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HomeMy WebLinkAbout1967 ANAHEIM AVE - Building Permits CITY OF COSTA MESA 4/41%. BUILDING DIVISION >%� ,,,,•' ; DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER tinr!ipirApis PERMIT J in PERMIT B00-01877 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT • Job Address: 1967 ANAHEIM AV Status: ISSUED Suite: Applied: 11/20/2000 Vicinity: 4-PLEX Issued: 11/20/2000 Parcel Number: 42214210 Zoning: Applicant: CIRALLI, DOUG ISSUED BY: Address: 735 FARAD ST Phone: (949)548-9884 COSTA MESA,CA Zip: 92627 Owner: CHENG, POH TON TR Address 420 CAME3RIDGE CIR Phone: COSTA MESA,CA Zip: 92627 Contractor: CIRALLI ENTERPRISES INC • Address: 735 FARAD ST Phone: (949)548-9884 COSTA MESA,CA Zip: 92627 License: 698771 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF EXISTING 2-STORY 4-PLEX(40 SQ).TEAR OFF EXISTING ROOFING&RESHEATH WITH 1/2"CDX PLYWOOD. INSTALL 15#FELT UNDERLAYMENT&REROOF WITH 30 YEAR COMPOSITION SHINGLES. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $9,000.00 Permit: $167.25 Claim Valuation: $9,000.00 SMIP Res: $0.90 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $168.15 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(&00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the _ work for which this permit is Issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which th s permit is• ued. - y workers coraqensatl1pf1�-1nsu���r.�$`�1cq\\e carver and policy number are: - CC /^� S.-1.-1°O -Carrier. .� rT2 \—Vel V Policy.Number.- SIJ \1? I _(This'section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the w.- or •ich this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Calif•r la and a• ea that if should become su act to the workers'compensation provisions of/ectipn 3700 the Labor Code,I shall forthwith comply with rhes rowsi•ns. !� !//�1'\/�a-�� Applicant Sig=ature: — C rw 1 Date: tl� CE) WARNING:FAILURE TO SECURE WORKER AA..-ENSA J. COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO TH .•4 •F 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 er provisigns of Chapter 9(commencing with Section 7000)of Division 3 of.the.Buslness and Professions Code,and my license is in full force and enact` -� 77 I (_class#.— r/' \ :?, Contractor's Signature:-- "Date' III a(C N CONSTRUCTION LENDING AGENCY: ❑ 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 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 nol 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. 0 Yes 0 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: ❑ 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: I 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 tiled 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 ❑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 0 N (Section 25534 of the California Health end 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? 0 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 a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U 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? ❑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 Quality 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 COMPUANCE 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 °lii inspection. Ol Lega r(sJ /IL J And/• •u,u--ooz•• �--Date BODE f INSPECTION TYPE •-I IUIDAL$ CODE! INSPECTION TYPE MI RBIDELE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof / mt° 210 Final Electrical 201 Final Block/Retaining Wall k----- 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 ORANGE COUNTY BUILDING DEPARTMET, APPLICATION FOR PERMIT 636 North Broadway �j y • 1fSANTA ANA, CALIFORNIA 1J/--,mow, RUIL® ' NG FOR APPLICANT TO FILL IN• FOR OFFICE USE ONLY (/ �, _ o ;Anilgr.)?RECEIPT NO. PERMT NO. ADIDRESS i / G 7. (�I.Latt-lr1 tV C.€929.? SCHOOL DIST. I }/}' V/) AAA (� RECEIVEBY ] DATE RE D. DATE ISSUE OR TOWN 1 I� . /A. 1 r�.. l� r� lW l '/ / V7 �� '_I NEAREST i T'� �J1,1E (/v / C� 9 O/� ./ ^CROSS ST. 1 -/ \f l'l�f/ � J c//� re-Q., //lJ /� J� I OWNER Qnn. 11 t S. A 13 A C kl_ ADD REISSI( 6 ) CACI-.,w../.e(/jir S• ADDRESS 1 Ii T - M1 ,ICry RAI IU� OR TOWN IST. -��V �YJLCa.. ��^ Gr_<a �ti e r' e. C C TEL NO. - NEAREST f�1 C CITY CROSS ST.. /11// d /^ ARCHITECT OR t LIC. ZONA/ NO. OF TYPE GROUP ENGINEER .IV O in -P_ NO. - PLANS U I I 1% : 1,7 ADDRESS APPROVED . /E Y//7r BY CONTRACTOR 0 6-1 P. }- NOAl.U h C ' W7 ADDRESS 9/ , p w / �. v - CORRECTIONS "lLL LEGAL I LOT , C( .BION / ^_ DESCRIPTION NO. L K TRACT (ATTACH METES a BOUNDS/ SIZE OF LOT G Y'/� 1 y a 'I NOW ON LOIS. Nan z 2Zcc.a��``A�'t"C�/�""� USE OF / I NO. OF I NO. OF / �///�J�����I��''�(�' '/��//�/��`�.��� 5�/E:a.h EXISTING BLDG. .� FAMILIES ROOMS' 1 �� �^ orL _ /I'-Y ,lYU i SETBACK LINE FROM: �/j� ) REAR :,,,,,,,,s, } e' . ('fes . JAI CENTER OF STREET i U /��^ SIDE // - JI) -.girl., / DESCRIPTION OF WORK -��^flMYVT i �- D NEW I ALTERATION I ADDITION I //n . .'n„( . % - �R�y%Z SVD REPAIR I I MOVING I I DEMOLISH I •O/"•' µ'¢w^r A.AR�1s+� ��~, r BUISIZE A0 v� V�,ROOMS y STORIES -}NO. OF - _ � -- 1`r OW EXTERIOR WALL "', I ROOT }T.±�nFEi_ COVERING ILL6UL rmvt AIA/0 1 COVERING t J. -'A"}' BUSE OF UILDING , r 6,e/ sTF� qy`�l', TSF AtiPROVALS FOUNDATION: LOCATION`'I NSPECTOR DATE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS FORMS, MATERIALS 1. L /1 P APPLICATION AND STATE THAT THE ABOVE IS CORRECT UNDER-PINNING VII 'i (-'�D 7 Jt AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FRAME: FIRE STOPS. eV' AND STATE LAWS REGULATING BUILDING CONSTRUCTION. BRACING. BOLTS etl!.�1AJ�� �r ' / [ ///; w././����f w..� {///�//� LATH. INT.�0\ (F1-1 r. n SIGNATURE UTTEFF vv. /Vr ,♦A LATH. EXT. // /j ,,e t� AAAA ^I1 J((J/fes. PLASTER. INT. -=,. tn�� ttr/ y AUTHORIZED AGT. PLASTER. EXT. f /� PERMIT FEE S MASONRY REINFORCED VALUATION $2,e7 `f (/ PLAN CHECK $ / .�'�`t, BOND BEAM A // I }� a FEEAL SIl 0 FINAL 4 ,/� kart--aS • � •- 11 .00 - a071-Jc�-s• __s3 tr 111 'Al • a `o • • 0 ns ? l • . • i9 �, w • . STR EET • • ni PLOT PLAN Show location 'and distances from property line and between buildings. Nvl/ L L©Z`,zs • • • • " " 40985DEC 16-75cN700 626* *****5.50 } COSTA MESA BUILDING-SAFETY DEPARTMENT • P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 • APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely—Use Ink Only DREWBDATE I5 E V PQTE REEV ADIDRES /967 / Nff ;y7 / v�. /Rj-/WP'lG' OWNER Recti/ 8. OW/A:cc A.P. NO. I5- 3211 - - 5 Y MAIL BUILDING 1967 ANAHErin 2p/o SEAu'.ew Q . 4_ Q TEL Stanek' �AGYtt Pct /1 JBLOCK C CITY CCPEL /7f4/I 617-1.177 TRACT LOT CONSTRUCTION ? / NEW ADO ALTER REPAIR MOVING DE`M!OII5H LENDER / C BRANCH • `�r / 'I OWNER / .ADDRESS a /`••e VALUE Q'0 ARCHITECT /J V d • TEL. USE OR ENGINEER „U! Wim!//f7V / NO. • -0-3/'�l // /�+ ADDRESS 7Ff /n �• /9T* J / • C-M1 ZONE / TYPE 1 GROUP �J�1 CONTRACTOR Y 1 • S. c?/jiffs BYPROV �fv// OATS /e/G A-, ADDRESS Om e� / TEL ZONE n/� NO.OF USE OF NEW CITY NO.S 7-OryJ KL, PLANS BUILDINGEnt/S0 F STATE CITY YARDS APPROVED YARDS APPROVED LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING tt4 SIZE / / NO.OF SLOGS. (FROM C/L g�Jr(,gEET) Ci.. OF LOT �O x 4CO NOW ON LOT FRONT 47r FT. FT. Q USE OF st� V) EXISTING BLDG. -R. G� FT. FT. Cl) \^•�` ` FSeparate permits are required for L�$ E FT. FT. O electric,plumbing and heating work. REAR FT. FT. I.. F BUILDINGAND WORKBE PERFORMED USE OF TO DISTANCE BET. BET.MAIN Q MAIN BLDGS. ACCESS. BLDGS. en / VAR.# DATE " C.U.P.# _APPROVED stGq } ROVED G• 4.4,R. P11 DATE 102- -- O/ -75 ix W • a. I hereby acknowledge that I have read this application and state us N cg that the above information is correct and agree to comply with m 4 all laws regulating building construction, and I shall not employ Z any person In violation of the workman's compensation laws of F. the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: n am exempt from the provisions of the State of California Business VALUATION PERMIT FEEet S • end Professions Code, Division 3,Chapter 9. �r�11 in N i.�). PLAN CHECK $ /--' "� e o Signature of // r /�A / / u. Permittee ' f i/ �' Imo' •I/1- 1 $�,(_� TAX $ /gypz /// U Authorized Agent / / TOTAL PAID 5 57,511 PAID 4.1299 FEB 17-767Nst 00 622* ***186.70 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely —Use InItlOnlyts RECE D DppATE ECEI Eiji` �7e r�rJJll (/�..a�J p+� �� � DATE ISSUED7 ADDRESS BUILDING / �^J /y LQC IPI km' Au ue 2' S f 77�� / / PERMIT NO. OWNER f, /felcf�. Cly Gvi les A.P. NO. /fS' ?2,2, L�,, MAIL ��JJ p AveILDING // r1 ADDRESS 74(O lea ii ew /-1 ADDRESS /7 ; —i A ��lyI�7(`er bsl rt n / ` A p TEL 673 MIRv FIFR '-i mit'. BLOCK CITU a....0 51-7-, /"'1 t�S l../C Qt NO' .�j'17 - CONSTRUCTION c'et /% O21 cpgJ NEWT ADD ALTER I REPAIR (MOVING ftFMOI ICH LENDER JJ cV/ BRANCH / (1 OWNER& ♦ r hide 8. G Pilfer ADDRESS /7 �y�( L ` qqq e.:=:: ) ARCHITECT r204i/'t '" 4- rI HS' TEL..) 1 USE APt USP VALUE 4. 1d `f �• I -/ ' "' • c� `l /'1 FIRE if S/SOS i ADDRESS ZONE IliYPE GROUP ..--••�� APPROVED / 2—� -7 CONTRACTOR Q/i✓/t CPC b ldv r BY ` DATE/r l7 ADDRESS Apt TEL. Z 1�� I NO.OF USE OF NEW4 uN �art tr ' CITY NO. P�� BUILDINVATT:GICia..- F STATE CITY YARDS APPROVED YARDS APPROVED LIC,NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING W SIZE 6/ 6/, / NO.OF SLOGS (FROM C/L T EET) [/�� � C. OF LOT rx �J FR .493 NOW ON LOT ONT FT. 'A ert,,n'l /—rd Q USE OF 41 EXISTING BLDG. A //�f /hl ie ` 0-4?ZS R.SIr1F 6FT, FT. cn r r if F Separate permits are required for L.SIDE //FT, FT, FT. electric,plumbing and heating work. CD'W - REAR , T. FT. (.., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& <Q MAIN BLDGS. ACCESS BLOCS. • 4 G0it 17L A D f s it 4 74Vc!es c,u.P.# DATE �J APPROVED / ✓ VAR.# APPROVED /P6- _ _ ----- —1 I • • II • • • • • • • -, \ CL w _` — , p. o 1 hereby acknowledge that I have read this application and state m CL that the above information Is correct and agree to comply with � % m 12s all laws regulating building construction, and I shall not employ o % Z any person in violation of the workman's compensation laws of • s the State of California. 3 I hereby certify that I am properly licensed as a connector under SO. FT. w N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m N Chapter 9, and that such licenses ere in full for a d effect,or ITHE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from ovisions of the State of al ornia _usiness v and Professions a Iv sion ha 9. VALUATION a PERMIT FEE E —j�,�• n P PSignature errmittee 05 :ilk of �� / / $ fS' elf� TAX CHECK $`6O;!9 J //// LL��tf�l 0 V Authorized Agent TOTAL PAID E • - /0299 :t:13 -Q-77�"-:00 466 u***277.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 , R CPLED A ION FOR STRUCTURAL PERMIT For Applicant to Fill in Co pletely — Use Ink Only � V DATE RECEIVED DAT E11SS U�Q� BUILDING / / / ADDRESS AyG V /�— PERMIT NO. OWNER (;Oe/P'FED' A.P.NO. BUILDING // G �J MAIL ADDRESS i / fads (ise, ADDRESS TEL. CITY NO. TRACT LOT BLOCK CONSTRUCTION ' NEW ADD ALTFR REPAIR MOVING nFMnLKH LENDER l / BRANCH /x` ' j / Fe-Sr � '1 OWNER //,y ! ADDRESS '/fit/ y /�/ ,/.V.A.L�UyE ARCHITECT TEL. USE �v'I�( /"� //yRT'/� OR ENGINEER NO, FIRE ADDRESS Ada. ZONE TYPE it GROUP r '/�:�1/ APPROVED CONTRACTOR ,(L( (�aAP DATE ADDRESS ZONE NO.OF USE OF NEW TEL. (PLANS BUILDING CITY NO. F STATE CITY YARDS APPROVED YARDS APPROVED LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING Is7 SIZE NO.OF BLDGS. (FROM C/L STREET) L OF LOT NOW ON LOT FRONT FT. FT. Q USE OF Ca EXISTING BLDG. R.SIDE FL FT, CA (—• Separate permits are required for L,SIDE FT. FT. electric,plumbing and heating work. REAR FT. FT. I.W. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 0 s 4 MAIN SLOGS. ACCESS. BLDGS. J� '�i VAR.# DATE "..3 414Ut f//{,//j/�J/ C.U.P.gW APPROVED ' / APPROVED y. _lY DATE ..l a W 0 I hereby acknowledge that I have read this application and state n lye that the above Information Is correct and agree to comply with m L all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of E 4 the State of California. CSt I hereby certify that I am properly licensed as a contractor under SO.FT. CO the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, end that such licenses are in full force and effect,or I THE PURPCGE OF ESTABLISHING A PERMIT FEE ONLY: to am exempt from the provisions of the State of California Business e VALUATION PERMIT FEE $ and Professions Code,Division 3,Chapter 9. 7—m PLAN CHECK $ O1 Signature of e Permittee $ TAX $ LL f /i U Authorized Agent TOTAL PAID $„.277�� • 45437 I rt COSTABOX 1200 SA BUILDING-SA LDIIA MESAFCALI OFOETY RNAIA 92626 T 5154 /21/78 8e50 TL ApplicantP.O. to Fill in Completely AP AT ON FOR STRUCTURAL PERMIT For P Y —Use Ink Only /%/ 7 ,r RE E DATE RECEIVED DATEIS/$$UED BUILDING // / /1t f //4j� n,/ / '-7x ADDRESS �j /q /J/ �/ OWNER /1/4.1654/,%• /709;6./ - A.P.NO./Ara222-r PERMIT NO. AMAIL DOR ESS �r/D f,f4�d':Gy a€f.. BVIID INS C2,4JV Wt/�h /,e /� �J �o pJ ADDRESS b Ir /�` �/ CIITYYTf4f ���J//,4 / /L��/'JJ\ NOL�T��GJ�f NEW�TRADD T Al TER REPAIR{tics �DBLO KH CK LENDER ON C,7L / 6� ,,,s /��7 BRANCH /'] • OWNER /o��LrF01.' A' 6 /TEs ADDRESS ARCHITECT �/I/ TEL. .SW `• USE /�(/UT otcc VALUE OR ENGINEER Y ✓/gl/i/�f NO. .7/ f�/ FIRE ADDRESS CAL pp ,..7 ZONE WIP GRO',/USP �s��CONTRACTOR 4t.4/4A/'&/JL!/'t BVpROVEDDATE�(� /•�Za • ' ADDRESS 2072 IpNO.OF USE OF NEW......., TEL. CITY NO. .BUILDING //CAC/2)4e. w STATE CITY YARDS APPROVED YARDS APPROVED ZLIC. NO, LIC.NO. MAIN BUILDING ACCESSORY BUILDING _ (FROM C/L STR ET)SIZE / NO.OF fax OF LOT 60 Y Z 0) I NOW ON LOOT FRONT 7/ FTTt C/ FT. Q USE OF /, /�(//�/ y EXISTING BLDG. �.SIOE / D FT.C — FT. GO f FSeparate permits are required for L.SIDE FT's FT. W REAR / electric,plumbing and heating work. 4-401%/fa�/ FT. t.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 'C MAIN BLOCS. ACCESS.BLOCS. CI Q T/6 m' /54/64.4__C ef,et VAR.# DATE C.U.P.# APPROVED �s 7 APPROVE* r — / (1 _7 �. ,BY . DATE J Wig m C I hereby acknowledge that I have read this application and state n N GL that the above Information Is correct end agree to comply with m a all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of e sthe State of California. I hereby certify that I am properly licensed as a contractor under SQ.FT. a the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT F E ONLY: am exempt from the provisions of the State of California Business y VALUATION PERMIT FEE $ and Professions Cod,Divi on 3,�hapten_. 1 , m ///J / L�,, PLAN CHECK $ m Signature of / ,%1%1"/((/��r/U, o Permittee _A hi L / 4 _ ._...rs $ TAX $ e. 7 0 2 u Authorized Agent TOTAL PAID $ 53