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Home My WebLink About3315 NEVADA AVE - Building PermitsL � 4 � 0 >. _ = J .'�„�,,a�' ��ia��sa-s2�s • Fax(�ia)�so-aess CITY OF COSTA MESA BUILDING DIYIS/ON DEVELOPMENT SERVICES DEPARTMENT PERMIT JobAddress: 3315 NEVADAAV Suite: Vicinity: Parcel Nunmber: 13957226 Applicant: JONES, BILLY Address: Owner: LASSEN„DAVID R Address .LASS�N; ROBIN J COSTq MESA,CA 3315 NEVADA AVE Contractor. B & J ROOFING Address: 2040 n, sacramento ORANGE,CA Zip: 92867 Arch : Address: Zip: Phone: License: BUILDING PERMIT Zoning: Phone: Zip: Phone: Zip: 92626 � Phone: 714-637-5609 License: 366956 • Eng: � Address: . r � PERMIT NUMBER , / 698-02224 � 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Q ( �� I V/* Applied: 12/75/1998 Issued: 12/15/1998 Phone: License: SCOPE OF PERMIT T/O EXISTtNG & REROOF THE HOUSE AND GARAGE WITH COMP. SHINGLE, FLAT ROOF NEW B.U.R. SYSTEM. ROOF CERT ATTACHED TOPERMIT. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $0.00 $99.75 $0.50 $0.00 $0.00 $0.00 $100.25 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING existlna: o NOTES: Rear 0- 0 Rear 0- 0 Reouired: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Pr000sed: 0 Calc Valuation: Claim Valuation Right 0- 0 Right 0- 0 $5,000.00 $5,000.00 EXPIRATION: This permit shall automatically ezpire 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 Inapectiona and tinal approval must be obtained. Failure to ob�ain inspections and final approval will resul� in ihe expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARATION: I hereby ettirm under penalry of perjury one of the following declaralions: . ❑ I have antl will meintain e certificete of consent to selt-Insure tor workers' compensation, as provided tor by section 3700 ot ihe Lebor Cotle, for the petlormanc�if the work tor which this permit is issuetl. ❑ I have end will maintain workers' wmpensetion insurence, as required by section 3700 of the Labor Code, for ihe peAormance of the work for which this permit is issuetl. My workers' compensation Insurence wrrier and policy number ere: Carrier. ' Policy Number: (Ihis secfion need nof be completed i! fhe permit is ve/ued af one hundred dollers ($100J or /ess.) ❑ I certity that in ihe ortnance oi the work for which tl' permit is issueQ I shall not employ any person in any manner so as to become subject to Ihe workers' compens ' aws of Ca i and e ree thet/' ho d ecome subject Io the workers' compensation provisions of Saction 3700 of the Lebor Code, I shall forthwith comply wii ese pro ' ' � �/ /��% �/ ,c— Applicant Signazure:� � ��X�7,/ .� �,.� v� � l J � 9 iJ� WARNING: FAILURE TO SECURE WORKERS' ENSNTI N CO RAGE IS UNLAWFUL AND SHALL SU&IEGT AN EMPLOYER TO CPIMINAL PENALTIES ANO CIVIL FINES UP TOONE HUNDRED THOUSANDDOLLARE($100,000),INADDITIIXJ THECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORINSECTION3]O60FTHELABORCODE,INTEREST,ANDATTORNEV'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby ettirtn thet I a ' d under provisions of Chapter 9 force end eflact. `a� % /1 � ConiractorsSigna�re.. ' with Section 7000) ot Divislon 3 ot the Business and Professions Cotle, antl my license is in full Class k �� ate: — � � CONSTRUCTION LENDING AGENCY: ❑ I here6y aHirtn that there is a consimction lending agency for Ihe pedormance of ihe work for which ihis permit is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lender's Address: Signatwe: OWNER-BUILDER DECLAHATIONS: Date: I hereby eMirtn that under penalry of perjury that I am EXEMPT FROM TTIE CONTRACTORS LICENSE LAW tor the tollowing reason (Sec. 7031.5, Business and Protessions Code: Any ciry or counry which requires a permit to consiruct, alter, improve, tlemolish, or repair any structure, pnor to its issuance, also requires the applicant for such permit to file a signetl stetament ihat he or she ISllcensetl pursuant to ihe provisions of tha Contractors License Lew (Chapter 9(commencing with Sedion 7000) ot Division 3 of the Business end Professions Code) or that he or sha is exempt theretrom and the basis for the alleged exemption. Any violation ot Section 7031.5 by any appliwnt tor a pertnit subjecis Ihe apDlicaM to a civ�l penalry af not mora than Trve hundred dollars ($500).): ❑ I, es ownar of the property, or my employees with wages as iheir sole compensation, WILL DO TF1E WORK, and the s[ructure is not intentletl or ottered for sale (Sec. 7044, eusiness antl Protessions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, antl w�o tloes such work hlmself or herseli or through his or her own employees, provided Ihat such improvements are not intendetl or oMered br sale. N, however, t�e bulldinq or improvement is soltl within one year ot completion, the owner-builder will have ihe 6urtlen of proving ihat he or she ditl not bulld or improve tor purpose of sale.). ❑ I, as owner of the property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct tha project (Sec. 7044, Business and Professions Code: The contrecrors License Lew does not apply to an owner of property who builtls or improves thareoq and who contracts for such project with a contrector(s) Ilcense pursuant to the Conirectors License Laws.). ❑ I am exempt under sec. Business and Professions Code tor ihis reason: Signature: Date: Owner ID venfied by dnvers license. ❑ Yes ❑ No Drivers License No. Evpires: Veniicetion oi Ownership by (type of document, i.e. - property tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICATION: ❑ I hereby certify that no excevation five (5) or more teet in depth Into which a person is requiretl to descentl, wlll be made in connectlon with work euthorized by this permit, and that no builtling siructure, scaXolding, falsework, or Oemolition or dismantling thereof, will be more then thirty-six (36) teet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title e, Celifomia Administretive Code). ❑ As owner-builder, I will not employ anyone to do work which would require a pertnit trom ihe Division of InGusirial SafeTy, as notetl above, unless such person has e permit to tlo such wark from the division. SigneWre: Date: Division of Industnal Safery Pertnit Number: CERTIFICATE OF COMPLIANCE AND AUh10HIZATON OF ENTRY: I certify under penalry of perlury tha� I have read this application entl s�ate ihat the information given is correct I egree to comply with all state laws and city ordinances rela�ing �o building constructioq and euthorize representatives of �he City ot Costa Mesa to enter upon Ihe ebove-described property for inspection puryoses. I agree not to occupy or allow occupancy ot any building euthonzed by ihis permit until tinel inspection. COOE I INSPELTIONTYPE 7fi16 Fixetl System Finel Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition 2d46-46 �uu: - !I� / � ' CODEt ixsvecnoxrrve 206 Finel Mechanical 208 Finel Plumbing 210 Final Electrical 272 Final Fire Prevention 220 Final Plenning Approval 222 Final Si�e 250 Finel Building/Occupancy PAiE CITY OF COSTA MESA REQUEST FOR OCCUPANCY TRACT N0. G, � / � LOT N0. � ADDRESS � � J �� (/(i(fp (��/'/ . DATE �v — �— �� 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) was or were) advised that this tract has not been given final. inspection nor has it been accepted by the City of Costa Mesa as having comp�ied 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. BY Lender I � JO# ],( $ Q Applicant m fill in all spaces exeept tnose within neavY �orAer lines ana sign a11 aoorovriate tleclarations. PERMIT NO. TRACT NO. LO7 NO. UNIT NO. :ITY OF COSTA MESA CONSTRUCTION PERMIT ProjectAddress 3315 Nevada � � Appiicant'sMailingAddress 2R9n ViA Mr3YtPnA Owner'sNameS�2V2_ aI]C1.�Cd11�V P13ttphone�66-2345 Address 3315 Nevada_ Co�1'a Mesa 926�26 Arch/Eng. � . License No. Address Contracmr'sNam Air Mananomnn� Phone ti��. �_,a—'�r+9Q Addresslmailing) 2$A� Ul8 ��"��Yl� CiryLicense�296 0' LICENSED CONTRACTO(i DECIARATION I hereby affirm that I am li[ensetl untle� provi5ion5 o( Gnarte� 9(commencing with section 7000) of Dib:3io[✓3 of the Business antl Professions Cotle, antl my license is in i I t e antl efiect. License Class �—�b License o 439296 oate �—% �aRd Signature WORKERS' COMPENSATION DECLARATION � ` I M1ereby affirm that I have a certificate of consent to self-Insure oi a certificate of Workers' Compensztion.lnsurance, or a certitietl copy thereof (Section 3800, Lar,,b'. r�r�) � Policy fYO�`� C2-216996-$ompany INA ❑ Certifietl copy i5 hereby fumishetl. ' �{1 CerSf'tlef� So0y, i filetl with the city BujlCing Division. �ate /—`4—if� AOPlicant A� Y MF171r'](JPi11PT11" EXEMPTION FROM WORKERS' COMPENSATION pECLARATION (Thissection neetl-not be completetl if tlie permit is for one huntl�etl ($100) or less):' I certi}y that in the Oerto�mance of the wotk to� wbich thi5 perm�t is issuetl, I Shall not ¢mploy any p¢�son in any manne� so as to becOme subjec[ to tne Workers' Compensation Laws of Calitornia. , Date Signa[ure NOTICE: If, atter makin9 this tleclaration, you shoultl become subject to the Workers' Compensation provisions oi the Labor Cotle, you must forthwith comply with such O�ovisions or this petmit snall be tleemetl �evoketl. CONSTRUCTION LENDING'AGENCV � I hereby atfirm that there is a�construction lentling agency for the performance of tM1e work for which this permit is issuetl (Sectlon 3097 Civ. CJ Lentler's Name Lentler'S AGtlress � OWNER BUILDE0. DECLARP.TION ' 1 hereby affirm.that I am exempt f�om the ConVactor'S Licenre Law for th¢ following reason (Section ]031.5 Business antl Pwfessional Cotle: Any ciry or county which requires a permit to construct, alter, improve, tlemolish or repalr any structure, prior to its issuance,'also requires the applicant for such permit t0 file a signetl statement that he/stte is licensetl.pu�suant to the provisions of the Contrac[or's LlcenSe Law (Cnapter 9(commencin9 with Section ]000) of Division 3 of the Busine55 antl Professionz Cotle) or tha[ he/she is exempt there(rom antl the ba5is tor tM1e allegetl exemption. Any violation of Section 7031.5 by any applicant fo� a pe�mit Subjects the applicant to a civil �enalty ot not more than five huntlretl tlollars ($500). I, as owner ot tM1e property o� my em0loyees witM1 wages as their sole campensation, will tlo the work, antl the sVucture is not intentletl or offered for sale (Section ]044, Business antl Protessional Cotle: The Contractor's l_icense Law tloes not apply to en owne� of a property who bwltls or improves thereon, antl wno Ooes such work himselt/herself or through his or her own emOloyees, provitletl tha[ such improvements are not intentletl or oHeretl for sale. If, M1owever, the builtlin9 or Improvement i5 Soltl within one yea� ot com- pletion, the owne� wlll have the bu�tlen of proving he/she tlitl not builtl or im- �rove for the purpose of sale). I, as owne� of fhe pro0erty, am ezclusively cont�acling with IicenSetl ton- tractarsto construct the orqect ISection 7044, Business antl Professions Cotle: The Contractor's License Law does not apply to an owner of property who builtls or improves thereon, antl who cont�acts fo� Such projects with a con- tractor(51 license pursuant�to tne�Contractor'S License LawJ. I am aware that proof o( tneir Worker'S Compensation insu�ance shoultl be provitletl to me. ❑ I am exempt untler Section B. & P. C. tar this reason � � 22 , TYPEOFCONSTRUCTION' NEW P.OD ALTERATION REPAIR � ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, # DESCRIPTIONOFWORK/USEOFBLDG. ReS1Cl2ri'tldl - S Main Buildi E TYPE OF PERMIT ❑ GRAOING FOVNDATION STRUCTURAL T Ffant ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING � MECHANICAL � A Reaf ❑ OTHER PROJECT DESCRIPTION SQ. F7. - oGCUPANCv � C Right K Left CONSTRUCTIONTVPE .VAWATION$ � � $ ' � ZONE GRADINGCU.YDS. ,ACRES PIng.Ref.# Remarks: Planning Notes: i _. Date Owner � � I hereby certi(y that I have reatl this application antl state that the above inPormation is correct. I agree to com0ly with all city antl county ortlinances antl state laws relatinq to builtlinq construction, antl hereby authorize repre- sentatives of this city to enter upon the above-mentione0 property for, Inspection 0 Poses. Signature � I1 L /, Drivers' License or 55 � CMF 0865-46, rev. 4/84 Sink Preventer Irrigation Clarifiers Dishwasher Drinking Fountains Floor Drains ' ' Floor Sinks - . — . � Gas Service 'Outlets Interceptors� Kitchen Sink Lavatories . P—Trap ' Roof Dreins . Reins{iection Fee : � $15 Boiler Duct- UnderGround Duct - Strucmrel Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. BIL ICBO # Heating System & Ducting �70-100,000 BTU 0100,000 „ � I I Heinspection Fee I $15 White - Builtlin9; Canary - Applicanh Pink - Accounting; Goltlenrotl - Assessor Service Sink Sewer Cap ' Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater WaterService � , Issue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System iF90-100,OOOBTU ❑100,000 System Repair/Alteration Issue Fee 0 FEES � $ 3 �11 $ 3 4975� 7/27/84 Accessory Building: Parking Req./Provided II<dl) TC Zone ELECTRICAL . FEE' Aummatic Washer - Transformer � 15�50 KW �- Construction Pole Sub. � 50 + KW Cooking Unit Meter Dup to 100 amps Dishwasher Meter ❑over100amps Dryers OGas ❑Electric Sub Panel Fan � � Motors �0-1 HP 01 %- 8 F.A,U. � Inc.Solar �9-15 HP �16-75+ Pixtures . Microwave ' - - Device Boxes Pole Light � Outiets Range ' Switches Si9n Garbage Disposal Standing Sections Generetor �0-5 KW 05-15 KW Trash Compacmr ' < I Reinspection Fee I$15 I I Issue Fee ' I $ 3 I DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By ' Date Building APvroved By �y�� Date Appliwtion luued By ' ��- v Date Z� . SUMMARV OF FEES ' ' BUILDING PERMIT $ SMIP $ -� PLAN CHECK $ PERMIT . PLUMBING $ ISSUANCE $ �� -. PLAN CHECK 25% $ ENERGV P.C.. $ - ELECTRICAL $ GRADING $ � PLANCHECK 50% $ MICRORLM $ 'i�� MECHANICAL 1� �IE�Q � TOTALFEE $ �.�..00 � PLAN CHECK 25% $ � Z O N 1 N G R E Q M T S. CONSTRUCTION AND PLANNING . POOL & SPA . �� APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector 9. Temporr+ry Electric8l Service or Pole 52. Pool & Equipment Location -2. Soil Pipe�Undrgrnd. . 53. Steel Reinforcement � � 3. Electrical Conduit Utility-Undrgrnd. . 54. Forms � � � 4. Electricaf Conduit�Undrgrnd. 55. Electrical Bonding � � 5. Steel',Reinforcement � � 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. . � 57. APPROVAL TO COVER�GUNITE , 7. Footings . � � 58. Electrical Conduit-Undrgrnd. 8. Foundation � 59. Gas Pipe, O Undrgrnd., Test ' 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. � 10. Structural Floor System � - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final � 72. SewerCap ' 63. Heater & VenriFinal 13. Roof Drains � 64. Plumbing System - Final 14. Rough Plumbing - 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar SYstem-Final ' 16: Rough Electric Wiring � 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. �Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL � 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � APPROVALS Permit # � � 21..Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas� ❑ Oil 23� Gas Pipe-Rough & Test . 72. Underground Flush � 24. Roof Framing , . 73. Undergrnd.StorageTank OGas ❑Oil . 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � .. 27. Frame and Flashing '' 76. Dry Standpipe � 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final ' 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: !� �S G�rC� (�•rs.� 34. Final Heating&AirConditioning �-/0'S'% C4l�.Grr�(- QS .(��2 303 p UM� . L,�i� 35. Final Gas Pipe-Test � , 36. Hood or Canopy 37. Final Factory Fireplace ' , 3S. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final � 42. Backflow Preventer , ' 43. Backflow.lrrigation . . . 44. �Landscape Irrigation System 45. Sound Attenuation ' 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING � 48. Special Requirements Completed . � 49. Electrie Release to Edison - � 50. Gas Release to Southem California Gas Co • . - 51. CERTIFICATE OF OCCUPANCY � ' _ . No. - Date� ' OWNER _76 LOT A TRACT ROUGN PLIIMBING PROP. SWR, LINE Q NOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH MEATING ANO AIR CONDITI TEMPORARY SERVICE Oft POLE UNOERGROUNO � POWER � ROUGH WIRING TRENCHES � FORMS � STE FLOOR SYSTEM BOND BEAM � STEEL REINFO SHEATHING FRAME ANO FLASMING LATHING � IN � OUT � PLASTEft.EtROWN COFT HEATING, VENT., REFRIG. AND F.C., FINAL PLUMBING, FINAL ANO GAS TEST �J ELECTRIC, FINr1L RIIIIOINf. FINGL � //�( DATE 3UILDING PERMIT N0. SUBCONTRACTOR � 32344 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626 Z . av t- Z Z Q O �n am J � J � Q W fl] J . �] J Q U N Z a W � d W J Q m Z J � W W o= z� w� N � �O OCT 15-70cnsa00 721 0*�***S.OQ APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RECEIVED V DATE R CEIVED pATE ISSUED ADIDRESS 3315 Nevada Street �d"� �%D �O_/ .JD Ayako Imanaka 9�� 7 P M�"�� OWNER �A.P.NO. aq( MAi� 33 Nevada Street BUILDING 33�57`�u��. AD�RESS ADORESS CITY C'OSt.B Mesa, No�545-7828 raacr 6694 LOT 8 BLOCK CONSTRUCTION ��/�#IM�dlN��##ii�61 CASH W ADD AL P LENOER y� BRANCH Ayako Imanaka —��--� OWNER ADDRESS patio VALUE ' ARCHITECT Wa ne Howard 11'1C.TEL. SE $�� OR ENGINEEF ,% N . . Bi Oi . . FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR Wayne Howard InC. ev DATE G,/ �% ADDRESS 1116 N. Harbor Blvd. � ZON NO.OF USE OF NEW CITY Santa Ana, No�531-6718 - P�.a.Ns BUILDING patio STATE .208Z�o CITV 1'AROSAPPROVED VARDSAPPROVED LIC. NO. UQ NO. MAIN BUILDING ACCESSORV BUILDING SIZE SSXIO� NO.OF BLDGS. (FFOM C/LL STF�ET) OF LOT NOW ON lOT 1 FFONT 'O I FT FT. useoF residence " EXISTING BLDG. E FT FT. NEWBLDG. �i(.LJ 8t1�00M5 --STORIES-1 L.SIDE FT. FT. EMERIOR WAIL ROOF COVERING COVERING atio- hotmo REAR FT. FT. USE OF BUIIDING AND WOFK TO BE PERFOFMED DISTANCE BET. BET. MAIN & lnstall atio roof MAINBLDGS. ACCESS.BLDGS. VAR.# DATE C.U.P.# '�qPPROVED APPROVED LJ � I hereby acknowletlge ihat I have reatl this application and ztate tha[ the above intormation is cor�ect and agree to comply with all laws reBulaHng builtling consttuction, and I shall not employ any person in vialation of Me workman's compensation laws ot the Sta[e of Calitornie. m b I hereby certify ffiat I am prop¢rly licensetl as a cantractor onder SQ. FT. o the State of California Business and Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOF Chepter 9, and that such licenses are In full force entl etfect, or I THE PURPC6E OF ESTABLISHING A PERMR FEE ONLV: m am exempt trom the provisions of tha Staie of California Business � VALVATION ( � � and Professions Cotle, Division 3, Chapter 9, pERM1T FEE 5 V � � Signatureot Wayne H ard ifIC. L�� m Permittee $ / v P�AN CHECK 6 �— E ,5 O �'^ `o Authorizetl Agent � D� TOTAL FEE $�J �� LL � Z . w w d U {- Z Z � d m J7 J N Q W Q1 J m J Q U N Z a w � aw J Q m Z J � W w 0 z� w° N 2 �O 3l�63 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626 c aa;eQ�1275'� *��141.00 A?R 22-70cMsu � ForApplicant to Fill in Completely APPLICATION FOR BUILDING PERMIT REC D V D E R IV D DA E ISSUED BUILDING / � �� _a0 7(� ADOFESS 3315 Nevada Avanue p� OWNER A O�.LO Develo ent Cor . P"P'N�' ^� P�y1{Jf"'� /b MAIL BUILDING AODRESS 1104 E. 17th Street P.DDRESS Ne ada A e CITV Santa Ai13 No.`�547-9673 TRACT LOT BLOCK CANSTRUCTION W ADD A R P LENDER U. S. National Bank X BRANCH �1R Office OWNER A ollo Develo ent Cor . ADOFESS 190 S, Broadwa San Die o Residence VALUE OR ENGINE R KeLIRlt 1%OYlllS %� NE�.675-1164 USE S� FIRE � ADORESS 3111 2nd Ave. Corona Del Mar Z�NE TVPE / GFOUP APPROVED CONTRACTOR (� 0�.�.0 Develo ent QOT . BV DATE ADDFESS 1104 E. 17th Street TEL. Z E NO.OF USE OF NE cirr Santa Ana No.547-9673 P�+�'�— BUILDING p, STATE CITV �'ARDSAPPROVED VARDSAPPROVED ��c. n,o. 252549 LIC. NO. I.6JO MAIN BUILDING ACCESSORV BUILOING SIZE NO.OFBLDGS. (FROM C/ STREET) OF LOT SS X ZOO NOW ON LOT -- FRONT FT. FT. USE OF EXI5TING BLDG. "' SI OFT. FT. SIZE OF NO.OF �Jry1.t�� NEW eLDG. 17H�L SF ROOMS $ STORIES 1 1.51DE I SFT. I FT. EXTEFIOR WALL e2 ROOF COVERING COVERING REAR FT. FT. USE OF BVILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCEA.BLDGS. Construct new residence with attached v°R.# DATE C.U.P.# APPROVED gara e. P�ROVED 'J � /'Y �V ' I hereby acknowletlge thaf I have reatl this application and state that ffie ebove intormation is correct antl agree io comply wiffi all laws regulating building consvuction, antl I shall not employ any person in violation ot the workman's compensation laws ot Me Stace of California. � �(J i i I hereby ceriify that 1 am properly licensetl as a contractor under SQ. FT.` � the State ot Celifornia Business antl Professions Cotle, Divisicn 3, THE AMOUNT OWN UNDER VALUATION IS FOF Chapter 9, antl that such licenses are in full torce end effect, or I THE PUflPO$E OF ESTABLISHING A PERMIT FEE ONLV: am ezempt from the provisions ot the Stata ot California Business � VALUATION � antl Professions Cotlp�Division , Chapter 9. (.� � `/� PERMIT FEE $ / D O Sie�at�re of r �y i Permittee � $�/ �� y P�AN CHECK 5 r O� f9� O Authorized Agent n� � TOTAL FEE $ i (/ / i�