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Home My WebLink About2129 NATIONAL AVE - Building Permits. . c � i CITY OF COSTA MESA / BY/LDING DIYIS/ON F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 7544856 • www.ci.costa-mesa.ca.us �.�� - � FOR INSPECTIONS CALL: (714) 754-5626 . PERMIT NUMBER. 607-00813 PERMIT TYPE B MISC STATUS: ISSUED DATE ISSUED: 07/0212007 ISSUED BY: SOK JOB ADDRESS: 2129 NATIONAL AV CM Suite/Unit: ' Vicinity: THROUGHOUT S.F.D. � � .. Primary Occ; ,�- �• Const Type:?? SQ. FT: 0 � . � Valuation:� . $3,600.00 SCOPE OF WORK: R�PLACE WItJDOWS THROUGHOUT S.F.D., LIKE FOR LIKE, TO.MEET 1997 U.B.C. EGRESS REQUIREMENTS. - � " OWNER: GARCIA, JQSE tAR105 PHONE: 949-283-4522 APPLICANT: GARCIA, JOSE LARIOS � PHONE: 949•283-4522 CONTRACTOR: OWN�R-BUILDER Address: Unit: Ciry/State: ARCHITECT: ENGINEER: PHONE: ZipCode: Adtlress: 2129 NATIONAL AV Unit: Ciry/State2ip: COSTA MESA, CA Adtlress: 2129 NATIONAL AV Unit: Ciry/State/zZip: COSTA MESA, CA License�No. License No. MISCELLANEOUS PERMIT FEE SUMMARY Building Plan Check: , - � . � y0.00 Building PermiC . , $9725 Electrical PermiC 50.00 Other Fee: $0.00 SMIP'Residential � ' $0.00 SMIP Commercial $0.00 TOTAL FEES $97.25 - License No. 000000 CELL: - PHONE: � PHONE:. NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California sWtutes and related regulaqons. (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 vrork authodied under this permit lo be considered legal, such work must comply with all applicable codes, and all required inspectlons and final approval must be obtained. Failure to obtain inspeclions and final approval vnll result in the expiration of this permit. COOE1. INSPEC710NTYPE D� IN IL COOE/ INSPEL710NTYPE D�T NTI RL 1816 Fixed System Final Fire Preventlon 208 � Final Mechaniwl 7268 Pool Spa Final " . 208 Final Plumbing 200 Final RB-Rool 210 Final Electri�yl 201 Final BIocWRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place � 220 Final Planning Approval 203 Final Sign 222 Final Sile S2,A�b V 204 Final Damolition 250 Final Building/Occupancy P/� � g WORKERS' COMPENSATION DECLARATION I hereby aKrm untler penalry of perjury one of the . ,dng tleclarations: � ❑ I have and will maintain a certificate of wnsent to sel(-Insure for.workers' compensation, as provided tor by section 3700 of the Labor Code, far the performance of Ihe vrork tor which this permit is issued: ❑ I have and will maintain v.orkers' compensatbn insurance, as required by sectbn 3700 of the Labor Code, (w the peAwma�e o( the wnrk fw which this pertnit is issued. My workers' compensation Insurance carrier and policy number are: Carriec (Tlvs setlm neeE nd Ee ampetN a f/ie pnM a rdliuctl at one nwqreO tldars (5f00) nleu) Policy Number: I iertify that in the peAormance of the work lor which this permit is uecf, I shall not employ any person in any manner so as to bewme subjecl to the workers' compensation laws of Califomia, and agree Ihat if I should hewme subject to Ihe workers' compensation provisions of Section 3700 of the�ode^I sh I forthwith comply vnth these provisions. � ' D i q�nnfsSO^a�ure= aR—" WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED 7HOUSAND DOLLARS (5100.000). IN ADDRION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND A7TORNEY'S FEES. LICENSED CONTRACTORS DECIARATION: I hereby aKrtn that I am licensed under provisions of Chapter 9(wmmencing with Section 7000) of Division 3 of the Business anC Professions Code, antl my license is in full force and eRect. Lic. # Class # ConVatlor's SignaWre Date CONSTRUCTION LENDING AGENCY: ❑ I hereby affirtn that there is a construction lending agency for the peAortnance of the work fa wTiich this pertnit is issued. (Sea 3097, Civil CoCe). Lender's Name: Lender's Address: Da�e OW NER-BUILDER DECLARA710NS: I hereby aKrtn that under penalty af perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the f011owing rea5on (Set. 7031.5, Business and Professions Cotle: Any city or wunty which requires a permit to construc[, alter, improve. demolish, or repair any structure. prior [o its issuance, also requires the applicant for suth permil to file a signed sW�ement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapcer 9(commencing wim Section 7000) of Division 3 of the Business and Professions Code) or that he or she is ezempt lherefrom and Ihe basis for the alleged exemption. Any violalion o! Section 7031.5 by any applicant for a permit subjects the appliwnt to a civil penalty o! not more than fve hundred dollars ($500�.�: 'l♦ as owner ol the property, or my employees vrith wages as their sole pensation, WILL DO THE WORK, ana the structure is nol intendetl or o ered for sale (Sec. 7044, Business and Professions Code: The Contrectors License Law does not apply to an ovmer of property who builds or improves thereon, and who does such work himself or herself or through his or her ovm employees, provided thaf such improvements are nol intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the ovmer-builder vrill have the burden ot proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner ot the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS ro crostruct the project (Sec. 7044, Business and Brofessbns Code: The contractors License Law dces not apply to an ovmer of pmperty who Duilds or improves thereon, and who contracts for such project with a contract«(s) license pursuant ro tlie Contractps License Laws.). �` I am exempt untler sec. B siness antl Professions Code for this reason: Signature �D-/ }_ 305F-66.�310Z Owner ID verifietl by drie ise. � Yes ❑ No Driyer's License No. �' � � �Pi� �ys;t �-�j� -� � �en iwtion of Ovmership by (type of document, i.e. - properly tax bill or deetlg DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: ❑ I hereby cenify that no excavation Me (5) a mwe feet in depth into wfiich a person is requiretl lo tlescend, will be made in wnnecl'an with work authorized by this permit, and that no builtling sWcture, scaf(dding, (alsework, or tlemolition or tlismantling Ihereol, will be more than thirty-s�c (36) feet high. (Chap. 3.2, Grp 2. M 2, Sec. 341, Ttle 8, Califomia Atlminist2tive Code�. ❑ As owner-builtler, I will not employ anyone to tlo work which woultl require a permit (rom Ihe Division of Industnal Satety, as notetl above, unless such person has a permit to tlo such work from Ihe division. AVW��'s SignaWre Dam Division ol Intluslrial Salety Pertnit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or presenl or future building occupant need to file antl certify a Business Plan for emergency response to release or threatened release o( a hazardous material7 ❑ Yes ❑ No (Section 25505 of the Califomia Health and Safety Code requires, vrith some exceptions, that a Business Plan be fled vdth the CosW Mesa Fire Department by every business which has at any one time during a reported year a quantity ol hazardous malerials equal to or greater than a weight of 500 pounds. or a volume ot 55 gallons. or 200 wbic leet of compressed gas al standard temperaWre antl pressure). 2. Does or will the applicant or present or future building occupant neetl to file a registration fortn for aculely hazardous materials? ❑ Yes ❑ No (Section 25533 of the Califomia Health antl Safety Code, wiN some exceptions, requires registration with the Casta Mesa Fire DepartmeN by each 6usiness which at any one time has on hand a quanticy of awtety hazartlous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic teet of compressed gas at stantlartl femperaWre and pressure). 3. Does or will the applicant or present or fuWre builtling occupant need to prepare an RMPP (Risk Management antl Prevention Program for acutely hazardous matenals)? ❑ Ves ❑ No (Section 25534 of the Califomia Health antl Safery Code provitles that Ihe Costa Mesa Fire Deparlment may require the preparation, certification an0 filing with Ihe Fire Department of an RMPP by 6usinesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently requiretl, has Section 25534 0( Ne Califomia Health anC Safety Code been fully complied with'! ❑ Yes ❑ No 5. Does or will Ihe appliwnt or present or IuNre building occupant require lor the work which is ihe subjec[ o( lhis applicalion a permit for such wnswction or motlification from tha South Coast Air Qualiry Managemenl Dislrict o� fmm any other air pollution control tlistnct or agency? ❑ ves ❑ No (Seclqn 658502 of Ihe Calilomia Govemment Cotle requires that the reduested information be fumishetl on applications fa rao-resitlential buildifg pertnits�. 6. Will any part of the facility to be conslructed under Ihis permit be Wlthin 7000 feet from the outer boundanes ot a school? ❑ Yes ❑ No (If'yes", the facilily must meet Ihe requirement of Sections 25534 and 42303 of the Cali(omia Health and Safety Code). 7. If a permit from the South Coast Air Dualily Management Dislrict or other air pollulion control district or agency is required for the v✓ork which i5 lhe subject of this application, have all of the disclosures prescribetl by Califomia Health and Safey Code Section 42303 been made7 ❑ Ves ❑ No, . 8.. (It'yes", attach certi6cate of compliance from t�e appmpnata air polWtion control officer�. � - CERTIFICATE OF COMPLIANCE: I cenifydhat untler penalry of perjury the inlormation givan abova is correcL I a9ree lo comply with all state laws and cirybrdinances re9arding Hazardous Materials and Emissions. � , � SignaWre Date . CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalry of perjury that I have read this application antl state that the information given is correct I agree ro comply with all state laws and ciry ordinances relaling to 6uilding construction, and authonze representatives o( the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupan y of any building authoriz b this p 't unti final inspection. � :Si re ol Legal Ovmer(s) 1 �' e AntllorAWhonzeEAppliranl Date CITY OF COSTA MESA BIJILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.wsta-mesa.w.0 . � FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER B07-00802 PERMlT TYPE B ROOF STATUS: ISSUED - DATE ISSUED: 06/25/2007 . - ''' ISSUED BY: KJB _ � �;.'; 5 ' ; , :i` JOB ADDRESS: 2129 NATIONAL AV CM '� �.. .,Suite/Unit �. Vicinity: „ - - . Const Type ??- SQ. FT: 17200 _ Valuation: $1,700.00 �� SCOPE OF WORK: TEAR OFF:EXISTING ROOF. REPAIR/REPLACE SHEATHING AS NECESSARY.,COVER WITH 30 YEAR COMP. INCLUDES ATTACHED GARAGErROOF PITCH�.IS 4:72 , � , �' � ?�:?.`� ,. . . . , r ` � , . � i.T::�...f- � OWNER: GARCIA, JOSE �. ' _ `�; �Address: I 2129 NATIONAL' UNt: ,. PHONE: 949-283-4522� City/StatelZip� :_ -- �. � _. � COSTA MESA; CA � � APPLICANT: GARCIA, JOSE �''-'�T •.� � . Address: 2129 NATIONAL Unit: , PHONE: 949-283-4522 '�� , �`- Ciry/State/zZip: COSTA MESA, CA CONTRACTOR: OWNER-BUILDER �` �- � ' - -- -' - � - License No. 000000 . Address: � Unit:, ..; - '; y pHONE: ' � ' � City/State: , � ;'`�.. '�ZipCode '..,, . - �_. .:. ', .. � CELL: - �� , i., : ._ m . 1i ARCHITECT: � � � License No. " � � a' PHONE:�I � ENGINEER: ' _ � _ � License No. - -- ; PHONE: . .r � .. . - c • . , , � FEE SUMMARY ' ' , , ,' . Reroof Plan Check: �.:.."$0 00' �� r . Reroof Permit Fee: � �'$60 10 �:' . r� ' — - - = - . � Reinspection Fee: $0:00: ;, '' . ; ,'i,;:= " "_ — . - . .' � . , -. TOTAL FEES $60.10 � _ . � - � NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Cali(omia sWtutes and related regulations. (Ord. No. 92-28, § 1, 12-21-g2) EXPIRATION: PERMIT EXPIRpS 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this pertnit to be considered legal, such work must comply vrith all applicable codes, and all required inspeetions and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit. cooe�, iNsrEcnoxrme 1616 Fizetl System Final Fire Prevention 1288 Pool Spa Final - 200 Final Re-Roof 201 Final BIocWReWining Wall 202 Final Facrory Fire Place 203 Final Sign 204 Final Demolition O�TF INifML � LOpEt INSPEC710NTVPE 206 Final Mechanical 208 Final Plumbing 270 Final Electncal 212 Final Fire Prevenlion 220 Final Planning Approval 222 Final Site 250 Final Builaing/Occupancy L1jE IN7I71AL5 WORKERS' COMPENSATION DECLARATION: I hereby aKrm under penally of perjury one of the toliowing declaralions: ❑ I have antl will maintain a certificate oi wnsent to self-Insure�(or workers' compensation, as providetl for by section 3700 ot the Labor Cotle, for the peAormance of the work for which this permit is issued. ❑ I have and will maintain xorkers' compensation insurance, as required by, sectbn 3700 of the Labor Code, for the peAortnance of Ihe work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier. (This setYin neetl not be mnpletMd(he permd a valveC af one huMred tlyWrs (SiPO) wlea.) Poli Number: I certify Ihat in the peAortnance of Ihe v.ork for which t�is permit is iss ed, I shall not employ any person in any manner so as lo become subject to Ihe workers' compensalion laws of Califomia, and agree Ihat i( I should become subject to the workers' compensation provisions of Seclion 3700 of ihe L,a or Code, I hall forthwith comply with Ihese provisions. / A�'sSi9naWre• � —De�e. � WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNL4WFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrtn that I am licensetl untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Pro(essions Code, and my license is in full force and eRect. Lic. # Class # Comroctor's S�gnawre Daie CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrtn that there is a constructbn lending agency fa Ihe pedormance of ihe �rork fa wfiich Ihis pertnit is issuetl. (Sec. 3097, Civil Code). Lender's Name: Lender's Adtlress: SignaWre Dale OWNER•BUILDER DECLARATIONS: I hereby affvm thal under penalty of perjury that I am EXEMPT FROM THE CON7RAC70RS LICENSE LAW (or the follovnng reason (Sec. 7031.5, Business antl Pmfessions Cotle: Any city or counry which requires a permit to construc�, alter, improve. demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed slatement Ihat he or She is licensed pursuant [o the pmvi5ions o( Ihe Contractors License Law (Chapter 9(commencinq with Section 7000) of Division 3 0( the Business and Professions Code) or Ihat he or she is exempt therefrom and Ihe Dasis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects Ihe applicant to a civil penalry o( not more than fve h dretl dollars ($500).): I, as ovmer of the properly, or my employees with wages as their sole co pensation, WILL DO THE WORK, and the strucWre is nol intentletl or oflered for sale (Sec. 7044, Business and Protessions 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 ovm employees, provided that such improvements are not intendetl or ofteretl for sale. If, however, the builtling or improvement is sold within one year of completion, the ovmer-builtler will have lhe burden o( pmving Ihat he or she did nol build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS lo consiruct the project (Sec. 7044, Business and Professions Cotle: The contractors License Law dces not apply to an owner of property who builds or improves thereon, and who cont2cts for such project with a contraclor(s) license pursuant to �he Contrac[ors License Laws.). ❑ I am exempt untler sec. Business and Professions Code for Ihis reason: Owner ID venfied by dma �isa. ❑ Yes ❑ No Driver's License No. Expires: � ' Verifcation of Ownership hy (lype o( tlocument, i.e. - proDerty tai bill or tleed): DIVISION OF INDUSTRIAL SAFE7Y PERMI7 CERTIFICATION: - ❑ I hereby certify ihat no excavation fve (5) or more feet in deplh into which a person is 2quired to descen4 will be made in connection vnth work au[horized by �his permit, and tha� no building structure, scaffdding, (alsework, or tlemolition or tlismantling thereof, will be more than thirty-sa (36) feel high. (Chap. 32, Grp 2. M 2. Sec. 347, Title 8, Califomia Administrative CoAe). ❑ As ovmer-builder, I will not employ anyone to do vrork which vrould require a permit (rom lhe Division of Industrial Satety, as noted above, unless such person has a permit to do such vrork from the tlivision. Applicanfs SignaWre Dale Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or fuWre building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Seclion 25505 of the Califomia Health and Sa(ety Code requires, vrith some exceptions, that a Business Plan be fled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantiry of hazardous materials equal to or greater lhan a weigh[ of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas at standard temperature antl pressure�. 2. Does or will the applicaM or present or future builtling occupant need to file a registration fortn for acutely hazartlous materials? ❑ Yes ❑ No (Section 25533 ot the Calitomia Health and Satery Cotle, with some exceplions, requires regislration with the Costa Mesa Fire Department by each business vfiich at any one time has on hantl a quantity of acutely hazartlous materials equal to or greater than a weiqht of 500 pountls, or a volume ot 55 gallons, or 200 cubic feet of compressetl gas at stantlartl IemperaWre antl pressure). 3. Does or will the applicant or presem or fuNre building occupant need to prepare an RMPP (Risk Manaqement and Prevention Progrem for acutely hazardous materials)? ❑ Ves ❑ No (Section 25534 of ihe Califomia Health and Safety Cotle provides lhat the Costa Mesa Fire Department may require the preparation, certification and fling with Ihe Fire DepaAment of an RMPP by businesses which are required to register awtely hazardous matenals with the Fire Department. 4. If an RMPP is presenlly required, has Section 25534 0( lhe Califomia Heallh and Safery Code been (ully complied with7 ❑ Yes ❑ No 5. Does or will the applicant or present or fulure builtling occupant require for the work which is the subjecl of this appliwtion a permit for such construction or motlification from ihe South Coast Air Qualiry Management DisMct or from any other air pollution control districl or agency? ❑ Yes ❑ No (Seclbn 65850.2 of the Califomia Govemment Code requires Ihat Ihe requested infortnatbn be fumished on appliwtions for non-residential building pertnits). 6. Will any part of the facility lo be consiructed under this pertnit be within 1000 feet from the outer boundaries o! a school? ❑ Yes ❑ No Qf'yes", the faciliry must meet the requirement of Sections 25534 and 42303 of Ihe Califomia Health and Salety Code). 7. If a permit trom Ihe Soulh Coast Air Quality Management Distnct or other air pollution contml district or agency is requiretl tor the work which is the subjecl of this application, have all of the disclosures prescnbed by Califomia Health antl Safety Cotle Seclion 42303 been made? ❑ Yes ❑ No. 8. Qf "yes", attach certificate of compliance from the appropriate air pollution control oKcer). CERTIFICATE OF COMPLIANCE: I certiy that under penalty of perjury the in(ormation given above is correct I agree to comply with all state laws and city ordinances regarding Hazartlous Materials and Emissions. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and sWte that the intortnation given is correcL I agree ro comply with all sWte laws and ciry ortlinances relating to building conslruction, and authonze representatives o( the City of Cos[a Mesa to enter upon the abovedescribed pmperty for inspection purposes. I agree not to occupy or allow occupancy ot any building authorizetl by this permit until final inspection. �SiynaWre ! gal0 er(s) �. D e ) /�l ' '9naWre. / D � � �� y� v 305]-a613/01) L/Y A � AN�onaeE App itdnl ORANGE COUNTY BUILDING DEPARTMENT . 636 P' �•h Broadway � SANTA . CALIFORNIA � FOR APPLICANT TO FILL IN BUILOING ADDRE55 ('1.'77Q NRi'lnTlAl SCHOOI OIST. ORTOWN rDBt� MeRa NEAREST CRO55 ST. �I'1Ct02+'la ADe � OWNER PUE8l0 HOME�� INC• MAIL ADDRE559�� WILSHIRE BIVD. cirv BEVERLY HIILS No.cR. 5 3� ARCHITECT OR LIC. ENGINEERCAIN S� MCKERRACHER No. AD�RESSZ��O E• WALNUTB ST.� PASADENA LIC. o� coNraqc7ok NEWPORT VISTA CO.No. �3]WZ AODRE559363 w��s��RE BLVD.� �EV.fIILlS DESCRIPTION I NOT -T I BLOGK I TRACT � J� � (ATTACH METES & BOUNDSI / NO. OF BL�GS. SIZE OF LOT OZ.ZO X � �� NOW ON lOT O USE OF I NO. OF I NO. OF EXISTING BLOG. Fqv.iues ROOMS SETBACK LINE FROM: REAR YAR �' CENTER OF STREET Snf+_ s�oe YAR� �Fj . DESCRIPTION OF WORK � EXTERIOR WALL ROOF COVERING STLI[[O COVEftING USE OF NEW BUILOING RFSIf]EN[K�_Ai]t r I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AN� AGREE TO COMPLY WITH ALL GOUNTY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUGTION. SIGNATUREOF NEHPORT VI O. PERMITTE AUTHONIZEO AG > • 5��' �iH O�OO PERMIT FEE $(Z VAI.UATION $ 3 p��H CHecK 5'Z F�EEAL SJ 9.90_39 APPLICATION FOR PERMIT � i�'��'�� FOR OFFICE USE ONLY RECEIPT NO. PERMIT h0. f33 �- �'G �6 BY DATE REC'D. OATE I65liED �l —� —� 3 C1 —,3 � 53 SCHOOL DIST. OR TOWN NEAREST CRO55 ST. I PLANS I CORRECTIONS APPROVALS : LOCATION INSP C' MATERIALS, �J� � - _ � . ,� . W .. _ . . _� . . . ___ .. .., .. . Z . W . J Z , j 1 � d . ' . � ^ . ., . _. � � '� . _ . ... . _ .. .. "_ a - o ' _ i a . . a . . . _ . ..� _- .i: ��. � �` � r � - �� , _ _. � .._ .. 1 / . ..' � � ' .JI:�� :_�.... .." "_' . . - � . . �� - .^.I: .'i�. _ � . �. ,' ..., � � .. rli. .. .� '_ _ . ' . ' - . 1 t � -. 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