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HomeMy WebLinkAbout287 17TH ST - Building Permits City of Costa Mesa Building Safety Department CERTIFICATE OF OCCUPANCY N? 2733 C P. 0. Box 317 Costa Mesa, California The Building located at 287 Fast 17th Street has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances cpplicable thereto for a Group PP Occupancy. Use of Building film supplies and 'related services Legal Description A. P. #1 7-192-19 (See reverse side for Metes and Bounds) Building Permit No. 32533 Electrical Permit No. 31884 Plumbing Permit No. none Floor Load Signs have been installed as Room Capacity Signs have been instaled as required under Sec. 2308 U. B. C. • required under Sec. 3301 (1) U. B. C. 17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied until the owner or operator has been issued a valid certificate of occupancy by the enforcement agency. (b) A new certificate of occupancy shall be obtained whenever there is a change in: 1) Occupancy classification of a building or portion thereof 2) The number of apartments or guest rooms 3) Ownership If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California Administrative Code, Title 8, Chapter 9, Article 8. Number of apartments and/or guest rooms ISSUED TO: Building Official Photo Disc Corporation by it LACL' A, // f' 1 • Date Detemb°r 22, 1970 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Form]31734-1M_11-63 4B r )I. CITY OF COSTA MESA nom : BUILDING DIVISION • i y ..�• 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us • 4. � FOR INSPECTIONS CALL:(714)754-5626 �'►on� • PERMIT NUMBER: BCO8-00412 PERMIT TYPE: B_COMBO STATUS: ISSUED Sub Type: COM_ALT DATE ISSUED: 02/17/2009 ISSUED BY: JOB ADDRESS: 287 E 17TH ST CM:r•' - 'Suite/Unit• :- -_•- APN: 42522304 - Zoning - Vicinity: PARKING LOT - PrimaryOcc: U ' Const Type: SQ. FT:. 74 _ Valuation`. $10,000.00 fi. SCOPE OF WORK: CONSTRUCTION OF'A NEW 74SF STAND-ALONE"BANK OF AMERICA"ATM KISOSK WITH THE ASSOCIATED SIGNAGE,SITE WORK FOR NEW BANK PARKING AND ELECTRICAL. - ' 1 SERVICE UP TO 200 AMPS ' - REQUIRES FINAL INSPECTION BY PLANNING'" -- OWNER: PERLMUTTER DAN M. • Address: 36 MISSION BAY DR- . 'Unit: Phone: - ' - City/State/Zip: -CORONA DEL MAR,CA .. APPLICANT: AMARE, PARESH_, Aidress: 1440 VETERAN . Unit: :STE205- Phone: 310-271-1128 ,. - .City/State/zZip: LOS ANGELES,CA CONTRACTOR: c- , - ;� License No. . • Phone: ' ;i Address: Unit: - ' Cell: City/State: ZipCode ARCHITECT: PETERIS ARCHITECT License No.C24006 - - • PHONE:310-271-1128 ' . .. ENGINEER: • • •License No. - PHONE: COMBINATION PERMIT FEE SUMMARY=.. Building Plan Check: $1.17.81'4't ------,[-s-- - -- Building Fees: `` ` =$181 25; _ • ' Electrical Fees: $54 00 • Mechanical Fees: - - -$0:00 Plumbing Fees: $0.00 ' SMIP Residential: $0.00 '"- . SMIP Commercial: $2.10r Bldg Std Admin Fund ?? TOTAL FEES: $356.16 • ' —Refer to fee receipts for all fees paid for project ' cia • 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. %WEr. alaci10NT7'pE MTh INI111ALS CODE INSPEc11ON TYPE MTS IN1RUL¢ 1618 Fixed System Final Fire Prevention 206 'Final Mechanical 1288 Pool Spa Final JOBS 200 Final Re-Roof A0, 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,_.,cense. 0 Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: 0 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 . Cr of the work for which this permit is issued. �4��Y, 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 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 Sloe: I person is required to descend,will be made in connection with work authorized ® l (� by this permit,and that no building structure,scaffolding,falsework,cc demolition fn�C `'" t•swrK 1"`e'v""F F� or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp on need not be gvrry(�ptllShe permf is valued at one hundred abAars(E100)0.less 2.Art 2,Sec.341,Title 8,California Administrative Code). Poli Nu r: 30(1 -a_'/ — 5-(Qib8' ,�/ 0 As owner-builder, I will not employ anyone to do work which would Iry 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 th- •rke ' •mp: sation provisions of Section 3700 of the La or orf ,I s j fr.�h. �co with these Prov cions. p Applicant's Signawre Date i� IL-/7-c I Division of Industrial Safety Permit Number: ties'mature • HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSAT N COVERAGE 1. Will the applicant or present or future building occupant need to file and IS 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 0 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 0nse is in full force and effect. /J a registration form for acutely hazardous materials? 0 Yes 0 No ? 7 (� (Section 25533 of the California Health and Safety Code, with some n _g exceptions, requires registration with the Costa Mesa Fire Department by ` m 1 f- p each business which at any one time has on hand a quantity of acutely �Cw� actors gnawre 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I 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 issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes 0 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 0 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 fcr 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? 0 Yes 0 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, as 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 California 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 employees, provided that such improvements are not intended or offered for 8. (If"yes",attach certificate of compliance from the appropriate air pollution 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: ('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 allstate laws and ❑ I. 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 • Date ' property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORlZATICN 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 ❑ I 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 properly for inspection purposes. I agree not to occupy or allow occupancy of any building • authorized by this permit until final inspection. . g •j Sig ur L I Date• �O Signature Date // r A --(, 4 3057.46(3/07) And/or Auto z A iCant L—Pate r CITY OF COSTA MESA ��t'"'� BUILDING DIVISION . N/ 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.d.costa-mesa.ca.uS °,n FOR INSPECTIONS CALL:(714)754-5626 • PERMIT NUMBER: BX08-00280 PERMIT TYPE B_MISC STATUS: ISSUED APN: 42522304 DATE ISSUED: 02/17/2009 Zoning: , ISSUED BY: JOB ADDRESS: 287 E 17TH ST CM - ' Suite/Unit: Vicinity: PARKING LOT Primary Occ: - ' Const Type :77 . SQ.FT: 0 i " Valuation: $5,000.00 - : SCOPE OF WORK: INSTALLATION OF(3)NEW 30'HIGH PARKING LIGHT STANDARDS. REF#:-BC08-00412 ,. . - OWNER: PERLMUTTER;DAN M Address:: 36 MISSION BAY DR ' Unit City/State: CORONA DEL MAR, CA Zip Code: 92625 Phone: . . - • •• :• - • APPLICANT: AMARE, PARESH Address: • . Unit: City/State: Zip Code:. Phone: 310-271-1.128 ( t " ' • CONTRACTOR; JOHN ARMSTRONG CONSTRUCTION License No. '771784 Address: 840 W FRONT ST - ' Unit: City/State: COVINA;CA .. Zip Code: 91722 - - - .Phone • 626967-8001 -- • . Cell: ARCHITECT: PETER'S ARCHITECT - License No. C24006 • Phone 310-271-1128 • . • ENGINEER: LES E SCHULZ • License No. SE2570 Phone - - FEE SUMMARY . Building Plan Check: $72.31 Building Permit: $111111.25 Electrical Permit:• - $124.00 SMIP Residential ' $0.00 SMIP Commercial ' $1.05 • Bldg Std Admin Fund $ 0? /'.-' • TOTAL FEES $309:61 - 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. CODE F, INSPECION YYPF g&IE Iling COOS1 INSPECnON TYPE PM !Sas 1816 Fixed System Final Fire Prevention 206 Final Mechanical 1286 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical Z/2-111 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign222 Final Site 07 ii r 204 Final Demolition 250 Final Building/Occupancy aV I WORKERS'COMPENSATION DECLARATION: Owner ID verified by drive. .•ense. ❑Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: • Driver's License No. Expires: 0 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 , pe ante 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a re; person is required to descend,will be made in connection with work authorized 7 C�./ t e I .1 `e / by this permit,and that no building structure,scaffolding,falsework,or demolition JTs l'e n <nS+l�►^ or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This section need not be co#pleted if the peon a vetoed at one handfed dollars($tOO)or less) 2,Art 2,Sec.341,Title 8,California Administrative Code). Po' y,' , b'.: 30 f(9 0-14 — ¢AbtP— ❑ As owner-builder, I will not employ anyone to do work which would ❑ 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 the workers'com sensation provisions of Section 3700 of Applicant's Signature Date th Labor Co / /e,I s lip, 'th coyly%ly with these Prov ciomns. r 1 -/7 rO'9 Division of Industrial Safety Permit Number: Av trtil.tore _etc HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS 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? 0 Yes 0 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 m .--nse is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑No • I O ;- , n (Section 25533 of the California Health antl Safety Cale, with some / ii� I _I exceptions, requires registration with the Costa Mesa Fire Department by .— ,/r/ LL1 — each business which at any one time has on hand a quantity of acutely 6410 igreture 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). O I hereby affirm that there is a construction lending agency fa the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 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? 0 Yes 0 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 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for 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? 0 Yes 0 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, as 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 California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No 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 8. (If"yes'.attach certificate of compliance from the appropriate air pollution 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 O I, 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 . Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractors)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 I 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. g .• real 4I ) Date Signature • Date ' !1��/_/7-01 aosTas 131071 ' 'nd•'u1MnZed. p icon -- DEC -2-70<HSp00 298* ****18.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to nFill in Completely ADDRESS Z87 E, I / SrRECEI�E�BY DATERECEIVED DATE ISSUED BUILDING . tai- rote n v-N Q 7 OWNER P401 Arc,- rote A.P.NO. II7-I/2-0 P✓NOr3� AMAIL DDRESS /6 ? • r A' C GAw / BUILDING 2 p7 C / n U.. sr ADDRESS -(v/yrO y,�p / W W (/y7 TEL / NJW TRACT*eta I�LOTS .,� BLOCK 0- C.) CITY ,Q!4�IfT ADA NOJJ!'fl�Oe♦ r Z < CONSTRUCTION NEWADDOV, ALTER REPAIR MDFMf1115H - • a. I- LENDER at. _i 0 BRANCH /�J� ,I� • -I N WNER PAC.1.0 (/ r • •C w ADDRESS /1 J� L'// �A1/,,,. 1/��,.,v Jake /yp/ `E //� �/ CO Q OR EHGINEE-00 RCr/[//'i IRIke' TEL LSI/T6 to /� SE --7-cff& V 'T(/L(N'/0781 FIRE W 2 ADDRESS 6�/ 4) fa L /r7'/4yj ZONE TYPE GROUP / a w ` APPROVED i 7 2 z 7a J Z CONTRACTOR je (J M£(_ 8,,,, K,," BY �J✓�L\DATE / L CO W W A — DDRESS ZONE NO.OF USE OF NEW ZETA t� `�^�' O= TEL. GIS PLANS a BUILDING Z 1- CITY NO. YttAki 1 AVES t fi.. jOftSTATE w �� CITY YARDS APPROVED YARDS APPROVED N LIC. NO. �( / 0 LIC.NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO.OF BLDGS. (FROM C/L ISTRI=ET)++-- SCL y}�EL, 57-4,OF LOT INOW ON LOT FRONT 41-'1FT. .To FT. USE OF EXISTING BLDG. _R..SIDE '� FT. ^///III / FT, I- SIZE L p NO. M / p.2 7 J l /J ZQ NEW BLDG. 48 Ift ROOMS / STORIES L.SIDE //!!, /�FTS d. At F7 Vt- U EXTERIOR WA ROOF ROOF ((`` COVERING �[,�_ COV ERING...S TZ. REAR FT. FT. aUSE OFBUILDINGAND WORK TO BE PERFORMEDSDISTANCE BET. / BET.MAIN& O. ©©r 1 PtA /-$.D/r/4+ S -p MAIN BLOCS. ACCESS BLDGS. �t DATE O tilt_'421 Sem Le CS e .#7-E-104-70 APPROVED II -Z- 0 I- L I APPROVED//yy I(-to 7 LI Z BY rT� SO----.. DATE 1 Z HOLD FOR SPECIAL REQUIREMENTS O U I hereby acknowledge that I have read this application and state ('Or (o ,')iTlnwIS I-fST✓/7 OAt 7 that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ n I- any person in violation of the workman's compensation laws of PPRoU� 64-N5 . the State of California. le ZI hereby certify that I am properly licensed as a contractor under SG. FT, O the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from the provide of th tate of California Business VALUATION and Professions Code, Divisl 3,C er 9. r o-o ry cc-- PERMtT FEE S Signature of / . E Permittee S�2OO PLAN CHECK $ [O 0 Authorized Agent 0/� a TOTAL FEE $ f An