HomeMy WebLinkAbout2455 NORSE AVE - Building Permits� AVP�icant to fill in all ipaces exeept ihose wilhin heavy corO�.�l�ngsvptl ziy.� all appropriate Ceclaretions. '
� CITY OF COSTA MESA � • - - - . . . . - � - - .- . - _ - - - 960.5 ! I /�]/9;- : � I . �` _ .
r RMIT NO TRAC� NO: LOT NO. t� BC G. . . .. �, . _
CONSTRUCTION PERMIT.. , ' . -. - ���� = ' 3 U U % /� ' , ' . : �. _ ' . , , -!� ,
, . : � .' '' _ .- ,
Pro�eCt Addre55 "'��,/� TYPE'OF CONSTRUCTION ` NEW - ADO '/�LTEaATION REPAIR ' �- �
Applicant's Mailing Address � Z��S'i ��'1 L� ✓S E? •��/}vS_ : :O CONVERSION .❑ DEMOLISH i� OTHER �
� � %'J:+� r L �LC: �rKC{7Fy phone ��3" � � s�%' DESCRIPTION OF�WORK ' A P� # / �
_ �
Owner's,Name _ � � - � .- S Main Building:. ' �
Address; Z-�iSJ ��%O✓SC! C% C'M.. � �%2(a•:L%' � - ' - � E
' TYPE�OF PERMIT � GRADING• ❑ FOUNDATION- STRUCTURAL' . . T Front ' _
Aroh/Eng., _ License No. �O TENANT ,❑ ELECTRICAL� � PLUMBING ❑ MECHANICAL � - 8' Rear . '�
Address � :� • � . ❑ �OTHER . ' r ' " . . '- � . A . . .
Contractor's Nam � � `•Phone � � � PRQIEC7 DESCRIPTION 5Q. FT.� ��''U � � ��� ocCUPANCV - - ' � R�ight � -
� ; K = . _
Addresslmailing) ' ' ' �ONSTRVCTIONTYPE VAWATION$ ����i•��� � g L¢ft
' ' ZONE GRADING CU. VDS. ACRES Ping. Ref..# .�� � �
City Licnnse No. � � • � � ' i � '
LICENSE� CONTRACTOR DECLARATION � :. ' ' I ' ' � Remarks: • � " � ' � �' Parking Req./Provided ' � �
I hereby atfirm that 1 am IicenSed untler provi5ions of Chdrt¢r 9(rommencing � � ' .
with'section 7000) ot DlviSion.3 ot the Business antl Profe551ons Cotl¢, dntl . . ' � ' , Uie Of Building: '
my-llcense is in full force antl eftect. • ' .
L'i'cense Class' - Llcense No.1 - ' � - PLUMBING i;. � FEES- Planning'Notes: .
:,�7ate•� ' Si9nature . . � . , � . ' i r
��;'-�lORKERS' COMPENSATION DECLARATION � �. Bar Sink I � ' ShoWerS ' ' �
�-�i heieby aftirm that I nave a certiflcate of consent to selt-insure or a certificate : gackflow Preventer ' Service Sink' ' • �
� of Worker5' Compensdtion InSuranCe, Or•a certiti¢tl copy thereot (Section ' - - - - - --- -
3800, Lab. CJ' + i ' � '
t � ". Backflow Irrigation Sewer Cap � i E
Policy No. '� � ^ Company ' ' � ' ' � ' '
. 8Eerti(ietl copy is hereby tumishea. :' � � � ; ' ' , Bathtubs � Sewer Connection � �Automatic Washer ,
Certifietl copy is filetl with Ihe�city Builtling Division. ' � . ' '
Date Applicant ' � �� j Clarifiers ' ' . Solar Collectors . ' ' �ConStruc[ion Pole$u6. �
� EXEMPTION FROM.WORKERS'-COMPENSATION��DECLA0.ASION — 5'- DiShvYasher : � � '
(Thissection neetl not be completetl iPthe permit-is tor one huntlretl ($100) or i � �� � �Solar Piping ' , "' '- � - " - Cooking Unit ' '
less . ' ' • . . . . . �
I certity'that in the performance,at the woik fo��which this perm�t i5,i55uetl, I• � �rinking Fountains � Solar Tank � Dishwasher
sM1all noC employ any person';in`any manner so�as to become subject to the ' � . - '
Workers' CompensaHon, Laws of Calitornia-. ! � � Floor D�ainsi � Swimming Pool w/Spa �. DrYers ❑Gas ❑E
Date Si9nature ' . , ,
NOTICE: If,'after making this tleClaration; you shoultl becOme SubjeGt to Jhe FI00� Sinks � � Urinal� • . ' Fan� �� �
Workers' Compensation- provisions of the� Labor Cotle,-you' must forthwith ' , • "'
compty ,with such provisions � or � this.0ermit shall be t CeemeG -revoketl. � Gas Service OuNets _ � Water Closet, � . . t � F�A.U. �-
CONSTRUCTION LENDING�'AGENCV.� + � �
I hereby atfirm that there is a construction lentling agency for the performance Interceptors � . Water Heater � Fiztures '
of the 'work �/Or which thi5: permif,�is' i55uetl "(Section 309] Gv. ;CJ. ' - - _ , "' -�
Lentler's Name,- � : KitcFen Si'nk - ' � Water Service � � � '
� _ . , , i _ De`vice eoxes
Lentler'i AtlCress� � '� � , � �y�ato�ies" � ~
OWNER BUILDER OECLARATION ; � - - ' . � , ' ' � � i _,� Out1Et5' '
�ny sVucture, priOr to its,issuance, also requires the applicdnt for Such permit .
(ile a:signetl statement�that ne/she is licensetl�pu�suant to'the prOvisions of �
z Contractor•s�License l.aw (Chapter 9'(commencing with�5ection 7000) of
/UJ3.0 Oy_any•appbcan[ foYa pefmlCsubfec[5 [he'appllcant to d Uvll
�enalty of�not more than tive huntlretl tlollars ($500).
I,.as�owner ot the p�ope[ty or my employees with wages�as thei� sole ,
mmpensation, will tlo the work, antl the structure is not intentletl or o(teretl''
tor sale' (Section �7044, Business antl Professional Cotle: The Contrac[oYs .
License Law aoes not appty to an'owner ot a properry wno'builtls or improves
thereon, antl'who tloes sucM1 wark nlmself/herself or through hls or her own.
employees, provitletl that such'Improvements are not Intentletl or olferetl.for
sale. If, howeveq the builtling or improvement is soltl within one year of com- �
oletion, tne owner will have [he burden of proving he/she tlltl not builtl or im-
�rove fo�che,purpose otsale).
I, as owne� ot the property, am exclu5ively cbnt�acting with lic¢nsetl Con- �
tractorsto construct the�project (Section ]044, Business antl Protessions Cotle:
Tne Contractor's.License l.aw-tloes not apply.to an own¢r.of. property-who
builtls or improves thereon,;antl who contracts for such projects witn a con- ,
tractor(s)license pursuant to the Contractor,'S License Law): .
❑�Pam exempt untler Section , B. & P. C. for this reason
n 77 cr'. 7- _] n,., 1itYc .'!.!' t� �
I hereby certity that I have reatl thi5 application antl state that the'above t
Information is correct I agree to'comply with'all tlty antl'county ortlinances
and state laws relatin9.�o builtling construction, and hereby.authorize repre-
Sentatives oP this city, to -ente� upon the abOve-mentionetl property �fo�
Inspection puiposes. � ^ � e - �/� , / _ � �J � i
' riex• t�' .:.lJ ue.r,
'-TraP � . .. . _
ROOf Drains� , � -
t. � �' . 1
�Reinspection Fee. '$25
Boiler ? � i ��. � �
Duct�- Under G�ound � ' �
Duct - Structural
Duct - Ventilating
ExhaustSystem ❑ Multiple��
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑ 0.100,000 BTU � 100,000 BTl
S�gnature `✓ � C SDate C7. I I ReinspectionFea
Driver5' License Or 55 � �� � � ���
CMF 0865-46 rev. ]/83� � Whi[ Pink - Accounting; Goltlenrotl -Assessor
$25,
� 1 .
Issue Fee - � _
Hoodar Typel' ❑ •
Canopy � Type 11 ❑ '
Refrigeration System
00-100,000 BTU ❑100,000 Bl
System Repair/Alteration
luue Fee
�
�
�
$,3 (?
FEES '
�
'—
$ 3
lectric
Garbage Disposal � ' �
Generator �0.5 KW �5-15 K
Cl . '
: �cone . .,� i
� Accessory Building�� �
/' ,
/ ' -
/l J
• Pa�k.Fees $� � ' �
� .
4
; i
� S
O
N ,
I
N
'• G '
, R ;
.• a
� FEES
�� �
�Transformer ❑ 15�50�KW , �;
. ❑ 50 +.
Meter ❑�up to, 100�ar
,Meter ❑�over100am
'Sub Panel . '
• .IncSolar,L19-75HP
� Microwave i
� �Pole Light � �
Range ' �
Standing Sections
Tf35h COTPdCtOf
Fee ' I$25 I� luue Fee � � . I:$' 3'
ES REQUIREME TS: '' . '
ey �7%« �/�/4E- ' Date � �
IVHI By � DdtO ' � "�_
Appliption.lssued By � ,�/ !'L/ -• Date_lLL�� �J
��•� �� '� � SUMMARV OF FEES � � �
. �BUILpING�PERMIT � $ � y� C' O SMIP � $ —���
;q, PLAN�CHECK � , $ �- ����%y PERMIT ,
PLUMBING $ ��SSUANCE $
� PLAN'CHECK � • $ ENERGV,.P.C. $ �
�� �ELECTRICAL $ GRADING $
� . PLANCHECK $ � MICROFILM ' $ �
MECHANICAL $ TOTAL FEE $ ���
� PLAN CHECK � � $ � � � '
_ . . . . . " " _ ' _ � ' ' ,
t
�
1
t
� � CONSTRUCTION AND PLA N G � � ' ,�; - F . & SPA . . -
� '� Date � � Inspector � -� `' ' �� � , Date Ins ector
� APPROVALS. .Peimit#' y '� APPROVALS - Permit#• . P
.1 � Temporary Electrical Service oi Pole - - � 52.. Pool &� Equipment Location - �
,�2. Soil Pipe�Undrgmd. . '" - , - 53. Steel Reinforcement � , � ' � '
3..Electrical Conduit Utility-Undrgrnd. ' . _ � , .54.,Forms , � - � � '
4. Electrical Conduit-Undrgrnd. �_ � � � 55. Electrical Bonding „ .
5: Steel Reinforcement.�t ��_�p_�� �'F��� ; � ' 56. Rougfi Plumbing�& Pressure.Test � �
' 6: Electrical UFER Gmd. �' � _ - ' � 57. APPROVALTO.COVER-GUNITE �
7. Footings � � 3 �� 58. Electrical Cohduit-Uridrgmd. �� - �
8. Foundation �' - . ' . 59. Gas Pipe, O.Undrgrnd., Test �
9.EWater Pipe-Undrgrnd.� . _ . '-:60. Backwash�Lines, P-Trap, O Undrgrnd. �'
10. Structural Floor System � � � . 61.`APPROVAL TO DECK ' .
11. Property Sewer Line & House Connection .62r Backwash & ReceptorFinal ,'
12. Sewer Cap , � � . 63. Heater & Vent-Final � �
13. Roof Drains - 64.. Plumbing System - Final' _ ' �
14. Rough Plumbing �� - ' - " 65. Electrical-Final - � � . � ' ,
15: Rough Electrical-Conduit�' • ' � � � '" ,- � 66:'Sola'r System-Final� "' ' •
16. Rough Electric Wiring . � � � -, � , t � 67. �Pencing & Access Approval'.. � � '
17. Rough Wiring Sign - ' � ' ' , 68. +APPROVED FOR PLASTERING � '
� 18. Rough Electrical-T Bar Ceiling - � � , ' , 69.'POOL/SPA SYSTEMS FINAL � � '
19. Rough Heating & AicConditioning �� . . � ' FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace� ' � ; ' APPROVALS Permit #� ' ,
27. DuC[s, in Structure � . � 70. Underground Hydro . .
22. Ducts; Ventilating � � :i � � 71, Product Piping � Gas� ❑ Oil �
�-�
j23� Gas Pipe-Rough & Tesf_; . � i 72. Underground flush i
24. Roof Framing - � � , F � , 73. ,Undergrnd, Storage Tank � Gas ❑ Oil
25. Roof Sheathing � . - . � � � 74. Overhead Hydro � � -
26. T-Bar Ceiling (Structural) & Monocoat' �- � - . � 75. Dry Chemical , r
27.� Freme and Flashing - , '- 76. Dry Standpipe � • .
28. Lathing�& Siding � � � � . 77. FIXED SYSTEM FINAC . -
29.'Insulation � � . � 78. FIRE PREV. FINAL �
, 30: Drywall Nailing _ � ' . � , . , . • HEALTH DEPT. REQUIREMENT . �
31. Plaster Brown Coat . � . ' , , � ' 79, FINAL INSPECTION ' � � -
32: Electrical Power MeterFinal � ' � � 80. FOOD CERTIFICAT.E ISSUED
33. Final Electric �� ' � • Notes: !J-���_� ���A � �S O fc`-r�1 'f'
34. Final Heating &•Air Conditioning_ ' ' �. ' 7�' '�d o i'
S.ti�h h�n
35. Final Gas Pipe-Test__ • _ � . ' . � . • ' � � �
�� yr �o uir �O�r a h � w
36. Hood or, Canopy - . ` ' . � " ' ' ,
wi iI Sf tp
37. Final Factory Fireplace � � +' ' - ' - � � , ' � � .� � �
38. Final Plumbing � � , � ' " ,
39. Water Service-Final ' � ' ' " '
40. Gas Service-Final ' , ' � � , � �
41 . Solar pomesticFinal . " ' : . ' _ . : ' ' �� '
42. Backflow Preventer " �. . _ ' ' ,- � �
43. Backflow Irrigation , � , . � � , • � - �
44. .Landscape Irrigation System : � , � � ,- ` � ,
45. Sound�. Attenuation : � ' � ' - , • � _
46. Han'iiicap Regulations ' _� , : , . , � . , � ' - �
47. F.INAL STRUCTURE & BUILDING l�-�5.,�: � � , � � ' . ' � •
48. Special RequirementsCompleted � � � ' , � � � �. - ' ' . �' - � .
49. Electric Release to Edison � t -� - --- - _- - - - - - � � • � '
50. Gas Release to'Southern Califomia;Gas Co '� - , � , � � . � � ' .. . � �
51. CERTIFICATEOF.00CUPANCY' " _ .. _-. _. �
' ' . . , - : . . . , � .
No. ' Date- - " . �
�
r
CITY OF COSTA MESA
BUILDING DIVISION
01NNER-BUILDER VERIFICATInN
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such
notice, and, as a condition precedent to issuing a building permit, require the completion and require
the return of, an owner-builder verification.
Attention Property Owner:
An 'owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity
to avoid unnecessary delay in processing and issuing your building permit. No building permit will be
issued until this verification is received.
1. I personally plan to provide the major labor and materials for construction of the proposed
property improvement. C�Yes ❑ No
2. I(hevc/have not) signed an application for a building permit for the
proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
Name
Address City
Phone ( 1 Contractor's Lic. No.
4. I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise and provide the major work:
Name
Address City
Phone ( ) Contractor's Lic. No
5 I will provide some of the work but I have contracted (hired) the following persons to provide
the work indicated:
Name
Address
Phone - Type of Work�
,�j,,.G�L A�s� j 2YSSiIGYSF. E y3 -GJ�s` i ����/r�✓-
I hereby affirm that I have received a copy of the information set forth in Section 19830 of the
State of California Health and Safety Code and have completed the above information to the best of my
personal knowledge, in compliance with this State law. �
� �
Signed: -'���y-- J .it" �`"� Ny Date: %l,rir . % ' d ^j
Name: / G ✓ �. �i ���'tL C: i7 `�' ✓
(Printed or Typed)
C.D.L. #or S.S. #
CMF 304246
_�
754-5273
Cement Coping Ootional
Channel Block With 1-3/8
OHorizontal Top of all
Fences
For Fences 5' or Less --
Vert. Bars 3/8" 0 at 4' -0" O.C.
For Fences Higher Than 5'
Vert. Bars 3/8" 0 at 32" O.C.
Fill Cells Solid With Grout
Where Steel Occurs
Reintorcing Steel.Shall
Conform to Sec.A-75-39
A.S.T.M.
All Steei to be Lapped
15"ortoCode �
NA7URALGRADE
TWO 3/8" 0 BARS
CONTINUOUS TOP
& BOTTOM
TYPICAL 6�� CONCRETE BLOCK FENCE
GENERAL- NOTES
MORTAR: pne Part Plasfic Cement, and
Three Parts Sand
GROUT: . One Part Cement Three and
One Half Poris S'and
COPING', One Part Cement, Three
Paris Sand
CONCRETE: Well Mixed f:2-I/2:3-I/2
Max. of 7-I/2 Goltons cf
�IYoter Per Sack of Cement
GROUT MAV 6E POURED FROM THE TOP
OF THE FENCE IN CELLS WHERE STEEL
OCCURS.
CEIIS AND AREAS OF HOqIZONTAL REIN-
FORCEMENT SHALL BE CLEAR, CIEAN &
FREE OF ALl MORTAR DEBRIS, E7C.
80NDSSHALLHE PROVfDEE1 BY LAVING
BLOCKS IN STRETCHER COURSES SO THAT
VERTICAL JOINTS ALTERNATE IN EACN
COURSE.
DEPTH GF EARTH7COTH
I/3 iFiE HEIGTH OF FENCE
BELOW BOTTOM OF FOGTING.
SCALE: I/2��= I'
FOOTING REQUIRFMENTS CHART •
WALL HEIGHT . . . . . . . . . 6 �. . . . . . . . . . . . 5�. . . . . . , . . . . . 4� . . . . . . . . . . 3�
WIDTH . . . . . 14'� . . . 14�� . . . 12��. . . . . . . . . 12��
THICKNESS 10". 10" . . . . . . . . . . . 8'� . . . 8 ��
DEPTH OF EARTHTOOTH . 24° 20�� . . . . . . . . . . . 16�� . . . . 12°
SPACING OF EARTHTOOTH. 12� 14� . . . . . . . . . . . 16� . . . . . . . . . . 16�
OWNERS NAME: _ �t /_C�� _j�'1=CfJ'Pi✓ _ _ _
City of Costa Mesa California ��e ADDRESS __2�15-� = jZU�-�Q L=_ ___
) PERMIT NUMBER;_ _
Building Department SIGNATURE _ _ _ _ _ _ _ _ _ _ _ _ _ _
�� I I pE51�ENCE I I I pESIDENCE
�
W
W
R
ti
h
STREET
�'lu�� � �loc���e.�
APPRO�D
CITY OF WSTA MESa
ALANNIfJG DEPT.
W�1ECf TO lLDG. DEiT. oEr.
bY.��-�'��DATE%%-7� ��
01![CTO! Or KAlfNINO
RESIDENCE
a� ss��e
�
RESIOENCE
JOB ADDRESS 2LLS5 NOT52
GENERAL WNTRACTOR KO
AP No.119-100-55�5fi LOT
INSPECTIONS
TRACT PIR� ZON�
� Signature� DAT� GROUPI �
\
DATE 2-26-62
BUILDING PERMIT NO.
VALUE $ 16��L 6.00
DL:SCRIPTION OF WORKR2S
J TYPE 1j 7.ONE
SUI3CONTRACI'OR
4v
16486 FE RECEIVED
C TA MESA BUILDING-SAFETY DEPARTMENT � g� b ig62
P. o. aoX s,� �o�A M�A. ��Fo��A � FI�9ANCE DEPT.
For Applieanf fo Fill In Complefely APPLICATION F�RYPER�TS�A MESA
TYPE OR PRINT .- �'�BUILDING
ADDRE'SS � 4' S S /�S � l .
COSTA MESA CALIFORNIA For Office Use Only
RECEIPT NO. PEP IT NO. �
OWNER U C Q O�%.r , D•
MAIL rf� �1 f: /� /� RECEIV BV DA ECE V DATH IBSUCD
ADDRESS � •� r � o� �-(o,�L �
crrr cS a � QSCC No.`i �/�42 BUILDING ` j� p�
ADDRESS V Or G
o� '7Ecr 7e�. COSTA MESA. CALIFORNIA
f 61NEER NO.
ADDRE55 � FIRE �
ZONE TVPE � GROUP� /
CONiRACTOR (/I%% P� ABYPROVED �' DATE " ' � .
ADORESS NING � �
ZONH NO.OF USE OP NEW Sa ���y e
(�'�T`( I PLRN9 Z BUIIAINO [f ��
STATE TEL. LEOAL 9
I.IC. NO. NO. Deetn�rTioH (7/' Q%% (J b ��� . J�
SIZE /' '/ NO. OF BLDG6.
OF LOT y 9• 'T / xOW oN LOT O A. P. NO. l I — � G � — s r� J �
USE OF YARDS EVES
EX16fING BLDG. APPROVED ALLOwED
98TBwCK 4N¢ FROM �/ � q (CBNTER LINB BTJ{�
GHNTER OP STPeET aC REAR YARD � 7� pRONT / FT. -- IN.
SI�E YARD I LEFT . 'D'/ I RIGHT S/ S// R. SIDE S FT. �^_ IN.
DESCRIPTION OF WORK �. S,oE '� FT. -- IN.
NE I�ALTERATION I IIADDITION I gEp,q Z J� pT 6 IN.
REPAIR I IIMOVING I IIDEMOLISH I BY�'ROVED�`� 'L�z6 �
DATE
BUILDIN NO. OF
srze Sn Rooms STORIES IiOLD FOR SPECIAL REQUIREMENTS
EXTERIOR WALLp uGGU I ROOF �� 9 /`'�`
COVERING J COVERING L� S J� 2 ��.. ,
USE OF BUILDING AND WORK TO BE PHRFO MEO
���%l- � %� / QS� �//CG - / ��� 0/
,��..�- ..
: l7" a- p `' , � � .
I HHq ACKNOWLEDO THAT 1 HAVE R6l�D TH19 APPLJCATION
AND 6TATE THAT THF� BOYE IB COPHEGT AND A6RE6 TO COM- THE AMOIINT BXOWN UNOEP VALUATION IB FOR THH
PURPOBE OF. EBTABLIBHING A PERMIT FEE ONLY.
v�Y w�Tt� wLL CITY RCINANGE9 ND BTATE LAW9 PEOUTATING
eWLo1Na CONeifNci N. VALIlA710N /
P RM^ITTE E OF 1� �`u���(/ '/ . PERMIT FEE $, .�!p �-- N
$ /1� �/ ��� PLAN CHEGK $ /OT��• p
AUTHORIZED AGENT / �j 5! - K
TOTAL FEE v � +� 4
�OWNER �Ul'1LLA� A.
JOB ADDRESS 2 55 n
� GENERAL CONTRACTOR
�z9=�5i-�
Cp� :CTIONS
GAS
W Al
�ROU
r PRO
� SPR
PLOMBI
$WR. ll
LING S\
TtMYONNNY SERVICE OR POLE
UNDERGROUNO � POWER �
ROUGH WIRING
TNENCHES FOPMS STEEL REINF
FLOOR SYST�M
BONO BEAM n STEEL REINFORCE ❑
SHEATHING
FRAME RND tLASMING
LATMING - IN n OUT [�
P"�TER, BqOWN COnT
TUFRL, FINAL
h_ ..-IHG. VENT., FEFRIG. ANO A.C., fINAL
PLUMBING. F�NA1. RN� G45 TEST n
EIECTRIC, FINr1L
BUII�ING, FINRL
me�i.� ecq„�oc..rurc
FIRE
DATE 4-13-1!
BUILDING PERMIT N0.
SUBCONTRACTOR
�
��'" 4380 ! �
�� COSTA MESA BUILDINGSAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING - / Q
ADD(iESS i S� / V
OWNER /� i/A/U //�//f .
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CITV I �_ ///. N
BFANCH
ADDRESS
ARCHITECT TEL.
CONTRACTOR �+/ ✓• '��fj'G/,�///�� C,
ADDRESS /��y/ �['[//�/�. f �
TEL.
CITV �,S �/n,/ � NO.
L C. NO. �� (�J�j � LICyNO.
S I Z E i NO. OF BLDGS.
OF lOT � NOW ON LOT
USE OF C� � �J_/ % /J �J
EXISTING BLDG. J l/ / (�J/y /\.
, Separate permits are required for
electric, plumbing and heating work:
USE OF BUILDING AND WORK TO BE PERFORMED
�
i / /� // _ . �
I'heraby acknowletlga that I have reatl this applicaiion antl state
that the abova info�matlon Is corract and aB�ee to comply with
all laws reg�lating builtling consttuction, and I shall noc employ
any person in violation of the workman's compensation laws af
Me State of Californta. "
I hereby certify thaS I am properly Iicensetl as a contractor untler
tha State of California Business antl Professions Code, Division 3,
Chapxer 9, antl that such licanses are in full force antl etfect, or I
am exempt from the O�ovisions of the Staie of Celifornia Business
antl Professlons Cotle,�� ptar 9.�
SiBnature af �I� � �
Permittee _ _ _ _. _ _ .
� �.���:
��� �;�-�7��F:,00 r�.,�y�E �::,��,.�8.50
APPLICATION FOR STRUCTURAL PERMIT .
RECEI DATE RECEIVED D TE^I$ =
�
A.P. NO.. �
� I� < � S^� PERMIT NO.
BUI�DING � �// �; //// �S Ci
ADDRESS� yJ �/v/J �
ae. //(
TRACT 3OO LOT � BLOCK
EW ADD ALT P
O�ER " / //NL T //%I •
SE � I//iIn ��%(J �OLC�E'U$ �OO..�
FIRE
ZONE TVP GROUP
APPROVED � �erc ��I/I r-/ /
ZONE _ NO.OF �
PLANS
YARDS APPFOVED
MAIN BUILDING.
(FROM C/L STREET)
VAROSAPPROVED .
ro�L
R. SIDE �, FT, FT.
L.SIDE rtl�'/`�/I� FT.
f�cs P. G.
REAR3� FT. FT.
DISTANCE BET. BEf. MAIN &
MAIN BLDCS. - ACCESS. BLD('aS.
' VAR. # �ATE ,
C.U.P.# qPPROVED
APPROVE�IWO � I� "_' 7� I eZ �
2�O SQ. FT.
' THE AMOUNT SHOWN UN�EF VALUATION IS FO
THE PURPOSE OF ESTABLISHING A PERMIT NL\
VALUATION PERMIT FEE $ / O G
f� PLAN CHECK $ ��
§ �O O TAX $ ' / G
TOTALPAID '$ � 5O
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