HomeMy WebLinkAbout131 MORRISTOWN LN - Building Permits ....--c rx
CITY OF COSTA MESA
BUILDING DIVISION
F iith 41 DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER
PERMIT
"*• mos 602-01288
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 131 MORRISTOWN LN Status: ISSUED
Suite: Applied: 08/16/2002
Vicinity: ROOF Issued: 08/20/2002
Parcel Number TPN98078 Zoning:
Applicant: BLANKS, JERRY ISSUED BY:
Address:
Phone:
Zip:
Owner: MONTICELLO HOA
Address 150 VALLEY FORGE RD
Phone:
COSTA MESA,CA Zip: 92626 •
Contractor: PREMIER ROOFING AND BUILDING CO INC
Address: 17501 NORWOOD PARK PL
Phone: (714)573-0155
TUSTIN,CA
Zip: 92780 License: 634404
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF FOR 131-145 MORRISTOWN LN.INSTALL 1 BASE,4 PLY WITH HOT ASPHALT THEN FLOOD
WITH ASPHALT AND ROCK."MONTICELLO"
FEE SUMMARY
Plan Check: $0.00 • Calc Valuation: $17,519.00.
Permit: $293.25 ' Claim Valuation: $17,519.00
SMIP Res: $1.75
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $295.00
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
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire 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 Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS �
l" l (-1
WORKERS'COMPENSATION DECLARATION: -
I hereby affirm under penalty of perjury one of the following declarations: ''r
❑ 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.
icI,]' I have and wit maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
✓ y workers'compensation Insurance carrier and policy number are: i
Carrier: J Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the pe ormance 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'
c•_•-• . 'on laws California,end afire that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
^ - p visions.
pplicant Si••- . .: • E ate:
` 45-
i O ��
WARNING:FAILURE TO SE RE WOR✓✓✓✓KERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL'ENALTI--AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DO I ARE($1 j,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:
I hereby affir• •: am license, under provisi nsof Ci apter 9(commencing with Section 7000)of Divisi of the Business and Professions Code,end my license is in full
force .1-- :-. C% _ -
esa C.
si tracto-tire: f. 1 c/c --
I
CONSTRUCTION LENDING AGENCY:
0 I 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).
Lender's Name: Lender's 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).):
❑ I,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.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes 0 No Driver's 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? 0 Yes 0 No
(Section 25505 of the Califomia 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 0 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 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 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ppermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes j I 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 0 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 district 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? 0 Yes 0 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 is
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 the
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! +r,,'��'-jj• _Owner(s) D. =
' -•lire.
An" 4. • • .•..licant late
CODE A 1 ECTi0N TYPE _� PAIL INITIALS CODE INSPECTiON TYPE WI KIM/
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof G(-11-442- - 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
4 PROJECT ADDRESS: 131 MORRISTOWN LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 069488
OWNER'S NAME: BOWENDAVID M
ADDRESS: 131 MORRISTOWN PERMIT NO: B 069488 PLAN CHECK NO: N GOVT; N SUPP: N
COSTA MESA,CA 92626
%; CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/O RESTH & REROOF W/COMP & HOT MOP SQ FT: 2 , 508
ADDRESS: UNIT:
CLAIM VALUE: 2, 508 . 00 CALC—VALUE: 2, 508 , 00 GROUP OCC: R-1 /
PERMITTEE: STOUT ROOFING, INC, ( 310 ) 923-6775
ADDRESS: 9700 WASBURN RD COMMENTS; REROOF SLOPE SIDE W/COMP FLAT SIDE BUR SMOKE DET, REQUIRED
DOWNEY CA 90241 ************�r***ir�ra6*sr********* ********�Ea6*s6*****�6*******�E*ar********a64E*;6+t*******
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENT S
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACK S
CITY LIC.: 059377�Yp
LA
STATE LIC.: 402536 CSS: C-39 XP; 10/95
Date:A OIO�( 0 signature MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I herebyaffirm that I have acertificate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR; FT IN FRNT; FT IN REAR: FT IN
Compensation q5u e o a ified copy thereof Section 3800,Lab,Ci LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: ] 269 EXP. DATE: va5/19/95
COMPANY: AIG , PARKING REQ: PROV; PARCEL : 41916268 ZNE: REF NO:
Certified copy is hereby furnished. i1VV Certified copy is tiled with the city Building Division. PLANNING NOTES>
r� r1.-W/�' I >
Date: 1L J( el A Applicant. ****************************it**************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION:: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES R EQU I R E M E N'`T S
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 California. ZONING APPROVED BY DATE
Date: Signature' BUILDING APPROVED BY : DATE:
NOTICE:If.after making this declaration,wiyou should become t i spermit to the Workers'Compensation provisions of the Labor
Code,you must fonhwilh comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; DATE- L..1JI_
which this permit is issued(Section 3097,Civ.Cl. **************************** ************************************** * *16**
LENDER: **************************** * ************************************** **** ****
ADDRESS: LEGALIZATION;N E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 54 .00 , 50
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Processions Code)or that he/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). ISSUE FEE
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 54 , 50 0 , 00 0 . 00 54 , 50 54 . 50 , 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale. If, however the building or REVENUE DIVISION TOTALS--> COLLECTED• 54 . 50 OVER/SHORT• 00
improvement
purlhin one year of completion,the owner will have the burden of proving he/she did not build Or improve
forthepose ofsale) BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 O O S O
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law). I am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL FEE B R EAK DOWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: SFR 2508 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 2 , 508 , 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said slate codes and the requirements for a
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions.
Date:__ Applicant:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property foor�inspecttiioonnn purposes.{
Dale: tO/[7bI"1/i( '�h DAT1 001705V-00170510
: 10/28/9417 TIME: 12:30 54.50
Signature.
Drivers License or Social Security a: •
r641-46 White—Building:Green—Code Enforcement:Canary—APplicanr:Pink—Revenue:Goldenrod—Assessor
4
CONSTRUCTION AND PLANNING
- PO I SPA ;---
Date Inspector APPROVALS Permit# Date Inspector
APPROVALS Permit#
-1, Temporary Electrical Service or Pole • 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 'J 53. Steel Reinforcement I
A -
•3.-Electrical Condoirt lit ilityiUndrgrncP: 54. Forms
__
"14i•Electrical CondLSt FYndrgrnd. 55. Electrical Bonding
,_ 5P'Sfeel Reinforcement 56. Rough Plumbing & Pressure Test
< _
'j 6:11.Electrical UFER_Cernd. a 57. APPROVAL TO COVER-GUNITE 1 , }
7.:Footings T 58. Electrical Conduit-Undrgrnd. + -
8.Foundation r 1 59. Gas Pipe, 0 Undrgrbd.,Test
9. Water Pipe-Uncirgmd. q - I 60. Backwa: �t:y,.,.i.'.iirap. 0 Undrgrnd.
'10. Structural Floor'System 61. APPROVAL TO DECK
11. Property Sewer Line.& House Connection 62. Backwash & Receptor-Final
12. Sewer Cap - 63. Heater & Vent-Final
13. Roof Drains It 64. Plumbing System - Final
14. Rough Plumbing -I " 65. Electrical-Final
15. Rough Electrical-Conduit . 66. Solar System-Final
I _ -
16. Rough Electric-Hiring1 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
r -u
20.E Rough Factory Fireplace I ,•4:-11; -r:4 x1, 1-.1 '' :APPROVALS._ c Permit# r
21:+?ucs,in.Str1ctu?F` I •,••••'
••• �^ c_ _ -;70. Ohdeg;Pund Hyo -
22. Ducts, Ventilating„ - '' :171. Producf Ppifig G'G5s JOil
23.Gas;PipetRoy qh 81-Test in ..7•4 *; `;72. UndergrbuntJ Flush • - '
r
24.:Rooi Framing re* '-• -' ^r• : -• ; _
• 1 •. - 7321Undergrnd.Stor STank 0 Gas 0Oil {{
25. Roof Sheathing ; k e. n� �l� Y 4.4. 4 : --74.-Overheadliydro_;` '`
26.-T Bar Ceiling (Structural) &•Manoeoat a ri i : 1 75,='Dry Chemical r
27.-Frame and flash" - - •' ' - .r7
x - . ,� 7r 76.- Dry Sianc�,E�i P.e 1-',�r, t �,
28. 'Lal#ting& Siding; r • - k . Z .. ..t . 77.2' FIXED SYSTEMJEINAL'
'29. Insulatigp -. _ " " s " " ' f
i• " 78g-FIRE PREY, FI(>.F,1_ r r.
30. DrywallNailno •• I x - HEALTHIDEPT; REQUIREMENT
;31. Plaster Blown Colt, r „ I ' 4. { 79.-'FINAL Ir $P.,ECTIO'N ' ' _
:32. Electrical Power Meter;Final ; '' I I; : n80.:f000 CERTIFICATE ISSUED
� --
33T•Final Electric '7 ,, i • -I' l •'••Holes• 1 ' .I
• 7 T
34. -Final Heating.& AIr Cbnd'tionii g " I ' r -t
35..*Final Gas Pipe-Test'N i' I I• it ' t•1,- '+• _
r- Thi + _ 1-....• r• I r• -.,,
36. Hood or-Canopy • ' I 1• `
37/:Final Factory Fire-prate * "' • ' t '. .i
38. Fina,4 Plumbing u3Y ; ,c
1.39. Water Service-Finals - • I It • - Jr:; . •r•
440. Gas Service-F,inal2_' at I I I: . "'" .-1- 11.1 !i t
41. Solar Domestic-Final •• 7 i lT •
:,i I I •
r42,=BI ,ackflow Prevente{' - � i ' t tr
43. Backflow Irrigation= i:_ _ • . •• ;'r •
-44. Landscape Irri at. ` r.' ,'.
1. P A ;oo SYstemy nt s - - 7 t-� -1'Ei T t ) ..
-A5. 'Sound Attenuation -+t'. - r r - -
r• `
-46. -Handicap Regulation _
s ' , . e q r• •• I
.47.,f1N'&LSTRUCTttRE & BUILDING `I.L ?-s -3 ;:c.
T
48SFINAL PLANNING. ' '`'y- i I I• u o' -
I I Ia . r _t .1
49._Electric Release to Edison i 1 i• .: r:; .
50. Gas Release to Southern California Gas Co : ! I_ : . •
.�.�t •
51. CERTIFICATE OFbCCUPANCY- -. ., „,
No. Date _
VIV1VELLL LJZ++V V.1.1.1.1-1-1 uuuu.Laag Isv. uclLLA .. ._S—v1
JOB ADDRESS 131 Morristown Lane BUILDING PERMIT NO. 27183
GENERt.L CONTRACTOR Owner-Bat. DESCRIPTION OF WORK Res.watt.gar.
AP No. l41-701-03 LOT 268 TRACT 5160 FIRE ZONE VALUE $ 17,6!10.00
INSPECTIONS I Signature Date GROUP I & J TYPE V ZONE R-3
Soil a1 SUBCONTRACTOR I PERMITS ISSUED
Gas _ - Date I Number I Signature
Wa�4,171-5-7-717-6,— . _ P umbin_ ,
Rough Plumbing MS. . g' -247,7,i,/l;.'!�1_.Jl.:�{' a- gag-. °tin
/ �//�
Prop. Swr. Line 0 House Con. 0 .— --0
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning fa!'jr.... {>
Temporary Service or Pole _ '! • 0f .7
Underground 0 Power 0
Rough Wiring ,q, s , _ Heatin nd en,"
Trenches f$ Forms ® Steel Reinf. leiti i _Ci y��/. ./��y ,. g/3'_,(•,'/ 4-207
Floor System e 7/3//(/x.,7 /
Bond Beam 0 Steel Reinforce 0
Sheathing 4 74 trot,
Frame and Flas jcit/I# !
. ...•.- • .
Lathing— In t► jr;ut 4 .�
('
Plaster, Brown Coat I en d" .2s 7 V
Structural, Final _ El• 'c �d��� � (� ,
Heating, Vent., Refrig. and A.C., Final _ . . ,G PI .1f6.4r=_ P/•It 31 'L oZ 0
Plumbing, Final and Gas Test Zr //.�� i/EP-4 I I+9�'iigagffJ717 t a. 07
a,
Electric, Final l_3 ,a LiJ A
Building, Final I . -"tie-
e Lp/F,/ C 7
•
•
2 t 83 PAID
JUtd 19 67TI.iS�OO7630 > ^'*'°i85.5"
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1208 COSTA MESA, CALIFORNIA 02626 -
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT 1/�- ., ^ �B�UILDING
SU I LD INS p D , , /l� 1�tl�M.l For V)(1Ce Use Only
ADDRESS
RECEIPT NO. PERMIT NO.
COSTA MESA. CALIFORNIA -------
yy�/// 11A67.21:21118.77
7/GP3
//,�� RECEI b' DA&'7 r//
OWNER l V CZLC- L ,C(L)
•� ��L11(`l4-GC-Il�.(/L�{/. �7 ((// 1
ADDRESS 2 .;LIF C(L etU mile INA., ADDREIS /31 o-�i�Ll:d.1/uh,J
/� _ FIRE V y
CITY Oa :Ctle (-!> No:'932i 0 G/ ZONE '3 TYPE GROUP
ARCHITECT ...(((,��/�]]}{���� yn n, IT T:87,234 APPROVED / / /
OR ENGINEER C- - �•^'W�� /'�DATB/d�CI
cl D 2— E 9-P,1 t , ttq ZONING
ADDRESS �,/ .•R{� �I No.of l OF HEW .
CONTRACTOR l� I.LJ-Y(,C„-Q1 V(�1\ 'Pu_1Iu / cl1. EDI- 2/M,/;-- e-A/
_ LEGAL ` �! Z 4 a ( J i IV 0
ADDRESS ((0 CULLL_Q DucRlmaN �,"��s/11
CITY G U.,.(.(.,W- A.P.NO. tilt-/— O /-� 6
NOTE: NO CAVE OVERHANG SHALL BE LESS THAN
STATE TEL 30'TO SIDE H REAR E.L
LIC.NO. NO,
EAVES
SIZEb`K -n I I NOW ON LOG . O ALLOWED (U.B.C.REQUIREMENT)
OF LOTLOT
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/L STREET)
SETBACK LINE PROM.------ morn Cc, FT.
CENTER OF STREET REAR YARD
A RIGHT R.SIDE d FT, A.
SIDE YARD! LE
DESCRIPTION OF WORK L.SIDE On. A.
NEW Le- ALTERATION_ ADDITION REAR C) n-. A'
DISTANCE BET. BET.MAIN&
REPAIR _MOVING DEMOLISH MAIN SLOGS. •• ACCESS.BLDOS.
BUILDING'') NO.OP /� VAR.# ,/'/ DATE �j
SIZE LO J( �� ROOMS •r STORIES Z C.U.p.# G' /4 Y' APPROVED 6-(/S-(03
EXTERIOR WA ROOF 0.."'^�a' ia-LL - APPROV[p,/ ///'I /' / /
COVERING O COVERING .'V1-e- C EY (Al . 0,. DATE l,p l• I 1 p- ln7
USE OF-SU I LD1 D VYORKgeter TOB ERFOR D 4 n a' D,
CC�A ^C:a.C.:;V( ()iL4 i'. oP Y� 3 yoo
MOLD FOR,(1 ECIAL REQUIREM!~pLTS `�
SQ.A.
o
I HEREBY ACKNOWLEDGE THAT.I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION 18 FOR THE
AND STATE THAT THE Aeon.Is CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT PEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STAT!TAINS REGULATING
BUILDING CONSTR CTION. VALUATIONf/y 0
SIdi GNATURE OF
PERMIT FEE s J /-- m
PBRMITTBF - A—( A —.L-4._ n, Y/7
/ / ti/ J / (/ PLAN CHECK S 021,570 W
AUTHORIZED AGENT - a ' �,
.. ., � TOTAL PEE S J/ Dn