HomeMy WebLinkAbout1016 NANCY LN - Building PermitsI
CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
1
B98-01133
PERMIT NUMBER
(714) 754-5273 • Fax (714) 754-4856 BUILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
.lob Address: 1016 NANCY LN Status: ISSUED
Suite: Applied: 06/25/1998
Vicinity: Issued: 06/25/1998
Parcel Nunmber: 93530009 Zoning:
Applicant: MIRANDO, FRANK
FEE SUMMARY
Address:
Plan Check:
$0.00
Phone:
Permit:
$45.75
Zip:
Claimed Valuation: $7,400.00
Owner: CURY, JOSEPH;R
$0.50
Address 1016 NANCY LN
SMIP Corn:
$0.00
1016 j : i%
Phone:
Other:
COSTA MESA,CA
Zip: 92627-- _
Inspection:
$0.00
Contractor/,ISLAND PACT FIC�ROOFING
Total:
$46:25
Address: "1.7762 CAMERON ST-_
Phone:
H . CA/'Zip:
92647
License:,- 631472
- Rea, - -0-0 Left 0- 0
Arch •% Eng-
ACCESSORY
Front 0-0
' Address:
Right 0-0
PARKING
/ -
Phone:
'
Zip:
_License:
SCOPE OF PERMIT
REROOF THE TRIPLEX WITH ONE LAYER OF COMP. SHINGLE, 2ND LAYER: CERT. ATTACHED TO
PERMIT
NOTES:
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 InapwUons 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) 7545626
FEE SUMMARY
Plan Check:
$0.00
Calc Valuation: 81,406.00
Permit:
$45.75
Claimed Valuation: $7,400.00
SMIP Res:
$0.50
SMIP Corn:
$0.00
Other:
$0.00
Inspection:
$0.00
Total:
$46:25
. PLANNING & ZONING
SETBACKS,.
MAIN STRUCTURE Front 0- 0"
- Rea, - -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:
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 InapwUons 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) 7545626
r
WORKERS' COMPENSATION DECLARATION: �-
I hereby of nn under penalty of perjury one of the following declarations: ,
❑ 1 have and will maintain a certificate of consent to seg -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.
❑ 1 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 permit is issued.
My workers' compensation Insurance carrier and policy number are:
Carrier: Policy Number:.
(This section need not be completed JI the permff is valued at one hundred dollars ($100) or less.)
❑ 1 comity 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 flel if I should become subject to the workers' compensation provisions ofSe Ion 37 of the Labor Code, I shall forthwith
comply With thempro(s9Q�
Applicant t Signature: —Yf–�� �i�',v�w�t�� 1Dale
��
WARNING: FAILURE TO SECURE7%kRKERT COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE (tloo,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31060E THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions 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. Lic. q Class N
Contractors �Date:—
CONSTRUCTION LENDING AGENCY:
❑ 1 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: Lander's Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirn 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 ls 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).):
❑ 1, as owner of the property, 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 appy 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 o1 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 appy 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires:
Verification o1 Ownership by (type of document, i.e. - property lax bill or dead):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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
pemdt 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, An 2, Sec.
341,Tim 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:
1 Will the applicant or present or future building occupant need to file and witty a Business Plan for emergency response to release or threatened release of a hazardous
materiel? ❑ Yes ❑ No
(Section 25505 of the Celifomia Health and Safety Code requires, with same exceptions, that a Business Plan be filed with the Costa Mese 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 builtling accepant need to file a registration norm lar acutely hazardous materiels? ❑Yes ❑ No
(Section 25533 01 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 California Health and Safety Code provides that the Costa Mese 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 en RMPP is presently required, has Section 25534 of the California Health and Safety Cafe been fully complied with? ❑ Yes ❑ No
....................................................................................................................................................................................................................................................................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this eppncation epernil for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes ONO
(Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits).
...................................................................................................................................................................................................................................................................................
8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
....................................................................................................................................................................................................................................................................................
7 It a Permit from the South Coast Air Quality Management District or other air pollution control district or agency is regwired 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? ❑Yes ❑ No
..............................................................................................................................ont.....offie.r...................................................................................................................................
B (If yes', attach cemficete of compliance from the appropriate air pollution conlyd 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 totaling to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for Inspection purposes. l agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
e al er� (s) Z Date
And/or Authorized Applicant (–Dare -
CODE 0 INSPECTION TYPE DATE g®El5 CODE l INSPECTION TYPE Od1F gjTIRAl$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Root - 210 Final Electrical
201 Final Block/Romining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
2D3 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
244646
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Applicant to fill In all spaces within heavy border lines and sign all appropriate declarations.
LA 1 Y F CQSTA 01{'SA PERMIT NO.
TRACT NO. LOT NO. BLDG. NO.
��P J/- '
CrNSTRUCTION PERMIT — /
��c -
TYPE OF CONSTRUCTION
T 9 �1
O� •
Project Ad rens D�
/ Phone
Owner y
NEW ❑ ADO aLTERATION
❑ REPAIR ❑ CONVERSION' ❑DEMOLISH
Address
,L
LJ
_ _ __.
ZONING REGULATIONS
Arch/Eng. License No.
OTHER — A P
DESCRIPTION OF WORK
ZONE 2. PLNG. REF. zP
TYPE P RMIT TTpp gg�tJJIl�p I G ,
❑GRADING ❑ FOUNDATION ❑ STRUCTURAL SETBACK A RD S PRl7PE RT�LINE
❑ TENANT-❑ ELECTRICAL ❑PLUMBING ❑MECHANIC SIDE V
'Address - _
'ContractorG hon
Addr �ij
LICENSED CONTRACTOR DECLARATION
9
I•hereby affirm thatam licensed under provisions of Charter (com-
�i� a p _
RIGHT
mencing with section 7000) of Division 3 of the Business and
Professions Code,my license is in full for pnd effect.
OTHER
REAR YARD (TO P/L)
,And
PROJECT DESCRIPTION
License Class
SQ. FT.
. PKGSPACE REQ. -
- PROVIDED
�a9nse
/
Data Signature _
-STREET WIDTH
PARK FEE E
WORKERS' COMPENSATION DECLARATION
lf-insure
OCCUPANCYTYPE
ZONING APPROVED BY
DATE -� Z_
1 hereby affirm that I have a certificate of consent o sa ora
VALUATION ZONE
flat -of Workers' Compensation Insurance, or a certified copy
-_CJION
SPECIAL CONDITIONS:
of (Section 3800, Lab. C.).
GRADING CV. YDS'. ACRES
_y No. - Company
❑ Certifled copy is hereby furnished.
REMARKS:
❑ Certified copy is filed with the city Building Division.
_
,
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed if the permit is for one hundred
or less,
1S10O)
certify that n the Performance of the work for whf h this Permit Is
Issued, I shall not employ any persojjj���!�illl in any m nner o as to become
PLUMBING PLAN CHECK
ELECTRICAL 'PLAN
CHECK.
subject to the Workers' Compensa[t IIf0 lid.
BATHTUBS SHOWERS
S0.FT. co FT
Dale
%�"�2—et9nat ure
NOTICE: If after making this declaration, you SbOuld become subject
TOILETS URINALS
GENERATOR 0-1 KW_
TRANSFORMER
1-10 KW
to the Workers' Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed
LAVATORIES DOUBLE LAYS
APPLIANCE 30-50 KW=50
+ KW - - - - -
revoked. '
KIT. SINKS DISHWASHERS
MOTORS '0-1 HP
HP
CONSTRUCTION LENDING AGENCY
-1-10
I hereby affirm that there Is a construction lending agency for the per-
SERVICE SINKS SUMPS
(INC. SOLAR) 10-50 HP=
50 + HP
'
formance of the work for which this permit is issuetl (Section 3097
FLOOR SINKS FLOOR DRAINS
FIXTURES' OUTLETS
SWITCHES '
Civ- C.).
Lender's Name
Lender's Address
DRINKING FOUNTAINS
GAS TUBE SIGNS
INTERCEPTORSCLARIFIERS
POLE LIGHTS
'
OWNER BUILDER DECLARATION
L hereby affirm that 1 am exempt from the Contractor's License law for
SWIMMING POOL PTRAP '
POLES METERED
SUS
the following reason -(Section 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 re-
WATER SERVICE' ALTERATION
PANELS MAIN
SUB
quires the applicant for such permit to file a signed statement that he
GAS SERV ICE OUTLETS
SERVICE
Is licensed pursuant to the provisions of the Contractor's License Law
I Oter 9 (commencing with Section 7000) of Division 3 of the
WATER HEATERS BTU OUTPUT
ass and Professlons Code) or that he Is exempt therefrom and the
for the alleged exemption. Any violation of Section 7031.5 by
SEWER CONNECTIONS
any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars ($500).
SOLAR TANK COLLECTORS
'
❑ 1, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure Is not Intended
or offered for sale. (Section 7044, Business and Professions Code: The
_
SOLAR PIPING SYS.
ISSUE FEE
'
Contractor's Ucenso Law does not apply to an owner of a property
who builds or Improves thereon, and who does such work himself or
ISSUE FEE
APPLICATION APPROVED BY
DATFT/ v
through his own employees, provided that such improvements are not
Intended or offered for sale. If, however, the building or Improvement
MECHANICAL PLAN CHECK
SUMMARY
_
OF FEES
Is sold within one year of completion, the owner will have the burden
of proving he did not build or improve for the purpose of sale).
BUILDING
/ SO
�s�s
0•'v
❑ I, as Owner of the property, am exclusively conlratting with
HEATING SYSTEM 0-100,00OBTU
PERMIT E
;
SMIP E
licensed contractors to construct the project (Section 7044, Business
AND DUCTING
100,000 + BTU
PLAN CHECK S i
PERMIT
and Professions Code: The Contractor's License Law does not apply to
ISSUANCE $
an owner of property who builds or Improves thereon, and who con-
REFRIGERATION 0-100,000 BTU
PLUMBING $
'
tracts from such projects with a contractor(s) Ilcesned pursuant to
SYSTEM -
_
'GRADING $
the Contractor's License Law).
100,000 + BTU
PLAN CHECK E
-
❑ 1 am exempt under Section B. 6 P. C. for this
BOILERS BTU
ELECTRICAL $ -
S
reason
-
SYSTEM REPAIR, ALTERATION
EXHAUST SYSTEM MULTIPLE
PLAN CHECK - E
MECHANICAL E
MICROFILM E
TOTALD- ; E_[_(.�_Z_
LESS AO -
Date Owner
I hereby Certify that I have read this application and state that the above
unty
Information is correct. I agree comply with all city and county
PLAN CHECK S
VANCE PC ' E
ordinances and stale laws relafi O construction, and hereby authorise
'
representatives this Pty o en[ upon the above mentioned
property for acts poses.
Signature Data /0 22
ISSUE FEE
FINAL FEE b
'
Drivers' License or SS i
CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor
K
9'2—
CMF
4
CONSTRUCTION AND PLANNING
APPROVALS Permit #
1. Temporary Electrical Service or Pole _
2. Soil ipe-Un rgrn'
3. Electrical..Conduit. Utility-Undrgro
4. Electrical Conduit-Undrgrn_
Steel ein orce
6.. Electrical UFER_Grn.
' 7. Footings
{- 8. - Foundation
9. Water Pipe-Undrgrn.
10. Structural Floor System
11. Property Sewer Line.& House Connection
12. - Street Sewer Connection _
14.
POOL & SPA
Date InspectorAPPROVALS - - Permit # v Date- Inspector -
'56. Electricai-Final
43. Pool & Equipment Lotation' " - - •- - --- ---
Rough Electric -Wiring--
'44. Steel Reinforcement., ---' -- -- -- - -- - - -
`r
'. 45. Forms
�7
'_46. ElectriraLBonding -. --- - - - - - - -- '
Ducts,inStructure
47. Rough Plunibing & Pressure Test- - -
APPROVED FOR PLASTERING
48. APPROVAL TO COVER-GUNITE - - - -
Ducts, Ventilating - - - - •-
Gas Pipe -Rough &Test
Roof Framing - - - - -- -
49. Electrigl Conduit-UndIr
21.1
22.
50. Gas Pi ❑Undr rn, Test
- -
NOTES:
51 Backwash Lines P-Trao. CJ h - ' " . .....-- - -
Insulation
"•.52. APPROVAL TO DECK-
24.
53..._11ackwash & Receptor -Final -
- - - 54. - Heater & Vent -Final
55 PlumbonaSyggrn - Final
14.
Rough Electric -Conduit
'56. Electricai-Final
15.
Rough Electric -Wiring--
57. Solar System -Final - -
16.
Rough Heating & Air Conditioning = - - - --
• - encing.& Access Approval
17.'.
Ducts,inStructure
APPROVED FOR PLASTERING
18.
19.t
20.
Ducts, Ventilating - - - - •-
Gas Pipe -Rough &Test
Roof Framing - - - - -- -
- - _ -. ___-. _ _._ _ .
60. POOL/SPA SYSTEMS FINAL'
21.1
22.
Roof Sheathing- -
Frame and Flashing -
- -
NOTES:
' 23.•
Insulation
24.
Lathing & Siding
.-25.
Drywall Nailing
' 26.
Plaster Brown Coat -
_
27.
Electrical Power Meter -Final
'
zis. r -mai -,eanc -
29. Final Heating &Air Condi
30. - Final Gas Pipe -Test
wateraerwce-rtnai -
Gas Service -Final
35. Landscape Sprinkling System
36. Sound Attenuation
37. Handicap Regulations
38. FINAL STRUCTURE & BUILDING
39. Special Requirements Completed
40. _Electric Release to Edison
41. Gas Release to Southern California Gas
42. CERTIFICATE OF OCCUPANCY
- - No - Date _
i
City of Costa Mesa Plan Department
Post Office Box 1200
77 Fair Drive
Costa Mesa, California 92626
l9PJCJ (714) 556-5245
Tract No.
Lot No.
9691
REQUEST FOR OCCUPANCY
(Single Family Residential or
Condominium Units)
Date 1/19/78
Address 1016 Nancy Lane, Costa Mesa, California -
The developer of the above entitled tract desires to sell the above
set forth lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that
(he, she, they) she (was or were) was advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa Mesa
as having complied with the conditions of approval which were imposed by the
City at the time the final tract map was approved.
The City assumes no liability for the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless
from any claim resulting in damage or personal injury to the undersigned by
reason of the aforementioned uncompleted condition.
Byrchaser
Balalis & Pigneri Development Corp..
By
Developer andtorAuthorized
Representative
Cross Country Mortgage
By 9— Lender
CMF 0569-26
r
3
OWNER BALALIS & PIGNERI DATE 4-26-77
JOB ADDRESS 1012, 1014, 1016 Nancy Lane BUILDING PERMIT NO. 43574
AP No. 115-023-11 LOT TRACT 9691 FIRE ZONE VALUES 190_?OO_(Y1
INSPECTIONS et al
Si nature
Dot* JITYPE
V GROUP
i ZONE
SOIL
Z 7
SUBCONTRACTOR
PErMITS IS
Dote N..bar llSi naturo
GAS
WATER [� !��
Plumbin
ROUGH PLUMBING
PROP. SWR. LIN@ HOUSE CON.
C,
Q
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING'
(r
TEMPORARY SERVICE OR POLE
UNDERGROUND POWER
ROUGH WIRING
•%
Naa in on Va t.
TRENCHES FORMS STEEL REINF.
' i
FLOOR SYSTEM
r --q,
BOND BEAM -STEEL REINFORCE
SHEATHING
'
FRAME AND FLASHING
LATHING - IN M OUT
PLASTER. BROWN COAT
_ ]
STRUCTURAL. FINAL
HEATING. VENT., REFRIG. AND A.C., FINAL
PLUMBING. FINAL AND GAS TEST
2
ELECTRIC. FINAL
4 -
BUILDING. FINAL
SPECIAL REOUIREMENTS✓
//(�•]
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11
ri.l r:' l'�i•.f117 w't- •.� •.til
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
RECEIVED BY
I DATE RECEIVED D TE�1 LED
'a.7
ADDRESSDING//,2 -(old • la/s GI' LA✓Fi
p PERM
3-
OWNER [. �f
A.P. NO.1)5 Cl
MAIL
BUILDING
ADDRESVoig IDIS l0/(.A)gnc
ADDRESS"aT az, 1141bfA L -✓Q•
TEL
CITY Al /w7 -J NO -i73 -Z,05_1
TRACT
LOT BLOCK
CONSTRUCTION
NEW
I -Q laP
LENDER
BRANCH
OWNER E2•
ADDRESSAR
VALUE
E S
CH
NE. t
OR ENGINEER Cf 1 'L OL, ;_Zf
FIRE
ZONE YPE GROUP Il a r
ADDRESSq57W 131ekLLCY 00f, N /J•
APPROVED L 1/.
CONTRACTOR O
BY DATE �)iD
ADDRESS
TEL.
4"�E_ep
NO. OF USE OF N W
PILO
CITY NO.
BUILDIN W
STATE CITY
YARDS APPROVED YARDS APPROVED
LIC. NO. LIC. NO.
MAIN BUILDING ACCESSORY BUILDING
SIZENO.OF
BLDGS
(FROM C/L REET
OF LOT
NOW ON LOT
ONT FT FT.
USE OF
EXISTING BLDG,
DE CaT, p
Separate are required for
permits
L. SIDE FT.
electric, plumbing and heating work.
REAR Q 76 FT.
E OF BUILDING AND WORK TO B ER RME
DISTANCE BET. BET. MAIN & 1
T G
MAIN BLDjJGSS. ACCESS. BLOGS.
//77// DATE
CURPd..FL'/!C jZ49 APPROVED -/�/
APPROV
By 'ATE
I hereby acknowledge that I have reed this application and state
that the above Information is correct and agree to Comply with
OLD FUa, Ji s.Ll a1
all laws regulating building construction, and 1 shell not employ
any person In violation of the workman's compensation laws of
ICC S�L/• `i`I! ( i
—' -
the State of California.
I hereby certify that I em properly licensed as a contractor under
7 70 SO. FT. L
the State of California Business and Professions Code, Division 3,
TME 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:
em enempt from M provisions of the State of California Business
end Professions Co , Division 3, Ch tar 9.
VALUATION
PERMIT FEE $
PLAN CHECK 3
• I'd
Signature of
r
Permittee
$� �oO
04
TAX f
Authorized Agent
TOTAL PAID S