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Home My WebLink About1695 NEW HAMPSHIRE DR - Building Permits(714)754-5273 • Fax(714)754-4856 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT .lob Address: 1695 NEW HAMPSHIRE DR Suite: Vicinity: DETACHED GARAGE Parcel Number: 13961216 Applicant: WOLSKY, BRIAN Address: 17662 METZLER LN Arch : Address: HUNTINGTON BEACH, CA Zip: 92647 Phone: 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Zoning: ISSUED BY: Phone: (714)847-9332 Zip: 92647 Phone: Zip: 92626 Phone: (714)947-9332 . _ License: 575002 Eng: Address: Status: HUNTINGTON BEACH, CA Owner: COZART, CHARLES A Address 1695 NEW HAMPSHIRE DR SMIP Res: COSTA MESA, CA - Contractor: TOM BYER ROOFING Address: 17662 METZLER LN Arch : Address: HUNTINGTON BEACH, CA Zip: 92647 Phone: 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Zoning: ISSUED BY: Phone: (714)847-9332 Zip: 92647 Phone: Zip: 92626 Phone: (714)947-9332 . _ License: 575002 Eng: Address: Status: ISSUED Applied: 03/27/2000 Issued: 03/27/2000 Phone: Zip: License: License: - SCOPE OF PERMIT REROOF EXISTING DETACHED GARAGE (5 SO). INSTALL 30 # FELT UNDERLAYMENT & REROOF WITH "CELOTEX" COMPOSITION SHINGLES OVER EXISTING WOOD SHINGLES, Total: $33.15 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 TICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related ilations. (Ord. No. 92-28, § 1, 12-21-92) 1RATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned period of 180 days. rECT10NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all fired Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. INSPECTIONS CALL: (714) 754.5626 FEE SUMMARY _ Plan Check: $0.00 — Calc Valuation: $750.00 Permit: $32.65 Claim Valuation: $750.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $33.15 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 TICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related ilations. (Ord. No. 92-28, § 1, 12-21-92) 1RATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned period of 180 days. rECT10NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all fired Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. INSPECTIONS CALL: (714) 754.5626 246646 WORKERS' COMPENSATION DECLARATION: 1 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. have and will maintain w rkers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. MyLwororkker�s' comgpensatio Insurance carrier and policy number are: -Carrier (This sectiomn'e�completed if the permit is valued at one hundred dollars ($100) or less.) ❑ I certify 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 Califomia, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of a Labor Code, I shall forthwith comply with these prn • ---- -Appllwnt.Signature:, Date: I z Jot 7 WARNING: FAILURE.TO SECURE WORKERS' CO NSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED -THOUSAND DOLLARE (SlOD,ODO), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: hereby affirtry'ihat't'am licenso under rowsions of Cha r 9 (commencing with Section 7000) of Division 3 0� f thee B ness and Professions Code, and my license is in full force and effecLLic..k—f �"�`T"L /Cass) # C-3 Contractors Signature: LData:_"1, c7) 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). Lenders Name: Lender'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 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).): ❑ 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 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 not 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by dnvars license. ❑ Yes ❑ No Drivers 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: 1 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 ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed 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? ❑ Yes ❑ Ne (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 ❑ No (Section 25534 of the California Health and 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? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication appernit for such Construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ 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 ❑ 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 distract 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? ❑ Yes ❑ 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 COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given i 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 th above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si re Of Legal Owner(s) ate 73r—%w- LAnd1 Ihoriz plicant COPE. # INSPECTION TYPE gAu INTITAA COPE INSPECTION TYPE g�TF, IMmAL 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 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 246646 (714) 754-5273 • Fax (714) 754-4856 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT Job Address: 1695 NEW HAMPSHIRE DR Suite: Vicinity: WHOLE ROOF OF HOUSE Parcel Number: 13961216 Applicant: WOLSKY, BRIAN Address: 17662 METZLER LN HUNTINGTON BEACH, CA Owner: COZART, CHARLES A Address 1695 NEW HAMPSHIRE. DR COSTA MESA, CA Contractor: TOM BYER ROOFING Address: 17662 METZLER LN Arch : Address: HUNTINGTON BEACH, CA Zip: 92647 Phone: BUILDING PERMIT v" PERM UMBER B00-00378 77 FAIR DRIVE, COSTA MESA, CA 92626 Zoning: ISSUED BY: Phone: (714)847-9332 Zip: 92647 Phone: Zip: 92626 Phone: (714)847-9332 License: 575002 Eng: Address: Status: ISSUED Applied: 03/27/2000 Issued: 03/27/2000 Phone: Zip: License: License: SCOPE OF PERMIT REROOF EXISTING SINGLE FAMILY RESIDENCE (10 SQ. OF PITCHED & 9 SQ. OF FLAT). INSTALL 30# FELT - INDERLAYMENT & REROOF WITH "CELOTEX" COMPOSITION SHINGLES OVER WOOD SHINGLES ON PITCHED AREA. ON LAT AREA, TEAR OFF EXISTING ROOFING & INSTALL HOT ASHPHALT B.U.R. Plan Check: $0.00 Calc Valuation: $2,500.00 Permit: $83.25 Claim Valuation: $2,500.00 SMIP Res: $0.50 SUP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 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 :E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related tions. (Ord. No. 92-28, § 1, 12-21-92) . 'ATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned ariod of 180 days. TIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all d Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. SPECTIONS CALL: (714) 754-5626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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. - li�l.heve and will m n n workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2 My coo ars com tion Insurance carder and policy number are: . �/ Carrier._ -1 LL��- policy— Nuumbar. 01 K � ? Z `S `(this section need not be completed if the permit is valued at one hundred dollars (S 100) or less.) ❑ 1 certify that in the performance of the workjjor which this�ppernil is issued, I shall not employ any person in any manner so aq to become subject to the workers' compensation laws of California, and a lh'al if I s BId"bamme subject to the workers' compensation provisions of Seen 3780 of the Labor Code, I shall forthwith comply with these _ / jAppicant Sim gnature:�Z - DL ales—c7 6� WARNING°FAILURE TO SECU-6 WORKERS' COMPE VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOUARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 5106 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm thaLl.am.licensed-arn provisions of Chapter 9 (commencing with Section 7000) of Division-3of-theBusiness and Professions Code, and my license is in full force antl effect. Lic. # � Com. -2, Class # Contractors Signature: '1 7- '-✓ 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). Lenders Name: Lenders 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).): ❑ 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 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 not 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 contractors) 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 of Ownership by (type of document, i.e. - property tax bill or deed): 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 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: 1 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 ❑ 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? ❑ 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 oaupant need to prepare an RMPA (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and 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? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ermit for such construction or modificatior 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 pernit 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 required for the work which is the subject of th application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ 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 ordinanc 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 give 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 above-described property for Inspection purposes. �y or allow occupancy of any building authorized by this permit until final inspection. azure O at Owner(s) Date Add/O.. u ed.Apphcant ' - �.r� _'C—Date `\ CODE ,#. INSPECTION TYPE PATE INTmALS CODEC INSPECRONTYPE 1` ppg j�Q 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retatning Wall 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 2"6-16 CITY OF COSTA MESA REQUEST FOR OCCUPANCY TRACT NO. (O SFS ��— IAT N0. DATE J _.M- / 2 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 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. BY Piet ase • i BY Developer and/or authorized representative BY Lender OWNER MODULAR Technology, Inc. DATE 7-15-71 JOB ADDRESS 1695 New Hampshire Drive BUILDING PERMIT NO. I3ju AP No. LOT 4e TRACT bj02 FIRE ZONE VALUE ECTIONS Si nature D t IGROUP I & J TYPE V ZONE R-1 SUBCONTRACTOR PERMITS ISSUED GAS Date Number Signature WATER Plu in RDUGH PLUMBING - - PROP. SWR. LINE USE CON. -loft- �-7 SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER ❑ ROUGH WIRING _ '7� Heatino and Ve TRENCHES ZF7FORMS 2r STEEL REINF.i- FLOOR SYSTEM IJ BOND BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING - IN 4L OUT Wrr PLASTER, BROWN COAT STRUCTURAL, FINAL Ie i I IG, VENT., REFRIG. AND A.C., FINAL P. .BING, FINAL AND GAS TEST ELECTRIC, FINAL oiiu niur niuAI [ ., Z /J Z W uw aU z za FDwn dm J7 J (n Q W m J -m J Q U N Za W cc aW W Z JO CO Z J � W w Z _ Z_0 wM �O I— Z Q U J CL CL Q O In Z O F U In N Z 33311 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely BUILDING OWNER Mociular Tecnnology, inc. MAIL ADDRESS 1104 E. 17th Street TEL. CITY Santa. Ana. NOS 47-8672 ADDRESS ARCH^TEOT. Kermit Dorius. AIA :,�L644-7111 All 20 7th ch011731 ` "* I N l 0 APPLICATION FOR BUILDING PERMIT REC IVED Sly I DATE RECEIVED DATE ISSUED 1 r7 b —.2-- 71 7 /5 =7 A.P. NO. PEF133311 1 ADI RIm ESS 1695 New Hampshire Dr. I X I hereby acknowledge that 1 have read this application and staterVALUATION FIRE v L that the above information is correct and agree to comply with ADDRESS 111 2nd Ave.d Del Mar ZONE TYPE GROUPAPPROVED Any person in violation of the workman's compensation laws of CONTRACTOR OwnerBV DATE I hereby certify that I am properly licensed as a contractor untlerFT.the ADDRESS Same LAITEL. 9, and that such li ses are in full force and effect, or IOF ZONO. OF USE OF NEW CITY SameNO.STATE PLANS l� BUILDING Y YARDS APPROVED YARDS APP OVED LIC. NO. 25`2,54 . NO. 16 0 MAIN BUILDING ACCESSORY BUILDING SIZE BLOGS. C/L ST�f EET) .OF OF LOT 50 X 100W ON LOT RONT FT. C FT. USE OFEXISTING BLDG. FT. FT. SIZE OF (� NNEW SF D BLDG.I4 TO RSTORIES1 L. SIDE FT. FT. EXTERIORWALLRCOVERING P CREAR FT. FT. USE OF BUILDING AND WORKORMED DISTANCE BET. BET. MAIN & MAIN BLOBS. ACCESS. SLOGS.//Construct new r&garage. VAR.* . i/ �S�wg DATE APPROVED �b APPROVED(LU RV naTF 9'j, � / I hereby acknowledge that 1 have read this application and staterVALUATION SPI that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ Any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor untlerFT.the State of California Business and Professions Code, Divisicn 3, SHIChapter 9, and that such li ses are in full force and effect, or IOF Eam exemptfrom the pr i��'i ns of the State of California Businessand '✓sion Professions Cod 3,ChSignatureoPermitteew Authorized Agent 5 TOTAL FEE 0 VALUATION IS FOR j A PERMIT FEE ONLY: $O� /_ N J K $ / D' V E LL