HomeMy WebLinkAbout647 18TH ST - Building Permits� —�
AVD���ant to fill in all spaees exceot lnose within heavy bortler Iines ana si9n al1 apvroo��ate Oaclarations.
CITY OF COSTA ME�S/A�f CONST LTION PERMIT PER T�O.� � TRACT NO. LOT NO. UNIT NO. A P�
Projectliddress �T"� �' � / ' _ S MainBuildi
QppliCant'S Mailin Addre55 TVPE OF CONSTHUCTION NEW ADD ALTERATION REPAIR E
9 G ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' T Front
Owner's Name Phone o3 DESCRIPTION OF WORKIUSE OF BLDG. � A Rear
Addreu
TVPEOFPERMIT GRADwG FOUrvoA7lorv STRUC7VaA� I C Right
ArchlEn9. License No. � K -
❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL , S- L2ft
Address
ContractOr'S Name �1 �-! hone � ��OTHER Ping. Ref. #
Address (m= �'��I O��J.� P.rU :�/ ��m� PROJECT DESCRIPTION 5(2. FT. OCCUPArvCV 9
D�j` CONSTRUCTION TVPE VALUATION $ Plannln NoteS:
City Licenv+No �. /�J ZONE_
LICENSED CONTRACTOH DECLARA710N
I hereby a11i�m that I am IicenSeU untler p�ovislons ot Chdr[¢r 9(commencin9 Remarks: .
wi[h section 7000) of Divizion 3 of the Businass and Professioni Cotle, antl
my license is in ful antl eifect. O�/Sp�
Licens I i< s No 7' O
Date Signature
�
WORKERS COMPENSATION OECLARATION Bar Sink
1 nereby attirm lhat I have a certiticate of canzent lo self-insure or a certificate
` Wolker5' CompenShciOn Insufant<, pr a ceftlfietl CODY �h<feot ($ectlon BdCkflOw PlEV¢Ot2f
10, LaD. n?7� /V� C�/�
iicy No.(��N-7y�U Company Q�!,—�' �+/�— Backflowirrigation
�Certi(i¢tl copy i5 heteby (u�nishetl. .
Certifi co Is (Iletl with the city �y�jryy(�iyisiOn/1 /A Bathtubs
Date%-�/ �� Applicant��/l�/ L-/y��— ���
E%EMPTION FROM WORKERS' COMWENSATION DECLARATION Cla
(This section n¢ea not be completetl i( t�¢ permit is for one huntlretl (E300) or
less). Di!
I cerlity thal in [he Derto�manc¢ Ot the yyo�k for whlch Nis pe�m�t Is ISSu¢tl I
shall not employ any person in any manner so as to become subje<t to t�e Ori
Workers' Componsallon Laws of Calitornia. .
Date Si9nature FI�
NOTICE: If, atter making this tleclaration, you shoultl becoma subject to the
Workers' Compensatlon provisions o( the Labor Cotle, you must iorthwith Flt
Comply wilh such provisions or thi; permit shall be tleematl revoketl.
CONSTRUCTION LENDING AGENCy Ga
1 hereby atfirm that tnere is a construction lentlin9 agency tor the pertormance
of the work ior which Inis Oermit is Issuetl (Se<UOn 3097 Clv. CJ Int
Lentler's Name
iking Fountains
�r Drains
>r Sinks
ServiCe Outlets
Lenaer's Atltlress Kitchen Sink
OWNER BUILDER OECLARATION
i herebv atfirm Lhat I am exempt from tbe Contractor'S License Law tor Ihe Lavatories
es a
to i'
a
rom anC Ine Dasis for the all¢9eq exert
5 by any app�itant tor a perrqit sul
;y of not more than five huntlrea qollars
as owner of the property or my em�
en5atbn, will EO the work, antl the str�
ale (Section 7044, Business antl prote
se Law tlo¢s not apply to an own¢r of a
70ooj oi Roof Dreins
is exempt
of Section
to a civil
with wages as thair sole
� not intentletl or of(eretl
Cotle: The Contractor's
v wh0 bulltl5 or Imp�oves
sale. Ii, however, the builtlinq or impra�ement is zolC wlthin ona year of com-
Ole[lon, the owner will have the burtlen of provin9 he/she tlitl not bulltl or im-
prOve fOr the pu�po5e ot sale).
❑ I, az owner of the proper[y, am exClusively contracting wllh Iicensetl con-
tractorsto construct tne pro�ect (Section 7044, Business antl Professlons Cotle:
The Contractor's License Law doe5 npt apply to an owner of prope/[y who
builtls or Improves thereon. antl who Contracts for such oroiacls with a ron-
tractor(s1 I�cense pursuan[ m me Contra<tor•s �Icansa Law). I am aware tnat
proof o( their Worker's Compensatloq insuran<a shoultl be provitlatl to me;
❑ 1 am ezemo� untler Section B. & P. C. tor tnls reason
Date
I hereby certily thal I
information Is correct. I
antl Stat¢ laws relaUn9 �
sentatives ot tnls <ity
inspec[lon pur es
Slgnature
Drivers' License or 55 �
0865-46,rev.5/88
Owner
ve read lhis applicatlon antl state that the above
ree to comply with all city antl county orElnantes
builtling constructlon, antl hereby dutnorlie repre-
enter upon tne above-menlionetl Oroperty for
���� Date / �"�
GRADWGCU.VDS. ACRES_
Reinspectian Fae � $15
eoiier
Dutt - Under Ground
Duct-StrUC[urel '
Duct - Veotilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. iCBO �
Heating System & Ducting
❑ ai oo,000 eru O i oo,000
Reinspection Fee � $15
—�--------_---�
White - Builtling; Canary - APPlicdnh Pink - Accounting; GOltlenrotl - Assessor
Showen
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Tre'ys
laue Fee
Hood or Typel ❑
Cenopy Type I I ❑
Refrigeration System
❑0-100,OOOBTU ❑100,OOOBT
System Repair/Alteration
Fire Dampers
Registers
laue Fee
FEES Automatic Washer
Construction PoleSuh.
Cooking Unit
Dishwasher ;.
� ❑ryers �Gas �Elec
Fan �.
.� F.A.U.
$ 3
FEES
$ 3
Device Boxes ',+
Ol1LI2[5
Switches
Garbage Dispoul
Generator �0.5 KW
Zone
Accessory Building:
2
O
N
I
N
G
R
Parking Req./Provided E
1 Q
� M
s S.
ELECTRICAL FEES
7ransformer ❑ 15-50 KW
❑ 50 + KW
Meter Uup to 100 amps
Meter ❑over 100amps
Su6 Panel
Mom�sOo-t HP 01Y�-s
InaSolar 09�75 HP �16-15+
Microwave
Pole Light
Range
Standing Sections
5 KW Trash Compacror
�einspection Fee �$15 � � Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
2oning qpprovad By
Building Approved By
Appliqtion Issued Bv .
53
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ �� ISSUANCE $
PIAN CHECK 25% $ ENERG�' P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $ �'p-��
MECHANICAL $ TOTAL FEE $ �_
PLAN CHECK 25% $
O1 00021677-00021677 Tf�T S,�Q
DATE: 12/04l8E TIPtE: 12:09
_ ,;`� ;... •
,,
� I CONSTRUCTION AND pLANNING ' POOL' 'PA
� APPROVALS Permit � Date Inspector qppROVALS Permit # Date Inspector
�. :F�1'. �Temporary Electrical Service or Pole , 52. Pool & Equipment Location
•�' 2. Soil Pipe-Undrgrnd. � �; 53. Steel Reinforcement .' �
3:�Electr`,ical Conduit Utility-Undrgrnd. � 54. Forms '.
4.,Electnical Conduit-Undrgmd. 55. Electrical Bonding '�
5..Steel-Reinforcement ' 56. Rough Ptumbing & Pressure Test
� .
6. Electiical UFER'Grnd. i 57. APPROVAL TO COVER-GUNITE
i
r 7, �Footings � � • ' ;r; 58. Electrical Conduit-Undrgrnd. � �
+ 8. �Foundation : �' � � . 59. Gas Pipe, O Undrgrnd., Test � �
l
�� 9.. W$ter Pipe-Undrgmd. � � 60. Backwash Lines, P-Trap, O Undrgmd.
�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 �
75. Rough Electrical-Conduit ' 66. Solar System-Final
16. Rough Electric Wiring � � ���"67. Fencing & Access Approval ' •
v17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
�18. Rough Electrical-T Bar �eiling 69. POOL/SPA SYSTEMS FINAL
_1�. Rough Heating & Air Cqnditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
• 21'. DuCts, in Structure 70. Underground Hydro .
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ 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. Electriral Power Meter-Final 80. FOOD CERTIFICA7E ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning � ,.
35. Final Gas Pipe-'iest w
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing �� �itt (,/L.D
39. Water Service-Final =-
40. Gas Service-Final •
41. Solar pomestic-Final'
42. BackflowPreventer-� . '�f�`
43. Backflow Irrigation': �
'v
44. ,Landscape Irrigation System /
45. Sound Attenuation ,: j
46. Handicap Regulations l �
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison '
�
50. Gas Release to Southern California Gas Co ..
51. CERTIFICATE OF OCCUPANCY -
No. Date ,
AOPlicant to fill in all soaces
, CITYVF COSTA MES �NSTRUC �01�LpyERMIT
Project Address fSl�
qpplicanYsMailinoAddracc`r/N37/ d�N�MP�' [t3 I'� �
i ,2
i� Owner's Narne u��Y � Phone �✓ �Z���
' AdAress �y 7 � �8 . � .S
Arch/Eng. Licenu No.
Address -�¢�����
Contractoi's Nam t' V' � %r Phone �/��
Addfesslm��'�;1 �'7�%� d�n. YCP LCS�/H
City License No. �3s3� �
LICENSED CONTRACTOR OECIARATION , '
I heleby affirm that 1 am li<ensetl untlar provisions ot Charter 9(commencing
with 5ection ]000) ot Divislon 3 ot the Business antl Professions Cotle, and
my license is in' full /orce antl ef( ct. `,O� �/�
Licens CI ss � - '� __Li<e 5e �r
�at Si9natu�e - Ca,�f(af«—
WOF�KERS' COMPENSATION DECL RATION
I her¢by afTirm'thaFl have a certificate of cOnsent to 5¢If-Insure o� a certlficate
e Workers' Compenution Insurance, or a certifi tl opy [hereo (Sectlon
100, �b. �
A �+o iCY No. Company GR'�
�T �erUfied copY is�hereby (urnishetl. /J
\V Cer fie�� co{�� /i�tl�le.tl with the city Build� Divislo �/�
DatE�S�E'��O-(�—APPlicant�L�� i^'��HAi1
EXEMVT16N FROM WORKERS' CO PENSATION DECLQRATION
`(ThiS seclion neetl �ol be completetl if the permit is (or one huntlretl (E100) or
IC55�
` I certi(Y t�a[ in th¢ pe�fOrma�ce oi the work tor whlch-this perm�t i5 i55ue0, 1
_v\shall not employ any person in any manner zo as to become subject to the
WorRers' Compensatlon I�ws of California.
� pate � Signature
� NOY�CE: If, after'making this.tleclaration, you shoultl become subject to [he
Worker5' Compen5dlion provisions of the Ldbor Cotle� You must forthwith
comp�Y with such provizions or Ihis permit shall be tleematl revoketl.
CONSTRUCTION LENDING AGENCY
I M1ereby affirm t�at tnere is a construction lentling agency tor the oerformance
of the work t0� which th(5 permlt is issuetl (SeGtiOn 309] Civ. C.)
Lender's Name .
�ender'z�AtlEress - - - - - - - —
OWNER BUIL�EN OECLARATION ` �
I nereby aftirm Mat 1 am exempt from the Contractor's Li<ense Law for the
to110M'ing reason (Section 7031.5 Buslness antl Professional Cotle: A�Y city or
countY �+hicn requires a permlt lo construct, alter- Improve, Gemolish or repalr
any structure, prbr [o iis issuance, also requires t�e applicant for such permit
�p {ile a signetl ztal¢men[ that ne/she is IicenseG purSUant to th¢ provisiOns of
the Gontractor's License Law (Chapter 9(commendng w�N 5ectlon 7000) of
Division 3 of the"Business antl Protessions-Cotle) or [ha['ne/she is exempt
`?refrom antl tde basis tor the allegetl ezemptlon. AnY violation o� Section
71.5 by any applicant to� a permlt subjects tne appticartf to a civil
ialty of no[ more than tive nuntlretl dollars (E500�.
�l L d5 Owner Of the Oroperty or my empbyees witM1 wages as [hair sole
comPensation, wi�� tlo Ih¢ wo�k, antl the st�uctu�e Is nOt Intentletl or o(feretl
1or Sale (Settion 7044, Bu5ine55 antl Pro(¢SSiondl Cotle: The COnIlactof's
Lice�se Law tloe5 �ot applY to an owner of a property wno builtls or Improv¢s
thereon, antl who Uo¢5 such work hlm5elt/h¢r5e11 or tnrouqh his o/ hOr own
emo�o eea, O�avitletl [hat zucb improvoments are not intentletl or otferetl for
Sy�G. �� how¢ver, [�e builtling or improvement is soltl wltnin one year o1 com-
- pletlon, the owne� wlll have the buraen oi Proving he/sne tlitl not builtl or im-
proVe for the purpose of sale). � .
❑ I, as owner of the properfy, am ekclusively contracting with Iicensetl con-
trac<orsto consVucl the project ISec[ion ]064, Businass antl Professions Cotle:
The Contractor's License Law doez not aPPly to an owner ot property who
builtls or improves thereon, antl who conVacts for such projects with a con-
tradar(sl ucense oursuant to ine Contractor`s Licanse Law). 1 am aware ihat
prooi of th¢ir Worker'S.ComPensaUon in5urdnce Shoultl b¢ prOvidetl to me.
❑ I am exempt untler Sectlon B. & P. C. tor this reason
Date ' � Owner - �
I hereby certity that I have reaa this application antl state that the a�ove
InfOlmation is WneCL-1 agree to Comply wrth ail city dntl county ortllnances
antl s[ate laws rela[ing to builtling construction, antl hereby autho��ze repre-
sentitfves of [his � to e er. u n tbe above-mentioneC prop ty or
InsOC«�on purpos /
' at � Y7K�> � Da(g f7
wlt�in heavy Eorticr Ilnes antl si9n all aD0�o0riata Geclarations.
TYPE OFCONSTRUCTION LJ NEW� LJ A�D �LTERATION LJ REPAIR
❑ CO�`1VERSION ❑ DEMOLISH ❑ OTHE / A p #
DESCRIPTIONOFWORK/USEOFBLDG.' �Pt% T!R �
S Main Building:
E
TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T FtOnt �
❑ TENANT �LECTRICAL ❑ PLVMBING ❑ MECHANICAL B Rear
❑ OTHER _ � _ %�
PROJECT DESCRIPTION' :SQ. FT. oCCUPANCv C Right
K Left
CONSTRUCTION TVPE VALUATION $ $ '
20NE GRADING CU. VOS. ACRES p�ng. Ref. q�
Remarks: ' ' � Plannin9 Notes:
Bar Sink
Backflow Preventer
BackflOw Irrigation
Bathtubs� "
Clarifiers '
Dishwasher �
Drinkin9 Fountains
Floor Drains
Floor Sinks
e
Lavamries , �
P—Trep
Roof Drains �
Reinspaction'Fea. $15
Duct - Undei Ground ,
Duct - Structural
Duct- Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting�
❑ o-i oo,000 sru Q i oo,000 er
� I5iqn ure
. Drivers' License ar 55 ������� � I I Aeinspectian Fae
CMF 08b5�46, rev. 30/84 Whi[e - Builtling; Canary - Applitant; Pink - Accounting; Goltlenrotl - Assessor
$15
Showers
Service Sink
Sewer Cap
SewerConnection
Solar Collectors
Solar Piping.
Solar Tank .
Swimming Pool w/Spa
Urinal
Water ClOset
Water Heater
Water Service �
Auto-Wesh '
n
F
Issue Fee $ 3
Hood or Typel ❑
Canopy Type It ❑
Refrigeration System
❑0.100,000 BTU �100,000 BT
System Repair/Atteration
Fire Dampers
Registers '
y
Issue Fee � $ 3
". _ _ ' _ r .
; ' ,2613 '9/05/86
10.50 TL
_ '. _. _.� Zone_ . _
Z
� O
, N
. .. �
' N
i � G
R
Parking Req./Provided � E
Q
' M
_ ' . � T
. . . " . . i i S.
Auromatic Wesher .
Construttion PoieSub. �.
Cooking Uni[ �
Dishwasher
Dryers ❑Gas ❑Electric '
Fan, _ _ _ , , , ,
F A.U.
Fixtures - '
Device Boxes �
Outlets
$WILCIIQS ' �
Garbage Disposal
Generator O65 KW �
' � Reinspaetion Fee
—
DEVELOPMENTSER
Zoning Approved 8y _
Buililing Approved By
ELECTRICAL � • �
Transformer ❑ 15-50 KW
❑ 50+KW,
Meter �up to 100 amps ,
Meter �over,100 arrips .
75-15 KW
Sub Panel � � '
Motors �0-1� HP �1�Yh;8 ,
Inc.Solar �9:75 HP �1615
Microwave ' �
Pole Ligh� .
Range '
Sign ' � �
Standing Sections �
Trash'Compactor ' "
$15 � � laua Fea
—
R EQUI R EME NTS:
i
$ 3
ation Issued By �- �-+1 �/ - � Data�l�� �,is
� -� SUMMARV OF FEES � "
BUILDING PERMIT $' SMIP $
PLAN�CHECK , $� --�PERMIT ' ' �
PLUMBING � , � $. � � ISSUANCE � $� �
PLAN CHECK -25% $.� ' ENERGV P.C: $ -
EIECTRICAL � $ �v•O `� GRADING� $ ��
PLAN CHECK 50%,$- -MICROFILM $.—�//��—��/
MECHANICAL $ � TOTALfEE ;$ �
PLAN CHECK -25% $ ' , i , �
CONSTRUCTION AND PLANNING "� POOL & SPA .
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
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. APf�ROVAL TO COVER-GUNITE .
7. Footings 58. Electrical Conduit-Undrgrnd. ,
8. Foundation 59. Gas Pipe, � 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
12. Sewer Cap � 63. Heater & Vent-Final �
7 3. 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
78. 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 OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil .;�'�
25. Roof Sheathing 74, Overhead Hydro �
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Freme and Flashing � 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL �
29. Insulation 78, FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
�"s1. Plaster Brown Coat� 79. FINAL INSPECTION '
i�
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 t, ,
38! Final Plumbing . . . ; , ' .,
39. Water Service-Final � , . , , ' ,
40. Gas Service-Final , -
41. Solar pomestic-Final . � "
42. Backflow Preventer ' '
�43. Backflow Irrigation - ! -"
. 44. Landscape Irrigation System ' � . � �
�45. Sound Attenuation � •
'�46. Handicap Regulations ' ' - ' -�
47. FINALSTRUCTURE&BUILDING . � �
48: �Special Requirements Completed , . "
49. Electric Release to Edison '�
- .« .
50. Gas Release to Southern California Gas Co . - � r
51. CERTIFICATE OF OCCUPANCY . � �
i�
No. Date _ ',
- p
\
�"''�Coata Mesa Building Department " APPLICATION FOR P �
��;�. � P. O. Box 3�� 3,589 B U I L D 1 N G
� COSTA MESA, CALIFORNIA
FOR OFFICE USE ONLY
FOR APPT,ICANT TO FILL IN t f� w� Reeeipt No. Permit No.
s�nat�9 I a2' S �
Addrese i
��7 W � osta Mesa, CiA��01'1115 Received by Date Rec'd. Date Issu���
Nea�est
.�' d :.z .� ; 9- s -
Cross6L i Building /�� ` �p� � �_
p Address. C�
Owner •^
M�ii � „ Costa Mesa, California
�
Address jr�,i Nearest /�
. _ J .. _ C�OSS SL L .
ArChiteCt Or'
tractor
(Attach Metes and
Size oi Lot /p�
New I ✓�
Repair I
Buildin9� r/
8ize 'J l[�
.�.—
No. �1 Zoni
Lic.
No. App
b
� ILy LIC.
No.
i
I 7 -'' � '
Block I TraEf��� —
t %' ,�// -/An- i�_
No. ot Bldga�r —
Now on Lot
� INo.M No.of
Familles I Room —
RearYard ��� �,
OF COSTA MESA
rving � I Demollsh � �T�� !'
No. ot j ;Y ; �
Rooms Storiea
Rooi
Cavering APPRQVAL
Foundation Location Inspecto�
_ Forms, Materials, `
Under-Pinning
. Frame: Fire Stops, -
Braeing, Bolts
I hemby acknowledge that I have read thfs Applicatton
end state that the abwe is mrrect and agree to comply Latb. InL
with all Clty Ordinan and State Laws regulating
bullding constructi , Lath. Ext
Signature "
Permittee Plaster,lnt
Authorlied Agt Plasler, Ext
Valuatlon Permit Fee $ 3 Q .� Maeonry Relnioroetl
/ Plan Check $ / � Bond Beam
$ /� l �� / 5� Tota� _ �
FR
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