HomeMy WebLinkAbout3222 OREGON AVE - Building Permits�
�
�oon�ssaemiaxc: 3222 OREGON AV
°'`"ERs"""E"�wo�`'": SMITH, ROBERT L
AD°"� 3222 OREGON ST
COSTA MESA,CA
545-7495
APPL. YIJWl1:1DDPE33:
ApCNRECT OH FNtlNEEH:
JICH. OH ENG.'S �DORESS:
UNT:
92626
uc. rro.:
UNT:
conm�cTarsruxE: NOCK PLUMHING (714)995-1246
LQlI11ACTORSYNIWG 11612 KNOTT ST
"��"�� GARDEN GROVE CA ��� 707775
92891 u'+T: 17
110ENSEU COMNACTONS UECLAHATION: I hereby Nvm unEer penetly d peejury thet I em Icenaed ueMn provieione M Cheqx e
(mmmeuiiq with Section )000) d Diviaion 3 d ihe Busimae eM PMesaiom Code, eM my fimnae w in lull Iwce vq aHeq.
cmuallo.: O50 6 acuss: C-36 b"j� 7=/�75 OEXP: 02/98
Dme: COMraraor: � � �'��T �
OW NEN BUILOEfl DECL4flAT10 1: 1 hneby elfirm uMx pmely d parjury Ihel I am e�emq Imm Ihe Cmlretlav �Jy��
Idbw'up eeaaon (�� ]0.A1.5 Bus'vims md PMessbns Code: AnY c'IY a munN �idi �eyuirea e peeme to camVuci. ellx. imP�.
damoleh, ar repeir eny sVucNro, priw to ea waerca, also �equirea IM epplimnl la euch peimil lo fib e egmA statement Met M a sM
u licenaed Wn��t lo iM po.+dms d the Canvecwa Liceme lew �Cheper e(�mamiq with Seaon )000) d Divmion � d Iha
BuaiMn eM Rdassiona Code� a �het M or Me ie evempt Iharehom end �M buie fa Ne elbped ssemqion. My vide�un d Seaion
]W 1.5 by enY eOWiranl fa a permil subjxtn the epplcent to e wil peeulry d M mae Ihan INs hurWreE tldlere IS500�.
❑ I.asoxirerdlMpropanYamymmpbyeeewYhwepeanihaiwbwmpanae�ion.willEo�hewwk.aMihee��uvYureendinteMed
or diered br sak (Seciion )OM. Butinesa eM PMesamsCetla: T�a Convmac Licmu lewdmv iwt epplyta en owner d qopeiry
wM bulds or imDro�� �heraon, end xfio doae euch v.mk himeeH a Mne1 a Nraqh he a her oxn empb�eea. pwideE Ihel wch
�mww��a �. �a mia,ese a on�a �«..b. n. no.a«. me d,ue�oa «mo�mem �.:aa wnn� oo. r� a o�o�oo. me
owrer-0uiker will heve iM buNen d prrnin0 � a� she did na Wild a imD�e iw Ihe qiryme d eeb�.
� 1. m owier d tM propery. em eKdurivaN �^Iredmg wilh licensed conttecion �o canmua tM P�I� (�� ]OId. Buai�a erd
Pmles+iwre code: TAe caniredas Ixeme Lew Aoae ml ePON b en owna d vrro�Y Ma buike «'vnG�'�a the�ean eM xho
conlrech br wM pioja.Ys wM e wMrmar�a) licensad punuent to �he Conlredve license Lew).
❑ I an azamq wdm Sxtion: B. 8 P C.. fa ihe reevon:
oma: o,.�,:
i ao na�nr o.�mv mm i� ew�e a�e �oe«s�,�a ine rea���*� a c�eo� �en �e smar coee sm�oo. uws. zssaa. d,a
2SS�a. eM Mei I a eny Mure buiMi�p ompani will / wil iwt (arcb ane) med lo comply wIh eeid pma mdm eM ihe reQuirememe br
epeimitlamnsWclionamoEifrationhaniMAi uai�ily.erepemenlDislnd.RniEeMelmM'uclioneppira�iomenuemqlromiMse
pIOM910118.
ome: nod�c
WORKEN'S COMPENS�TION OECLAH�TION: 1 Mreby elfiim undx pendry d per'ryry ms d iM IoDoxi�p Dede�etiom:
❑ i na� �e �;� mdo�� e oan�r�ma d���� m.en;M�� i« wa��; �omro�m�, e. ww�a.d i« nr sec� s�ao w m. �.no.
coee. i« me we�e a me � i«.,�n mm v� �. B.�,ae.
fl in�d,e�;��m�wo��•�o�����.m�a��reaMsae�,a�ooame�ca.coaa.m�mewd«�dm.
� wwk /w whirh thie pmnil ro ieaued. My waMeis eompannetbn inwrenea umer eed pdiry number are:
o�.: r,nr.nFN FACi.F EXPIRES
Pdicy Numbm: niwr a� i i a� n� 0 9/ O 1/ 9 7
(This section rieed nm M canplxed / tM p�armt'a M one huMnd EdWrs /SIP01 n Im.)
❑ I wnN �t in ihe pMormar�ce W Ihe work br xfibh �hie permil o imueE. I ehell M emplry e�ry person in enY manmr eo u to
wcmie wd� � ��na e' romw�.uion uw. a cdnomie. end mm J ����eeehhhQQpuuum nxane wbjea m ma wonfen•
compenaeiipn P •g�� �f d Ihe Lebor COEe. I Mell lat�MnlrYhW�pm�ro. �
i_ �� / � �
ova: �1i c noWcem: / �
W�ml�p: F�llun ro��cvn wotlrx�' compwuatlan roverps b vnNwNl, me �Hll wb/�cf an xnployx ro ctlMml p�mltlu �M
clvll IIM� up ro on� hunCreC flwusnW do/br� (S1 W,000/, In ME/fbn b tM eost ol eomp�nufbM1 Mnrpu a prvvMN M In
Sxtlon J]G6 0l tln lffior Cotls, lnf»s4 eM ettomsy� I�u.
CONSTflUCT10N LENDINO AOENCY: I hereby elfi�m uMw pwielry d perjury thm Ihre n e can9iudion bnEi�p epmry br the
peA«merce d iha xak fa whiM t�e peeml is ewed (Seecn �09]. Cir. Cl.
LENDEN'S NAME:
LENOEN'S ADDRE55:
I cailify ihel I heva read ihia eppliratim ud alete Ihe� Ihe eEova inlormetion ia corteG. I eprea lo canply wi�h dl ciry eM couMy �nenme
end ete�e lexs �Neim9lo Wikip consvutlion erd hereby ei�lpr¢e represenlaiivea d ih's my to enter upon IM ebave�maMinntl pmperry
la iropedion purpous.
oN �cx
nM Nema � �
o�a: ���5?'/ �
si9rwure a O,medAB.nvAPVliranUComrecior
(5151-16.WP) WhNe-Buildiq 8 Sela�Y: �reaMFle: Cenary-AppfceM: Rnk-Revenue:OdEenro�baea�or
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: P 083012 PLAN CHECK NO: N
CONSTRUCTION TYPE: V—N
PERMIT TYPE; PLU
PERM NO: P 083012
GOVT; N SUPP: N
PURPOSE: OTH
JOB DESCRIPTION : DISHWASHER CHANGE OUT SQ FT;
CLAIM VALUE: CALC—VALUE; GRdUP OCC; R-3 /
COMMENTS: NO OTHER WORK ASSOCIATED WITH THIS PERMIT
******��r*�r*�*u*�*u***�*x�*****�*�*x�*�****+��x*��*�t�**�*�***x***�*�c��*��c�***�e�**�
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
---- ------- MAIN BUILDING ---------- — ------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
PARKING ftEQ: PROV: PARCEL; 13909307 ZNE: REF NO:
PLANNING NOTES>
%
1F 1F iflF iF iF if'lE if iE iE 1E 1E 1F 1E 1E iFlF 1F fF �f if 1k 1f IF �If if iElE iF 1F 1F 1! 1F 1E If 1Elf 1f # 1E iE �E'lE iF i! 1E �)f 1f if iElF iE iFlE 1f iE 1E iE if 1E 1f 1F if k i! fE iF 1F iE iE 1E iE fE �lhlE fFlE iE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE;
BUILDING APPROVED BY : DATE;
APPLICATION ISSUED HY: �n� DATE: S 23
1EiEiEiEitiElEikifiElEiFiE�FifiFiEiE1E1E1ElEiFiF�ifTfTf�FiF'3F'iF�FiF3EiF3FiF�TFiF� 3F3F3f�F3f�F7fiF�FiFiEiE�EiE1E3E1EifiEiE lf1E
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECFIANIC
PERMIT 8.75
25�
PLAN -'
ZSSCIE FEE 22.00 /,`
BUILDING—DIV—> PERMIT ISSUE PLAN.—�CHECK
TOTALS----> 8.75 22.00 !"� 0.00
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBZNG ELECTRIC MECHANIC
30.75
FIRE SMIP/RES GRADING
SMIP/NON—RES
TOTAL PAID DUE
30.75 30,75 .00
30.75 OVER/SHORT; ,00
FIRE SMIP/TOT GRADING PLAN—CHECK
iE 1E iF 1E 1E IF 1E IF if k 1E 1E 1f if if 1E iE 1F 1E jF iE 1E 1E 1E if 1F iE �ElE iE 3f fF ff 3f 1f iF iE 3E 1E if 1F 1E iklf k iE 1E if 1E �F i( 1E 1E ik iE iF iE iE �E iE iE iE ff 1k 1E fE 1F 1ElE 1F iE fE �E iE 141E 3E jE iF
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
PLU 7. DISAWASHER . 8.75 8.75
END OF FEES
EX�T�� E
DATE �� � � � 06-�9-±997/IQ:p? pr/i30.75
F'EfiMIT rT0836i�2
CONSTRUCTION ANO PLANNING - ,. �_. POOL & SPA '
APPROVA�S Permit�h �'Date Inspector �pppROVALS Permit# � ' Date Inspector
7. Temporary Electrical Service or Pole '. 52i Pool & Equipment L`ocation , _
i -
2. Soil Pipe�Undrgrnd. � '. � � .53. Steel Reinforcement � , .
3. Electrical CAnduit ULiiity-Undr9�ntl. 54. Forms �?� � '"
4.,Electrical Conduit-Undrgrnd. , ' - � � � 55. Eleetrica� Bonding , � ,
5. Steel Relnfarcement` •' � 56; Rough Plumbing & Pressure Test '' � �
6. Electrical UFER Gmd. ' - � 57. APPROVAL TO COVER�GUN17E - �
� i �.
7. Footings - � 58�. Electrical Conduit-Undrgrnd. _ _ /�
8. Foundation . � � �� 59. Gas Pipe, � Undrgrnd., Test ' �� �
9. Water Pipe-Undrgrnd. ' ',� 60: Backwash Lines, P-Trap, O Undrgrnd. ,
10. Structural Ploor System �-- 61. APPROVAL�TO DECK �, ' '
i t. Property Sewer Line & House Connection � 62. Backwash &' Receptor-final : �
12. Sewer Cap ' 63. Heater & Vent�Final `' �� " _
I
13. Roof Drains � � � -64. Plambing System - Pina1� � ' ,
14. Rough Plumbing� ,� � � . �65. Electrical-Final . .
� 15. Rough Electrical�Conduic � .'` � , 66. Solar Sysiem�Final .
16. Rough Elect��c Wiring , '� - ' 67-. Fencing & Access Approval � '
17. Rough Wiring Sign - ;� 68. APPROVED FOR PLASTERING � '' �
18. Rough EIecT���al-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL �
79: Rough Heat�ng & Air Conditioning - - - PIRE DEPT, REQUIREMENT - `
20. Rough Factory Fireplace � � a �-� APPROVALS- - Petmit #
21. Oucts, in Struc[ure . � - _ 70. Unde�ground Hydro
22. Ducts, Ventilating _. � - 77. Product Piping CGas OOiI
23. Gas Pipe-Rough & Test . - 72, Underground Plush
24. Roof Framing - ' 73. Undergrnd.StorageTank uGas ❑Oii
25. Roof Sheathing . � - " 74. Overhead Hyciro
26. T.-Bar Ceilio9 (Structurali & Monocoat � � 75: Dry Chemical " �
27. Frame and Flashin9 - . - �� � 76. Dry Standpipe _ _ " '
28. Lathing & 5�din9 � '� � '•' 77. F1XED SYSTEM FINAL .
29. Insulation - . 78. FIRE PflEV. FINAL � �
30. Drywali Nailing � �� HEALTH DEPT. REQUIREMENT _ .
31. Plaster Brown Coat _ 79. PINAL INSPECTION - .
- . ��
32. Electrical Power Meter-Final . 80. FOOD CERTIFICATE ISSUED ' r
33. Final Electric ; - Notes: __ _ t W,
34. Finat,HeaiiOg�& Air Canditioning �� � �/ � � _ . � - '
35. Final Gas PiPe•Test - ; _ _
- 36. Hood or Canopy � �� � - . - . � - � - .
37. Final Factorv Fireplace' � - ` ' �
38. Final Plum6in9 � . _ _ -• '
39. Water ServiGe�Final � " � - ' '
40. Gas Service-Final . .
41 . Solar pomesticFinal � � � _ -
42. Backfiow Preventer . -
43. Backflow Irrigation " -
44. Landscape Irripation System � ' �
45. Sound Atten�ation
46. Handicati Regulations , � - -
47. FINAL STRUCTUAE & BUICDlNG � " �
48. FINAL PLANNING .
49. Electric Release to Edison
50. Gas Release to Southem Caiifomia Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
reor�,00sess: 3222 OREGON AV
� OWA�S NAME: SMITH, ROBERT L
�aooxess: 3222 OREGON ST
COSTA MESA,CA
RNCH/ENGINEEfl:
nooness:
uxir:
92626
NEG.NO.:
UNIT:
� t:.
renmmee: �J R. CONSTRUCTIQN (714}F91-7448
aoosess: 3 Z 1 B OREGO , AV
COSTA MESA "�; CA 92626
IICENSED CONTflACTOB OECIABATION: I h¢reby aitirm Ihat I am Iiten5e0 UnA¢r pmvisio af Chapter 9(cammencing wi�� Sec�ion
7000) ol Div��sion 3 of Ihe Business and Pmlessions Code, and my licens is in Iull for a d ei
cirr uc.: p 3 9 81 sTnre uc.: 4 8 5 3 6 7
Daie: �_-__9_ �_._ Signature:
WOBHENS' COMPENSRTION OECIAflATION: I hereby aifir at a a c i �e oi consenl Io seli-insure or a ceeificate oi Workers'
Compensalion Insurance, or a cerlilie0 coOY ihereo� (Sec' . b.
roucrNo.:7.96856-9?. E%P.DRE: OSIOl�y3
comrnxr: STATE FUND ,//f
❑ Certilietl copy is hereby �umishetl. (}� Certitied copy is fj�i9.y�iih Ihe ci� Buil IM1g ivi '
L � i
Date: �� g' � 2' APPlicant: � �'�
E%EMPIION FA�M WONBEflS' COMPENSATION OECIAflRTION:. s s io e 1 be compleletl il �he permi� is �or one hundrea (3100) or les5�.
I cetlily Na� in I�e Dedormance ol t�e work lor which Ihis D i� i 55 d, shall nol employ any person in any manner so as lo heCome
sublect �o the Workers' Compensalion Laws ol Cahlomia.
Oaie: Signalure:
NOTICE: II, a�Ier making this Eeclaralion, you shoultl become sublec� to the Workers' Compensation pmvisions of �he Labor
Cade, you mus� �otlhwi�h comply wi�h such pwvisiuns or this permil shall Oe tleemed revoketl.
CONSTNUCTION LENOING AGENCY: I �ereby affirm Iha� Ihere is a consimc�ion lentling agency lor the pedormance o� Ihe wark lor
which Ihis permit is i5suetl (Senian 3097. Civ. C�.
LENUEfl:
p0UXE55:
OWNEB BUILOEB OECNPATION: I nereby atfirm ihat I am exempt imm tAe Coniractors' State License Law for t�e tollowing reason
(Seclion 7031.5 Business and Professional Cotle: Any city of county whic� requires a permi[ �o con5tmci, alier, impmve, Aemolish, or
repair any slmcWre. prior lo ils issuance. also requires ihe applicant Ior such permil to file a signetl stalement ihat helshe is licensetl
pursuanl io Ihe provisons o� ��e ConVactors' S�a�e license Law (Chap�er 9(commencing with Section 7000) o� Division 3 0� ihe Business
an0 Professions Cotle) or Ihai he/she is exemp� �herelmm an0 ��e Oasis for ��e allegetl exemD��on. Any Nolalion ol Seclion 7031.5 by
any applicant lor a Dermil suhlecis ihe applicant to a civil penalty of nol more ihan five hunOreO Oollars (5500).
❑ I, as owner of the pmpeny or my employees with wages as their sole compensation, will Oo the work, antl lhe
stmcWre is nol imenaea or o�feretl �ar sale (Section 70M, Busine5s and Pmfessional Code'. The Conirac�ors' S�a�e License Law
tloes not apply to an owner oi a propetly who builUs or improves �hereon, and wha tloes such woB himself/hersel� or thmugh
his or her own employees, pmvitlea ihai such impmvemen�s are no� in�entletl or o��eretl for sale. tl, however the huiltling or
improvemeni I5 soltl wiihin one year o� completion, the owner will �ave t�e burtlen o� pmving he/she tlitl not build or improve
lor the purpose oi saie�.
I, as ownerof ��e Oroperly, am exclusively conVaciing with licensetl conVactors to conslmcl lhe pmle�� (Seclion 704d, Business
❑ ana Pmfeuions Cade: The ConVactors' Sta�e License Law tloes no� appty �o an owner of pmperry xTo builds ar imDmves �hereon
and who conirac�s for suc� pmlec�s with a con�ractor(5)license pursuan�to ihe ConVaclors' S[afe Lic¢nse Law�. I am aware
ihat pmof o� Iheir Worker's Compensalion insurance shoul0 be pmvitleU to me.
� I am exem0� unaer Section: B. 8 P. C. .
lor ihis reason:
Dale: Owner
I ao hereby ceNfy Iha� I am aware of antl untlersiand the reqwrements oi Calilomia Health an0 Safety Cade Sec[ions 25505, 25533. an0
25534 antl Poa� I or any IUNre buiiaing ottupan� will/will nol (CirCle one) neetl lo tomply with saitl s�aie COdes an0lhe reQUir¢ments br a
permil lor canslmc�ion or matlilicalion tmm Ihe Air Oualiry Management DiSVic�. flesitlential cons�mc�ion applications are exempt imm
these provisions.
Daie: ApPlicanP. '
I herehy cetlity�hal I have reatl�his applicalion antl state �hai Ihe above inlormaiioni rre t.l agree lo comply wi�� allcity and coun�y
'or0inancesantlsta�elawsrelatingroGuildingconstmclianantlher amhorizerepre t iv flhisciryloenierupon��eabove-menlioneJ
propetly lorinspeclion purposes.
�a�e'.���� Signalure:
Onver's Gtense ar Social Security a: � �
t6at�a6 WM1pe—Buildin9l Green—Code Enlorcemenl Canary—Aoollcanl: Pink—Revenue: Goltlenrotl—Assessnr
CITY OF COSTA MESA — BUILDING PERMIT PEkM NO; B 0`809
PERMZT NO: B 058092 PLAN CHECK NO: 02561-92 S GqVT: N SUPF; N
CONSTRUCTION TYPE; 5—N PERMIT TYPE; STR FJRPOSE: OTH
JOB DESCRSPTION ; 60 LIN FT OF 'PII,ASTER WOOD' FENCING 5Q FT: 6�
CLAIM VALUE; CALC—VALUE: 600.00 GROUP OCC: R-3 /
COMMENTS: PILASTER WOOD FENCING W/GATE AT SIDE.
�x�� ******�********��c x�r***+�*�***�****x��*�**�c�*����r�txx ****x**�***�r***�r*�t**��r�*�*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAZN BUILDING ---------- --------- ACCESSORY BUILDING -- ------
FRNT: FT IN REAR: FT IN FRNT; FT IN REAR; FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN
PARRING REQ• PkOV: PARCEL; 139Q9307 ZNE; Rl REF NO:
PLANNING N6T'ES> PROPOSEn 60 LINEAR FT „ 6FT, HIGH, BLK. WALL ALONG THE SIDE
> OF THE PROP, LINE,
iE 34 iE iF iE iE iF �f iF iE 3F iE it if iE if iE iE if iF iE iE-lf )F iP if 1F �k if iF if # iF iE iEiE iE iE iFlF iG iE iFlE iF iE 9f iE if if iFlf IE IE �F iF1f )f if iF 1E �)f iE 3E ii� if ?8 3F iE * if !E if i(.3t1E �1F iE �1E
D E V E L O P M E N T S E,R V I C E S R E Q U 3 R E M E"N^iT,S
7.ONZNG APPROVED BY ;�f_�CK DATE:
HUILDING APPROVED BY :J l/ DATE: �_�/� 2
APPLICATION ISSUED BY; � DATE• •�" � �I%Z
iflf�fiElEiE�1elElfiF�lElliEiEiElflflFlEiEikiE r � �F r � ifihj6iEififiFfEiEfE ��c3FfF
�r**�r*�tit�*aE**+tjtx**iF*�rit�E**+�*�F***�t*iF+�*�t*it***ie+ x ��r�t�t�********�*��x�t*jc*it��at�***�r#**+e
LEGALI2ATION:N F E E S U M A R Y STRUCTURAL SEGMaNT;Y
t�'`
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 17,00 �-1 .50
� SMIP/NON—RES
PLAN 11,05 `,
ISSUE FEE
BliILDING—DIV—> PERMZT ISSUE PLAN—CHECK TOTAL%���• PAID DUE
TOTALS----> 17.50 0,00 ]1.0; 28,55 ✓' 28,55 .00
REVENUE DIVISION TOTALS--> COLLECTED; 28,55 OVER/SHORT: .00
BLDG PMT PLUMBZNG ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECR
17,00 C?�O SS.OS
/!
1E iE 1E iE 3E iF iF �E 1f � iE if 1F iF iE iE IF � if if iF � jf 3E aElE if �k?h iF if if if iE iF iE iF iE 3f 1f if a't iP if� if ii iF it IE aE iF iE if if iE �(� iF� if if iE iF ik �blF fE iP if 3E if iE 3f 3c?(� �E 1F aF 3E if �F
I N D I V I D U A L F E E H R E A K D O W N
TYPE QTY D E 5 C R I P T I O N UNI�T COST TOTAL COST
SFR 60 RES—PILASTER WITH ENDDbFTFEEST/ FT, 10.00 600.U0
�
r / n � "�+3
- :. . _, r; � p ��,. � ,
,� , �
� �' JUL 0 B 1992 '
CITI: OF CQSTA MESA
� POOL & SPA
� rCONSTRUCTION AND PLANNING : - ' � -
APPROVALS Permit# � Date � Inspector - " Date °. Inspector
APPROVALS Permit #
.� ✓ ,
1. Temporary Electricai Sarvice or Pole �� � 52. Pool & Equipment Location - - l.j
1 ;y�
2. Soil Pipe-Undrgmd. - � ' �'/� 53. Steel Reinforcement � . Y-
` '� _
3. Electrical Conduit Utiiitv-Ur(drgmd., �_ 54. Forms � ��/
4. Electrical Conduit-Undrgrnd , i� 55. Electrical Bonding. y
5. Steel Reinforcemen{ - 56. Rough Plumbing & Pressure Test . �
6. Electrical UFEfi Grnd. � 57. APPROVAL TO COVER�GUNITE
7. Footings ��� � 1� '2. �� 56. Electrical CqnduibUndrgrnd. „
i
8, Foundation , ..' �!�, •�, 59. Gas Pipe, � Undrgmd., Test �
L-
9. Water Pipe�Undrgrnd. �� °- f 60. -Backwash Lines, P•Trap, O Undrgmd. '%%�
70. Structural Floor System . � J '%�(�7 - 67. APPROVAI, TO DECK ,�
71. Property Sewer Line & Hous Connection � 62.� Backwesh & Receptor=Final • r:�,
72. Sewer Cap ����, �'� �.�-� - 63. Heate� & Vent-Final t. �
73. Foof Drains �` '1 :! i 64. Plumbing SYstem - Final -- �
14. Rough Plumbing 65. Electrica��Final
15. Rough Electrica6Conduit 66. Solar SYstem-Final .
-16. Rough Eleciric Wiring 67. Fencing & Access ApProval �
17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING
78. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTHMS FINAL
19. Rough Heating & Air Condixioning FIRE DEPT.-REQUIREMENT --
20. Rough Factory FireplaGe � APPROVALS Permit #
21. Ducts,in Structure � 70. Underground Hydro
22. Ducts, Ventilating 77. Product Piping O'Gas OOiI
23. �Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing _ 73.-Undergrnd�. Storage Tank � Gas ❑ Oii
25. Roof Sheathing � 74. Overhead Hydro -
26. �T-Bar Ceiling (Structura�l & 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. Elecvical Power Meter�Final . ' '�"''.� � 80. .FOOD CERTIFICATE ISSUED
33. �Final Electric � { � - � 'Notes: '
34. Final�Heating&AicConditioning, . � � . . . � - �
35. Final Gas Pipe�Test - . i � ' ` �
36. Hood or Canopy � �' � - - . �
37. Final Factory Fireplace � � ,
�� '
38. Final Plumbing ! ��
39. Water Service�Final . "
40. Gas Service-Final ,
41. Solar pomestic-Final .
42. Backflow Preventer � � _ZZ� �l -� � /�-
43. Backflow Irrigation • - �.�_�
44. Landscape Irriqation System � � , .''' '=-
pS.� '� �
- �45. Sound Attenuation . � ^'
46. Handicap Regulations � � ' " . ' .,
c
�
47; PINALSTRUCTURE&BUILDING Z : � � � �� "
i
ne. FINAL PLANNING -�, � � . - ! �;� -
,�..J. , n -
49. Elec[ric Release to Edison - • ' e��
50. Gas Release to Southem Califomia Gas Co � � ' r '
� ".'.,^-
57. CERTIFICATE OF OCCUPANCY
No. Date
Permit #�� 2
THIAL �NSPECTIONTREQUESTS Ny
` �`��l'�S'1
�PROV�I� '
c�rr oF cosr� ►�► ; �
plqNNING D�•
. , t � �p BLD6. DVL !�. ".
B
�� - � � ,1 L!' ("1"�'
v i� DATE-�
/yJ1NIN0
NO�E
ADDITIOPJS, DtL'TIONS; Q�; COR�2ECTIONS SHAAL
BE APPRO\fED BY iHE PLA��!idii�G D�PARTMEN(f
SllRVE`�' dF ��T UNE
MAy gF_ FE�e'��RED
� APPROVED
City of Costa Mesa Building Dept.
�Y DATE �7g�
THESE PLANS MUS7 BE ON JOB AT ALL TIMES MAKE
NQ CHANGES WITHOUT PRIOR APPROVAL OF DEPT.
'T�FIE ISSUANCE OR GRAN ��,f, pi A FER IT OR APPqOVq� pF
PLANS AND SPECIFICATIO�° 5�;.,�,. hr,l ac ,p�T�D TO BE A
PERMIT FOq, OR AN APFn �+[ ��^:r ah�d v kp7�aN OF ANY OF
THISC ;' •.�, r£;?a;�?pqESlAA1NGTOGIVE
AUTFpqITY TO VIOLATE Q;,.;;;C;EL �!-;F . NGYISIONS OF TNiS.
CODE SHALI BE VALID EXC �T�iN >G f.�A A THE tYORK OR USE
WHICHITAUTHOqIZE51SLA Fin
D �
'Y�5 "1. ��i � �� � ��� �'l � ��
U
�'�� "I W�- �� �� � � �
_ ��
11EtlD[Iltt
��.I-� !'
W
IQ- ,i
� o � 3�z2�
, `,
IILt1ptMC[
11E�ID[NC[
� G[� STREET � _
- A ERAfIi 8ASE0 Ui'v7J P�A�,;g µp
S CIFICATIONS SHAL NO pqEVENT T1 BUN,Dk,6, (KF��
F M THEREAF"fER RE UIR TF{r L'OiiHE 'TiCIY OF ERqpqg ¢,�
D PLANS AND ECIF aTIONS OR -qOA{ p{�yEMp,�,
LDING OPEqqT10N£ BE !;AkRlf� (� qEUt�Eq WFIEry
W IOlAT101J OF THIS ODE OR OF ANy OT ER OqpINqNCE pF
h .CITk[fIOENtb ,
._ _ _ ..., .T_Y_PICAL
-; �:;-T;,.
Cement Coping Ootional '
Channel Block With 1-3/8� .
; Horizontal Top of all ,
Fences ., ..
For Fenees 5' or Less
Vert. Bars 3/8" ¢ at 4' �0" O.C.
For Fences Higher Than 5'
Ven. Bars 3/8"� at 32" O.C.
Fill Cells Solid With G�out
WhereSteelOecurs __. _____._
Reinforcing�SteEl Shalb, r'� ('"+ : �,? . �
Co�form to'Sec.A-15_39,'" : .._� ! ;
A.S.T.M.
All3feel�to�Be Capped"� � +"r'��' e
24" or to Code'
, � ' -.
- � � NATURALGRADE
x.... -�. . ` ' i°/� �ti�J . .6
� `
� TW03/B"48ARS 7
., . � . - CONTINUOUS TOP. �, . I
- ., & BOTTOM _�{
, .. p
HOR7iSTEE1. MUST 8E TIED IN� �- ��
' PIACE AT TIME �OP TRENCH � i,;�.
INSPECTION, p
�
.- . ,
6�� CONCRETE B -L-OCK__ .F.ENCE,,
-��
� GENERAL=1NOTES
•y� t
MORSAR;, � pne Parf� Plastic Cflment, and
-'� Tliree Ports Sond
�GROUT;" "One"'Part Cement Three and
One Half Poris S�ond
COPING: One Purt Cement, Three
Parts Sand
CONCRETE: Well Mixed 1:2-I/2:3-I/2
Mak. ot 7- I/2 Galtons ot
� Water Per Sack of Cement
GROUT MAV BE M�!PED FNOM THE TOP
OF THE FENCE IN CELLS WHERE STEEI
OCCURS.
CELLS AND AREASOF HORIZONTAL REIN-
FORCEMENT SHALL BE CLEAH, CLEAN &
FHEE OF AlL MORTAH DEBRIS, E7C.
Z �
�) w n�
�
1
' ' i
: ;;
��" N !
on �— (
c.. �
� �HIDTH
�, SEE��CH[
o BELOYV
, , . � , f
e � ,
FOOTING REQUIREMENTS CHART
/
i
H GF E4RTHTCOTH �
�/3 ir1E HEiGTN OF fENCE
�ELOW B � TOM;OF'FOGTiNG
' SCALE: I/2°= I'
�' ,
6
WIDTH 14" . . 14�� . . . 12��... :,,. . :' 12��
THICKNESS . . 10�� . . 10° . . . . . 9,», � :_ -,8 ��
OEPTH OF EARTHT007H ... 24�� 20" .. 16�" .��. . 12��
SPACING OF EARTHTOOTH , 12' I4' ... 16'. . _`:-- .. 16'
City of Costa Mesa, California
Building Department
,. . �-Fvr�pD Nov. e:.
�.
� �, 7 - � � � � .._--�_
PflOJECT AOOflESS: ' 3 2 l z OREGON p.V
OWNEH'SNRME: SMITH, ROBERT L
�,�,� aooeess: 3222 O�EGON ST �
COSTA MESA,CA 92626
545--7495
OflCHIENGINEEfl: NEG.NO.:
ROUflESS:
UNIT:
UNIT:
PEXMITiEE: CI'IAMPION ROOFING ( 213 ) 259-0451
aooRess: 3257 VERDUGO
L.A, • CA 90065
LICENSEO CONTHRCTOfl DECNBATION: I hereby allirm Iha� I am licensed untler provisions of Chap�er 9(commencing wi�� $eclion
7000� ol �ivision 3 al Ihe Business antl Professions COJe. antl my license i5 in �ullforce and e�fect. '
ciTr uc.: 0 2 7 2A 5 STRTE LIC.: t; z�J t] 8 1 cu� s: = 3 4
^, - �Y � - Signa�ure: _
WOPREfls' ComPENSRTION oECLAPATION: I nereby aflirm thal I nave a ceNhcate ol consent to selbinsure or a cenificale of workers'
Compensation Insurance ar a ceniliea copy ihereol (Seclian 3800, Lab. C).
voucvNo.: WPO�i?819-04 EXP.OFTE: OGIOZI92
comraer: PACIFIC INS CO
❑ Cenilietl copY is �ereby �umishetl. � Cehihed copy is �ile///d ���wi�h Ihe cily Builtling Division.
� �f� qpplicani: �
E%EMPTION FPOM WOPREBS' COMPENSATION OECIANATION: (This semian nee0 not �e comDleteO if ihe Oermit is for one hunared (5700) or less�.
I certity Ihai in �he petlormance o� ��e work far which this permi� is issued. I shall no� employ any person in any manner so as to become
suhlecl to ��e Workers' Campensation Laws of Calilomia. '
�ate: � Signature:
NOTICE: II, a�ter making Ihis declaraiion, you should become suble�< <o Ihe Workers' Compensation pmvisions ot the Labor
Code. you musl lorihwi�h comDly wi�� such pmvisions or ihis Oarmit s�all be deemetl revaketl.
CONSTPUCTION LENOING RGENCY: I here0y atfirm Ihai �trere is a construclion IenAing agency �or t�e peAormance of lhe work for
which ihis permit is lssuea (Section 30W. Civ. C�.
LENDEB:
AUONESS:
OWNEH BWLUEB OECLABRTION: I hereby aftirm Ihat I am exempi imm �he Conirac�ors S�ate license Law br �he bllowing reason
�Seclion 7031.5 Busine55 an0 Profe55i0nal COtle: Nny ti�y Of tounty whic� requires a p¢rmit m tonSimCt, aiier, impmve. demolis�. Of
repair any simcture, orior to ils issuance, also requires Ihe�applicant tor such permit to lile a signetl statemenl Ihat helshe is licensetl
pursuant �o �he pmvisions of ihe Coniractors' Stale License Law (Chapter 9(cammencing with Section 7000) of Division 3 0l tAe Business
antl Prolessions Code) ar Ihat he/s�e is exempl therelmm and Ihe basis for �he allegetl ecemption. Any viola�ion o� Seciion 7031.5 by
any applicanl Ior a vermrt su�ie��s Ihe applicant to a civil penalty of not more ihan five nuntlretl tlollars (�`�1.
I. as owner oi �he pmperly or my employees wi�h wages as Iheir sole compensation, will do the work, and �he
❑ s�mciure is nol inleneee or offere0 �or sale (Seciion 7044, Business and Prafessional Cotle: The Conirat�ors' State License Law
does not xpply to an owner o� a pmperiy who Uuilds ar impmves thereon, and who doe5 such woM1 himself/hersell or (hrough
�is or Aer own employees, pmvitlea ihat such impmvemems are not intentletl or oiferetl lor sale. I( however t�e builOinA or
impmvement is sold within one year o� comple�ion, the owner will have �he bm0en of proving he/she tlitl no� builtl or impmve
lor I�e pur0ose of sale�.
I, as ownerol �he pmperty. am exclusivety conVacting wi�� licensed contractars lo con5�rucU�e pwle�� (Seclion 7044, Business
❑ and Pmiessions Cotle'. The Coniracmrs' S�a�e License Law tloes noi apply Io an owner o� pmpeey wAo builtls or improves ihereon
and who canirac(5 �or suc� pmlec�s wi�� a canVac�ar(s�license purSuanlio Ihe Contractors' State License Law�, I am aware
Ihat pmo� o� their Worker'S Compensa�inn insurance shoWd 6e pmviaed �o me.
� I am exempt un0er Section: B. 8 P. C. , ,
lor ihis reason:
' CITY OF CUSTA MESA — BUILDING PERMIT PERM NO; B 054119
PERMIT NO; H 054119 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION ; T/OFF REROOF W/FELT 6,COMP. SQ F.T: 3,000
CLAIM VALUE: 3,000.00 CALC—VALUE: 3,000.00 GROUP OCC: R-3 /
COMMENTS: SMOKE DETECTOR RE�UIRED "
*x���x�**�r*���**�***�+�*�*�* �*�r***+e**��**�***�*****��e***�**���+��r�*�**�*�**�r�x**
• Z O N I N G R E Q U I R E M E N T S '
S E T B A C K 5 \
------------ MAIN BUILDING ---------- --------- ACCESSOit`� HUILDING ------
FRNT: FT IN REAR: FT IN' FRNT: FT IN REAR: FT ZN
LEFT; FT IN RGHT; FT IN LEFT; FT IN ft�i3T; FT IN
PARKING REQ • PROV; PARCEL: 13909307 ZNE; REF NO;
PLANNING Nt)TES>
i
*�**�x*�**�,«�,��*��***��******���**���*�����**�****+�**,��*�***�x.*�*�*��:*****��*�*
D, E V E L O P M E N T S E R V I C E S R E Q U I R E M E N`T S
20NING APPROVED BY DATE; '�,,�
BUILDING APPROVED BY ; DATE: ',�'
APPLICATION ISSUED BY: _—� DATE: � ���
ik if �E If jE �IE iE 3F iE iElE iE if iE If iF if iF iF iE iE iE�iFiFiE F�'�7FiFiF1f iF if if iF iE 3f iE if 3F���iE M�
iEiEiflfiE�E3E�fiE3FlEjFiFiEifiEiEiflEiFiElFifikiFiEiRiEiP�EiEiFiP3flf3ElEiE iFiFiEiE�)biflEiFjFifiEiPrtiEiEiFiPiFlf#�tikifiEiFiE�EiE3F�EiflFlifiEiEifik
LEGALIZATION;N F E E 5 U M M A R Y STRUCTURAL SEGMcNi:Y
HLDG PMT PLUMBZNG ELECTRZC MECHANIC FZRE SMIP/RES." GRP.DING
PERMIT. 54,00 ' ,SQs,
SMIP/NON=RES
PLAN . '>,
ISSUE FEE
BUILDING,—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID ''^r DUE
TOTALS----> 54,50 0.00 0.00 54.50 59.50 • •,00
REVENUE DZVISION TOTALS--> COLLECTED: 59,SQ OVER/SHORT: .00
BLDG•PMT PLUMBING ELECTRIC MECAANIC FIRE SMIP/TOT GRADING PLAN—CHECK
SY,�� ,J� y
; ;
9f iF iE �(' ff ff ff iE iE fF iF 3E iF �7FlE if 1F �E iEik iElf �E ak iF if ik �lE iE �1P iE 1E i6 if �f-�If iE iF if iF ff iP �1F 1E iF if iF if iF af Ik if 1E if 3f if� *if�if if )i iE 1f iF if iF if N if R 1f iE if iF iE ik lk lf 3F
I N D I V I D U A L F E E B R E A K D O W N �-
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
Date: Owner � I SFR
I ao hereby cemty ihat I am aware o�,antl unaers�and Ihe requiremems o� Califomia Heal�h an0 Safety Cotle Sec�ions 25505, 25533, antl
25534 an01ha1 I ar any iWure building occupant will/will not �ci�cle one) neetl lo comply with saiA state codes and ihe repuiremenis for a -
peimi� br conSlmcUon or modilica�ion imm �he Fir Quality Management OistricL Residential cons�mcfion applications are ezempt fmm
Inese pmvisions. . �
oale: • Applicanl:
I hereby cerlily Ihat I have reatl Ihis application antl slale I�a� I�e a6ove inlormation is correcL I agree lo comply wiih all ciry an0 counry
ortllnancesan slatelawsrelatinglobwl0mgcon5�mcilonantlhere�YaWhorizerepr en�ativaso��hlscirytoenierupontheabove-meniianetl
pfOp¢f�y Ip Ip ¢CI100 p11fpO5C5. �
�e1r ��� Sgnature:
oa�ers ucense o� sociarsecu�ity a: � v
�6a1�46 White-9uiltling: Green—Cotle EnlorcemenC Canary—Applicanl: Pink—Revenue: Goldenmtl—Assessor
3400 REROOF BY VALUE RESIDE:NTIAL N020NE
END OF FEES
>
1.00 F: 3,000.00
0! OP0981i7—U:�J53i�� Ya:i�- ...
DRTE: 44/ryE.'�^; TL�t: IGsG°
,
�
� �
G�JNSTRUCTION AND, PLANNING ! �- POOL & SPA . , �
APPROVALS Permit`# � : Date Inspector AppROVALS Permit # . Date Inspector
.1. TemporaFy.Electrical ServicrpnPole � `�� 52. Pool & Equipment Location ��^
�.
2. Soil Pipe-Undrgrnd. '�•i �` �� 53. Steel Reinforcement �i
� a.
�.3.� Electrical Conduit;l,ltility-Undrgrnd.� �. � "" 54. Forms � _ �. �
. �4. Electrical Conduit-Undrgrnd^� . �' ' 55. Electrical Bondirig . �
;: 5� ;S�eel Reinforcement � � . _ � 56. Rough Plumbing & Pressure Test �
�`6..=Electrical UFER Grnd. . � . � 57. APPROVALTO COVER-GUNITE
'� 7'.,Footings - � � 58. Eiectrical Conduit-Undrgrnd.
��: 8.� Foundation � 59. Gas Pipe, O Undrgrnd.; Test �'
__(
9. Water Pipe-Undrgrnd. "'•�'1 '�� 60. Backwash Lines, P-Trap, O Undrgrnd.
'. � `��/
10. Structural Fioor System � , �.\) - 61. APPROVAL TO DECK
71. Property Sewer Linc�& Hou3t�:Connection ' � 62. Backwash & ReceptorFinal - 1. �
.T
12. Sewer Cap '� � �" �
. 1, 63. Heater & Vent-Pinal
13. Roof Drains 64. Plumbing System � Final
14. Rough Plumbing � ' 65. Electrical-Final , ,
15. Rough Electrical-Conduii 66. Solar System�Final • .
16. Rough Electric Wiring 67. Fencing & Access ApProval �
17. Rough Wiring Sign 68. APPROVED FOR-PLASTERING
18. ftough Electricaf�T Bar Ceiling , 69. POOI/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning' "FIRE DEPT. REQUI�REMENT �
r r
20.�Rough Facto.ry Ffreplace �' � � _ C .� � APPROVRiS'� ��'Permit# � �'
.f > - i ..r � .0 . _ F"
21.'Ducts, in Structu er ; . -. _'' � = `�� ' '' " '
. c c �. , y �.70. Wnderground_ Hydro -
22. Ducts, Venti�rting + � -_ � �t •' i77. Product'Piping O Gas ❑ Oil
23.-Gas Pipe-Rough & Test � .;� _ . - E. , 7Z, Underground Flush= , - ', "
24.+Roof Framing _ . -• > � V � � �� ^73.�Undergmd.Storag2Tank �Gas ❑(3il
•,i :3 Y ( .
25. Roof Sheathing ,��� s � ' ��� � , `',;;, ' �'7q,'Oyerhead Hydro . �� ,�,
26. T�Bar Ceiling (Str.ueturap &�Monocoat �r 75.� Dry Chemical -
ti ��
27. Frame and Flashing` ' ` y , 76. Dry Standpipe .,. '' �
28. Lathing&Siding • _ "�t�•. i: +v�. � �� � 77,.FIXEDSYSTEM-F�INAL� •
�29. Insulation '' . - �' '� ' ° � � ' 78iFIRE PREV. F�NAL . >:
��'30. Drywall�Nailing ��w , _ ���%-j�� � HEALTH�DEPT. REQUIREMENT '
a <
_31. Plaster Brown Coat� , ; , ,. ' �'�,A , ,79:'FINAL INSFECTION ' .: j
,32. Electrical Power Meter,�Final� :_ i � � � . �80. �FOOD CERTIFI�ATE ISSUED -
33.fFinal Ef,ectric � ,. _l, ; "- � ,Jt � Notes: � -' ; .�.� � ,,�
,�,.34. 'Finzl Heating & Air Conditioning, - ' rI`] �• - � • , . , _ � '
M1-� F . r
35. �Final Gas, Pipc-Test. _ • ' ' �'`S.� •��� • • � � .' ',�
� . 1 , .. - . ,. . ' .
36. Hood orCanopy > ;�� � '. + s� : Z,�
N
�37. �Final Factory Fireplace ` ��'� �' � ' ' Y + ,
�-38. Final Plumbing • � i � • � ` .. �
M ' Y F.
.39. Wat�r Service�Final ' - ' � ' � ' ' "
,. , .
.40. Gas Service-Final : _ � ,; i . . �
. 41. Solar pomesticFinal . ' � -+ ' _ -
-� '
42.-Backflow Preventer. , ' . � "- . � _ - .
43. Backflow Irrigation '' ' � ? '` - � �
. ,
: l: � � .
.44. Landscape irripation System� �; � � �. ,:, ,
� 45.:Sound Attenuation ' ' _ � � : " �
46.,Handicap Regulations ' � . . . �� , . , .
'47. FINAL STRUCTURE & BUILDING � • � 'C ` _,IJ` � /j � ! i /,) �
�� � �7� /f'- O Lt.[�
48.'FINAL PI.ANNING . �� . � � �'� � , ', � +� •
- i r .
49:. Electric Release to �Edison . �, , • . ^ �
50.,Gas Release to Southem Califomia Gas Co t � :'� �� :.• .
,51. CERTIFICATEOF.00CUPANCY . .} . • ; - .
No. Date
' �.:��59
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 COBTA MEBA. CA6IFORNIA
For Applieanf fo Fill In Complefely
TYPE OR PRINT
ADDRESS 3222 Oregon Avenue
COSTA MESA. CALIFORNIA
1533 B�er St.
Costa Mesa TEL.KI
�rden Grnve
Dike & Colegrove, Inc
1533 Bal� r St.
Costa Mesa. Calif.
��w�t �t�. 9-
u�.No. 1 ?293 NO. KI•
OF LOT 1�41Xi_hyS� V8 X 1�0 I Now�o
6¢TBAIX LIN¢ FROM I�
CeNiex oP srneer 48 � REAR VARD �
SIDE YARD ILEPT 1�� IRIGHT ��
DESCRIPTION OF WORK -
I9 ZE�'NG 1560 3Q �� ROOMS T STORIES �.
AND WORK TO BE
, ; "�'� �' ^t
u e . . . �. . _ e..
C� ;cN 1 S i�s�
r� , � •r ll 1- .
��. i 1,; F T
�i�" (;i= �,(JS'.' n'I:SA
APPLICATION FOR PERMIT
BUILDING
For Offiee Use Only
NECEIPT NO. � �QM�T�O
�J \_O
BY OATB RECF�IVED oATE 198UED
� / �. � 7 � /I _�i{f11 1 n inAC
BUILDING
AODRESS
COSTA MESA. CALIFORNIA
ZONING
Zory� I I PLAN9 _1 I6UILDIN6e
lq"' -TT
LEOAL L�y V� yj'• 3403
OEBCRIPTION
YARDS EVES
APPROVED ALLO
fCBNTGR LINB BTJ , _
�1
. ...__ , �
Sin le £amil residence �rith 7"
attached garage. Plan 21CR
1 HBPEBT AGI(NOWLEDGE THAT 1 XAVE RGAD TH18 APPLIGTION THE AMOUNT 6XOWN UNOER VALUATION 19 FOR iN¢
AN� 9TATE THAT THE ABOVE 19 CARRECT AND R6q2E TO CON- pURP08E OF EeTAeLI8HIN0 A vERMIT FEE ONLY.
nLY WITX ALL CITY OPDINANCEB AND 6TAT8 LAW9 IiEOULATIN6
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