DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT
/B04-00872
(714)754-5273 • Fax(714)754-4856 • www.ci,costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1873 TAHITI DR Status: ISSUED
Suite: Applied: 05/11/2004
Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 05/11/2004
Parcel Number: 13941208 Zoning: R1 R1
Applicant: KRZAKALA, GARY ISSUED BY:
Address: 17885 SKYPARK CIRCLE
Phone: 949-553-0678
IRVINE,CA Zip: 92614
Owner: SHAHANDEH, AMIR TR
Address 1873 TAHITI DR
Phone:
COSTA MESA,CA Zip: 92626
Contractor: PREMIUM BUILDERS
Address: 17885 SKYPARK CIRCLE
Phone: 949-553-0678
IRVINE,CA
Zip: 92614 License: 492049
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF SHAKE ROOF,RE-SHEATH AND RE-ROOF WITH FIRE FREE SHAKE.INCLUDES ATTACHED GARAGE.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: 515,000.00
Permit: $251.25 Claim Valuation: 515,000.00
SMIP Res: $1.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $252.75
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
2446-46 lamol
DECLARATIONS /—' ) r' j
WORKERS'COMPENSATION DECLARATIO .
I hereby affirm under penalty of perjury one of the following declarations:
O I h e 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
for which this permit is issued.
have and will maint4in 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'co pe yat�ion I urance rrier and policy number are:
Card 'Sker: J G•^0 Policy Number: Da) 72 eV --2e0-f/
(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 California,and agree t t I hould become subject to the workers'compensation provisions of Section of the Labor Code,I shall forthwith
comply with these provisions. ' 1- 0
O\-1
Applicant Signature: Date:
WARNING:FAILURE-TO SECURE WORK ' EJGS)ATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RIVES UP O ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ON THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisio 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.Lie.p Class N
Contractors Signature: /YS Date:
CONSTRUCTION LENDING . CY:
❑ 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).
Lenders 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).):
O I,as owner of the properly,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 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 Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property 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 6,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 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 Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
has Section 25534
the Califomia
_.._ ___._...._.._.
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 aermit for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes jJ 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 property for inspection purposes. roe not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signa/•%' egal Owner(s) 5/'—O�(\f4te
4r Authorized Applicant Date
,
;ODE 1 , 'Y•I• I a PANE )NIIDALS ;ODE* INSPECTIONMg 2LIE INRRAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final / 208 Final Plumbing
��7/''
200 Final Re-Roof `07 ) 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
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT - PERAT NO. TRACT NO. LOT NO. UNIT NO.
p�./ ///��� r3a39/ — 6030 3/02/6; 50[)0 TL
Project Address /O ' 3 r 1111 }� u r E '<
•
Applicant's MailingAddress
V%i '✓,L`1 (A f f' TYPE OF CONSTRUCTION ❑ NEW lJ ADD U ALTERATION tIS REPAIR f
/ /�l kat) Lt ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone
Owner's Name -,t,'CP ��L� / PhoneSSy�� DESCRIPTION OF WORK/USE OF BLDG. —
Address �-I S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING c--L>-OUNDATION ❑ STRUCTURAL E Front Q
Address '❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear N
A I
Contractor's Nam- '1 G '.._ 1_...,_di f .i •hopeI 0 r ❑ OTHER C Right N
Address(mailing) i /� ;'7 CS PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Left G
�7 1 U CONSTRUCTION TYPE VALUATION $ SR
City License No. - -i 6�7� ZONE GRADING CU.YDS. ACRES
,ta�0 E
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parkingg�jReq./Provi `., U
I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: CEwFD 1 lAR M
0
with section 7000) of Division 3 of the Business and Professions Code, and RC T
my license is in full f• c+ . d effect.
License Class -se / i n •. S
rale - " v %� Signature ����� . l PLUMBING EES
'KERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
:eby affirm that I have a certificate of consent to self-insure or a certificate _
Workers' Compensation insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
Automatic Washer Transformer ❑ 15-50 KW
3800, Lab. C _
Policy No. „Cf
Company (*Azle Backflow Irrigation Sewer Cap ( Construction Pole Sub. 0 50+KW
Zertified copy is hereby furnished. .
— Cerlil let/copyyjt:,f6diled with the city Byl n I' ' n.n�/ /J Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date OJ /Y/- Applicant) //V G--/
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or
less). Dishwasher Solar Piping Dryers ❑Gas DElectric Sub Panel
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 Drinking Fountains Solar Tank Fan Motors❑0-1 HP ❑1%-8
Workers' Compensation Laws of California. —
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+
NOTICE: If,after making this declaration,you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCYGas Service Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance 2 Pole Light —
of the work for which this permit is issued (Section 3097 Civ. C.) interceptors ! Water Heater V, --in Outlets Range
Lender's Name
Lender's Address Kitchen Sink - Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,Improve,demolish or repair P—Trap Laundry Trays Generator 00-5 KW 05.15 KW
any structure, prior to Its issuance, also requires the applicant for such.permit Trash Compactor
file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains
Contractor's License Law(Chapter 9(commencing with Section 7000) of
ision 3 of the Business and Professions Code) or that he/she is exempt
irefrom and the basis for the alleged exemption. Any violation of Section •
/031.5 by any applicant for a permit subjects the applicant to a civil .
psnalty of not more than five hundred dollars($500).
LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work, and the structure Is not intended or offered - Reinspection Fee ' $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I FEES
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
Hood or Type provided that such improvements are not intended or offered for Boiler I ❑ Zoning Approved By - Date
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0
plelion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date
-prove for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct- Ventilating 00.100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ PERMIT
❑ 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Bll. ICBG# Fire Dampers /
PLUMBING $ .5• ob ISSUANCE $
Date owner Heating System& Ducting Registers ENERGY P.C. $
PLAN CHECK 25% $
I hereby certify that I have read this application and state that the above 00-100,000 BTU ❑100,000BT1, ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repre-
sentatives of til city
cittyy ttfoo enter upon the above-mentioned propertylfoto r
inspection purfR�A// / ` Ot_//_ SJ/ MECHANICAL $ TOTAL FEE $ LJ�
Signature "
,_ .
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor /
Fir
CONSTRUCTION AND PLANNING POOL & SPA
f•:• Date Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit#
.f
1. Temporary Electrical Service or Pole 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 p;-• 58. Electrical Conduit-Undrgrnd!i
8. FoundatidR' 59. Gas Pipe, 0 Undrgrnd., Test-
la
9. Water Pipe:Undrgrnd. 60. Backwash Lines, P-Trap, ❑\Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK -
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
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. POOL/SPA 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 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 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 PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED ( r:
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 46/Be `On
39. Water Service-Final ! u/
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
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY 4
No. Date
..iir.Uv, a¢. U. C.Y. ..v.
(VITIVElp
L.+.,..
JOB ADDRESS 1813 Tahiti Drive - BUILDING PERMIT NO. 27195
GENERAL CONTRACTOIDwner- r. DESCRIPTiON OF ZK lies.w/att.garage
AP No.139-11-12-08 LOT TRACT FIRE ZONE VALUE $ 33,44'4.00
N INSPECTIONS Signature Date GROUP I & J TYPE V ZONE R-1
y' f^/� Q
Gas , r ��� SUBCONTRACTOR Date I Number 1 Signature
Water - its -Ai"03r Plumb'
Rough Plumbing if `--/`- /i/ 1I1�/Ajl.�._ -_/O- 40-7,2_47,
Prop. Swr. Line fl -ouse Con. r, . s-9-n `j-7,�l2 ' C. 7-/D gi/
Sprinkling System / 7
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole
Underground AZ Power ❑ 1%4'#') 7 /2-•(7
Rough Wiring I%if ?1-7°.47 Hea and Vent.
Ig
Trenches Forms gi Steel Reinf. 1,9":505K 7-22-62/1.4-,4 j,,/ fife/ 1-7-6 7 ,S�lo6
Floor System ' Rte- 1-t5--G7
Bond Beam 0 Steel Reinforce 0
Sheathing efm- r-47,-67
Frame and Flashing 9 R-i 6-67
Lathing-In.® Out 4 W- .2_9-r-y
Plaster, Brown Coat OW 9-3c-- W
Structural, Final Electri '/
Heating, Vent, Refrig. and A.C., Fi al - it / -" - _"���� ,"_' - 7-//-Soy 273s/-3
Plumbing, Final and Gas Test s'i ': - /94' �f ' /
Electric, Final ` .!/71
Building, Final __i% .. i�
PNO t: )•
27195 �uazo-6��—SAoo,70�-:- I'.••• I�o.;�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 02620 .
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
iii7)
1,/�/� For Office Use Only
BUILDING
ADDRESS ( �j / 7) 90:-/LA- �lI/lit/
RECEIPT NO. aMI/ryp�
COSTA MESA, CALIFORNIA 1 Y
n� C / , / /- Re wJ[Ric7 [D<� DATE ISSUED
OWNER M J. C�VC/Lt� L-� �y•(�/Yn2!//-LLG�%� 7
Titans 4�o W W . Caytsr I-{wv Ao ESS •no /O /d lV� / .,�/. -
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CITY M ween4- )�L'j} i4 NOL a Z. ZONE R GROUPS: /
ARCHITECT TEL APPROVED `f�I - _ �'tC/.. /
OR ENGINEER NO. BY !� DAT6 ✓ !o
• ZONING
ADDRESS ENO.OF� sUuSa
ODNx[W/
-/ PLANS %,
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LEGAL .1.1, / /Z 9- 1/2
ADDRESS D[SCwITo �7(, ./[ //{"�j
CITY A.P.NOJDt X -Iia-4 -t/ 13
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE g� LZG TEL sr TO SIDE&REAR P.L.
LIC.No. 00 moi' O TE
SIZE 77.I7
1 'G 41 *IgEAVES
OF LOT 1 051 X Ili-.53 NOW ON LOT . 0 ALLOWED (U.B.C.REQUIREMENT)
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. I (FROM C/LSTR fT)
SETBACK LINE FROM REAR YARD 32 I FRONT.50 07, FT.
CENTER OF STREET r
SIDE YARD' LEFT I Cr ( RIGHT S I r R.SIDE V 'FT, CL---1"4 FT.
DESCRIPTION OF WORK L SIDE /rT./� 6L1'1'1 FT,
NEW ALTERATION ADDITION REAR =,•21111-. FT.
DISTANCE BET. BET.MAIN&
REPAIR MOVING DEMOLISH MAIN BLIMPS. ACCESS.BLDGH.
BUILDING E{7 nom VAR.* DATE
SIZE 253:" ROOMS 1 STORIES I C.U.P.# APPROVED
EXTERIOR W0 ROOF SNA ed. APPROVED 1(/1'����''�''••___� .� // qq ,�,
COVERING WI
SDJCCO I COVERING IT ��AY"�'�DATE[J4—/ X07
USKg,,O,��F BUILDING AND WORK TO BE PERFORMED P.
4eSIDEAX'E to/ AT'r". C4P ) -44c. w
y
•I.
I1Sa3SQ.rr) .46-11
X
I HERESY ACKNOWLEDGE THAT.I READ TIME APPLICATION THE AMOUNT •HMVM UNDER VALUATION IS FOR THE oti
AND STATE THAT THE ABOVE RRECY AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. rIy
PLY WITH ALL CITY TRN Co TS WS R[ouLAnxs VALUATION
BUILDING CONSTRUCTION. l�///// aPERMIT FEE 5 /`/L)
05-6 E
SIGNATURE
PQTT
RMIHF OF i��
$33 9951L--''7 PLAN CHECK S .rC0.�S w
GENT /
UTHORIZED ATOTAL PEE 5/ 5475"
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