HomeMy WebLinkAbout1630 MYRTLEWOOD ST - Building PermitsJECT ADDRESS: 1630 MYRTLEWOOD ST UNIT:
IWNER'S NAME: MONACO, RENATO P TR
+ADDRESS: 833 DOVER DR #16
NEWPORT BEACH,CA 92663
ARCHIENGINEER: REG.NO.:
ADDRESS: UNIT:
PERMITTEE: LEE ROOFING (714) 642-7223
ADDRESS: 1653 SUPERIOR
COSTA MESA CA 92627
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professionsf and effect.
CITY LIC.: 07.8751 STATEuc.: 349686 CLASS: 9
-X.ite:—�Y^''y Signature6O!$-
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers'
Compensation Ie o a c hfie , Lab.
POLICY NO.: "bO�-b If EXP. DATE: 66/30/94
COMPANY: STATE FUND,,--+J�
❑ Certified copy is hereby furnished. 1J Cerand is til a city Bui cion.
Date:? - -y' / y Applicant �I —
E%EMPTION FROM WORKERSS COMP�DECLARATION: (This section need not be completed if the permit is for one hundred ($100) or less).
I comity 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 WorkersCompensation Laws of California.
Date: Signature:
NOTICE: It. after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor
Code, you must forthwith 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
which this permit is issued (Section 3097. Civ. C),
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of 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/she is licensed
pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/she is exempt therefrom and the basis far 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 em loyees with wages as their sole compensation, will tlo the work, and the
❑ structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law
does not apply to an owner of a property who builds or Improves thereon, and who does such work himselVherself 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 wilf have the burden of proving he/she did not build or improve
for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
1-1andProfessions 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 eontractogs) license pursuant to the Contractors' State License Law),I am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B. 8 P. C.
for this reason:
Date:
I do hereby certify that I am aware of and understand the
25534 and that I or any future building occupant will/will
permit for construction or modification from the Air Conti
these provisions.
Owner:
requirements of California Health and Safety Code Sections 25505, 25533, and
not (circle one) need to comply with said state codes and the requirements for a
ly Management District. Residential construction applications are exempt from
Date: Applicant:
I hereby certify that I have read this application and State that the above information is carr¢ ereA to comply with all city and county
ordinances and slate laws relating to building construction an TCprESen2dv of is city to enter upon the above mentioned
property for inspeclion purposes.
Date: l ll —1Y Signature:
Driver's License or Social Security u:
164146 Whne—Building', Green—Code Enforcement, Canary—Applicant: Pink—Revenue: Goldenrod—Assessor
CITY OF
COSTA MESA - BUILDING PERMIT
PERM NO: B 06680
PERMIT NO: B 066803
PLAN CHECK NO: N
GOVT:
N SUPP: N
CONSTRUCTION TYPE; V -N
PERMIT TYPE: STR
FT IN
PURPOSE: ALT
JOB DESCRIPTION T/OFF REROOF W/COMP
SQ FT:
3,600
CLAIM VALUE: 3,600,00
CALC-VALUE: 3,600.00
GROUP OCC:
R-3 /
COMMENTS; SMOKE DETECTOR REQUIRED PRIOR TO A FINAL
Z 0 N I N G R E Q U I R E M E N T S
S E T B 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 REQ• PROV:
PARCEL:
13919334
ZNE: REF NO:
PLANNING N TES>
aF 1! * 1E 1E iE 1E 1F fE if iE 1E i6 41E 1E 1E fE iE if iE BE 1E 1E 4 * 441f ¢E ie k 1E ik iE fE fE if 1E * 1f fL iE iE iE fE 7E * fE
41E * * !f if iE if BF * * iE iR iE li * 1E aE iE iE i61E 1E nE 1E jE iE iF iE if -
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 BY:
iF*iF iE 1E 1f 1F iE iE fF ek it iE eE iP kiE'lE if if iF ik��
DATE:
1E iE 4E iE iE iE iE iE it lFiF�FiF 9F
iF 9E 6E 1E ie if iE BE iE * 1E iE jE iE iE iE 1E iE * * aE BE 1F k 1E iE iE iP iE iF ie if !e iE lE iF iE * * 1E iE �iE eE if-iE as aE BE lF 9t 1E 1f aF aE aE ie ek 1E 8E 8E 1E #f if iF iE iE aE fE iE if ie ie ie iE iF iE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC` MECHANIC FIRE SMIP/RES GRADING
PERMIT 63.00 ,50
PLAN SMIP/NON-RES
ISSUE FEE
BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE
TOTALS ---- > 63.50 0,00 0.00 63.50 63.50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 63.50 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK
63,00 .50
***Bf*iE*1E 1E if 1E*44kfE iE ie%iE*iE 1f#ffle It iE iE*itleiE*iE iE if if iE if lE*fEfE if iP if lF iE ff HE 4Ek%it iE lE iElE if iE lF illt lF ii lF IF iE BP if if Bf aE iE it if Bf iE
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
F.
SFR 3600 REROOF BY VALUE RESIDENTIAL NOZONE
END OF FEES
t
I
1.00 .3,600.00
01 00158891-00158892 TOT 63.50
DATE; 04/14/94 TIME: 07:57
CONSTRUCTION AND PLANNING
,APPROVALS Permit r Date
Inspector
POOL, ,r'A
APPROVALS Permit
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53, Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.
57. APPROVAL TO COVER-GUNITE
i
7. Footings - -
58. Electrical Conduit-Undrgrnd,
8. Foundation
59. Gas Pipe, ❑ Undrgrnd., Test
-
9. Water Pipe-Undrgrnd. '
60. Backwash Lines, P -Trap, Undrgrnd,
10. Structural Floor System
61. APPROVAL TO DECK
l
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12, Sewer Cap -
63. Heater & Vent -Final
I
13, Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16, Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69, POOL/SPA SYSTEMS FINAL
19, Rough Heating & Air Conditioning
` FIRE DEPT. REQUIREMENT
APPROVALS ' Permit
20. Rough Factory Fireplace
21. Ducts, in, Structure ....
,70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping G Gas ❑ Oil
23. Gas Pipe -Rough & Test
72, Underground Flush
24. Roof Framing
73, Undergrnd. Storage Tank O Gas ❑ Oil
25. Roo` Sheathing 1
`l % _ %Y
G.+�
74. Overhead Hvdro
26. T -Bar Ceiling (Structufatl & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation -
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
- ,.
Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
-
36. Hood or Canopy
37. Final Factory Fireplace
38, Final Plumbing
39. Water Service -Final
A0. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
-
43. Backflow Irrigation -
-
44. Landscape Irrigation System
-
45. Sound Attenuation
.-
46. Handicap, Regulations
-
47. FINAL STRUCTURE & BUILDING Z.Z,-Rte
fti
-
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
TYPICAL 411 CONCRETE BLOCK
TOP VIEW 3/8 Bar
4!� Blocks 8°Blocks
1/4° 0 Pencil Rod Below Top —
Course Of All Fences
4° Concrete Block Fence With 8°
Pilasters. One 3/8" Vertical Bar
CQnfinuous From Earthtooth Thru
8' Pilaster.
3/8° Vertical Ties 2' Long
Hgoked In Footing, And Grouted In
4 Blocks 4 0/C Maximum.
rovide Cleanout And Inspection
(Hole At Pilasters.
AAXAAAA
x ,
NATURAL GRADE
FOR WIDTH SEE CHART 01'.0,tW o'
TWO 3/6 BARS CONTINUOUS)4�:
FENCE MAY VARY IN HEIGHT
FROM 3' TO 6
STEEL MUST BE TIED IN PLACE
AT TIME O F TRENCH INSPECTION
6' ................
5 ...................
4" ..........
3
■.MIN
.... ..............
--
. ...............
s
Ci
•
TO 16"O.C. MAXIMUM
I`➢
I Bn°I
I
r.'.I
:.
DEPTH OF EARTHTOOTH .. ....24°
.. .............
20°..................16
4,
12°
SPACING OF EARTHTOOTH....12�
o� DEPTH
OF EARTHTOOTH 1/3p�
I`p'b
16 -
THE HEIGHT OF FENCE
-
t; l
BELOW BOTTOM OF
j FOOTING.
■■®®MIMM��
ME
IMM
■■
-'_IMM
AAXAAAA
x ,
NATURAL GRADE
FOR WIDTH SEE CHART 01'.0,tW o'
TWO 3/6 BARS CONTINUOUS)4�:
FENCE MAY VARY IN HEIGHT
FROM 3' TO 6
STEEL MUST BE TIED IN PLACE
AT TIME O F TRENCH INSPECTION
FENCE
"GENERAL- NOTES"
MORTAR: One Part Plastic
Cement And Three Paris Sand.
GROUT: One Part Cement And
Three And One Half Parts Sand.
COPING: One Part Cement,
Three Parts Sand.
CONCRETE: Well Mixed 1'2 1/2,
.31/2. Maximum Of 71/2
Gallons Of Water Per Sack
Of Cement
REINFORCEING STEEL SHALL
CONFORM TO SEC. A-15-39
A. S.T. M. ALL STEEL TO LAP
WHERE SPLICED, 2'-O" MINIMUM.
GROUT MAY BE POURED FROM
TOP OF FENCE IN CELLS WHERE
VERTICAL STEEL OCCURS. HOLES
SHALL BE CLEAR, CLEAN, AND
FREE OF ALL MORTAR, DEBRIS,
ECT. WITH INSPECTION HOLES
AT BOTTOM. BOND SHALL BE
PROVIDED BY LAYING BLOCKS
IN STRETCHER COURSES SO
THAT VERT. JOINTS ALTERNATE
IN EACH COURSE.
�-'�3�� CLEARANCE FROM BOTTOM r'-�'1 SCALE; 1/2 = I
HEIGHT.
6' ................
5 ...................
4" ..........
3
WIDTH..
.... ..............
--
. ...............
s
Ci
•
TO 16"O.C. MAXIMUM
I`➢
I Bn°I
I
r.'.I
:.
DEPTH OF EARTHTOOTH .. ....24°
.. .............
20°..................16
4,
12°
SPACING OF EARTHTOOTH....12�
o� DEPTH
OF EARTHTOOTH 1/3p�
I`p'b
16 -
THE HEIGHT OF FENCE
-
t; l
BELOW BOTTOM OF
j FOOTING.
FENCE
"GENERAL- NOTES"
MORTAR: One Part Plastic
Cement And Three Paris Sand.
GROUT: One Part Cement And
Three And One Half Parts Sand.
COPING: One Part Cement,
Three Parts Sand.
CONCRETE: Well Mixed 1'2 1/2,
.31/2. Maximum Of 71/2
Gallons Of Water Per Sack
Of Cement
REINFORCEING STEEL SHALL
CONFORM TO SEC. A-15-39
A. S.T. M. ALL STEEL TO LAP
WHERE SPLICED, 2'-O" MINIMUM.
GROUT MAY BE POURED FROM
TOP OF FENCE IN CELLS WHERE
VERTICAL STEEL OCCURS. HOLES
SHALL BE CLEAR, CLEAN, AND
FREE OF ALL MORTAR, DEBRIS,
ECT. WITH INSPECTION HOLES
AT BOTTOM. BOND SHALL BE
PROVIDED BY LAYING BLOCKS
IN STRETCHER COURSES SO
THAT VERT. JOINTS ALTERNATE
IN EACH COURSE.
�-'�3�� CLEARANCE FROM BOTTOM r'-�'1 SCALE; 1/2 = I
HEIGHT.
6' ................
5 ...................
4" ..........
3
WIDTH..
.... ..............
14°..................12°
. ...............
12..
THICKNESS. ..............10"................
10°..................8°
................
8.1
DEPTH OF EARTHTOOTH .. ....24°
.. .............
20°..................16
..... �..........
12°
SPACING OF EARTHTOOTH....12�
........
........ 14'..................16'...
............
16 -
City Of Costa Mesa , California OWNERS NAME: L Oq �l f S _ Ll 0 /' -F _ _ _
JOB ADORESS: L 46 Z O -EL E 07D D P- _
Building Department PERMIT NUMBER:_ _ _ _ _ _ _ _ _
SIGNATURE:
Form BUU-YM-4-M S -BP
CITY OF
SUBJECT TO
DIRECTOR OF
,
F.
TA ry ESA
IC DEPT.
REG.
QV cl Cmft Wima Building Dept.
INM E KAT,4 Wa ST ME ON JIOB SAT ML BIMRS
MAA go 4Ga 'k%TtRiPGXUT MOR AVPRDV?A
" 041K.
THE i%V01M 00 aA:JTJ,M OF A :PFRkI'IT OR APPRO NI
OF PiAM V.1) SPUCT!FIC,AT':2165 SNrLT NOT BE 0014TYM
TO BE A PuiW!," FOR. OR A'r .1PF:;OY:+i CF, ANY NI®LAPIO'N
OF ANY GT FROVS10-S LF THIS CCDL NO PERMIT 'M,
SUMING TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF THIS CODE SHALL BE VALID. EXCEPT IN SO
FAR AS THE WORN OR USE WHICH IT AUTHMIZES IS LAWFUL.
THE ISSUANCE OF A PERMIT BASED UPON PLANS AND
TCATIONS SHALL NOT PREVENT THE BUILDING OFFICIAL
THEREAFTER REQUIRING THE CORRECTION OF ERRORS
® PM§ AMO OMFIDATIONS OR FROM PREVENTING
Mtl0 9MATiM YNNOi 9ANIPt@ OR ffigN N90 WHEN
RESIDENCE I I I RESIDENCE
%3G /fly r
-—__.�STREET
Lt
STRUCTURAL APPROVAL ONLY
SEPARATE PERMITS ARE REQ!!(RED
FOR ELECTRICAL, PLW.jai{t;;
HEATING, VENTILATING AND
REFRf4RATION WORK
X 11-n y ��
THIS fr'Uf9g�R'h9PANY
ALL IfJSPECTIOiSTJ ACCO
REQUESTS
� FOR SLIItCiP.'�S C::� " P6FSOf1
BE fM7� SUGGEST T1 � pIE
�n [ ur 1i,.LtYLI/;'dIH
IND! 57RiAt SAFETY $E CC;UI fIS ON OF
ADO TONAL REQ()IRFA9;: & SCL ED FOR
OWNER
JOB ADDRESS
DATE
VALUE
aP. No. LOT }.y� TRACT
INSPECTIONS (-eq-AV
DATE
FIRE ZONE DESCRIPTION OF vvv.n RPr
GROUP T CN ,T TYPE p ZONE gj
Underground Soil ,v4-, ' U.G. Water/jos'
G-�'3 �5�
SUBCONTRACTOR
PERMITS
ISSUED_
/-r'
UndCrgrOund G3S
—
DATE
—
NUMBER
Overhead Water and Gas
Rough Heating $
Rough Plumbin_ gyy
-17-6'2/
•-7 -
i-, --.-�� /
/,=-!/-.S 7
Miscellaneous a
Prop. SwrrLine, HoAbXon. St. Swr.
Sprinkling System
• n. 5"/J
., �a.v- c.c.`J`--
3 S
_
V
Heating, Final
/O
Plumbing Fixtures
Final Gas Test/5-
(v
Construction Pole%:
/-
Underground Power
Rough Whin ♦
L'FForms
i . -
a.J>/2, $%(/i,,,n _r��`i
7/S" -S-`/
rStec
Tenche -
Floor Sy t m
D/iS,Cr"
_
Steel Reinforce Chimney Re -Rod
Bond Beam
_
Sheathing MVU
Frame and Flashing
Lathing In ! Out 14
Plaster, brown coat
-I
Plumbing Fixtures, Final
jo- -
Electric Fixtures, Final /I ip
Building, Final 'wl�
•'Z -S
OCCUPANCY
Form 210-3M-4-59
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA, CALIFORNIA
MR APPL/CANT TO F/LL /N COMPLETELY
TYPE OR PRINT
ADDREISS 1(140 M
yktlAwn(+d St
COSTA MESA, CALIFORNIA
C� 3 sD.;c
VINANCE DEPT.
APPLICATION FOR PERMIT
BUILDING
FOR OFF/CE USE ONLY
RECEIPT NO.I
�PgRMIT�NO. /
;l
OWNERcres
/l
MAIL y�q E. 17th St.
R CEIVED BY
GATE RECEIVED
DAT ISEDEOt
L—S
ADDRESS
BUILDING
TEL.
CITY NO.
ADDRESS
ARCHITECT Carlson & LID'
COSTA MESA, CALIFORNIA
OR ENGINEER NO.
Middlebrook
FIRE
I
`(�L
ADDRESS 6ar-den Grove
ZONE Type
Grouu
77��l2C917 ���� GOleve 1nC-L C NO.16 2
CONT1fR&& puuro/J
APPROVED
BY
DATE
ZONING
ADDRESS
LEGAL
LOT
�J422
ZONE
NEW
DESCRIPTION
^,
NO. 124
BLOCK
TR
PLANS
INL G
IUSE DI
BUILDING
APPROVED
A.P. NO.
BY
DATE
SIZE NO. OF BLOGB.
EVES
OF LOT 50 x 1Q9 Now oN Loi none
REQUIRED
ALLOWED.
USE OF
(CENTER LINE ST.)
EXISTING BLDG.zt�
FRONT
Ff.
IN.
SETBACK LINE FROM q'
501 REAR YARD 241
p
CENTER OF STREET _
R. SIDE
\� FT.
IN,
L. SIDE
FT.
IN.
SIDE YARD I LEFT 5' I RIGHT 51
DESCRIPTION OF WORK
REAR d L Pr.
IN.
NEW I ALTERATION I ADDITION
REPAIR I II MOVING I I DEMOLISH
BUILNo OF
DING 1560 1
SIZE ROOMS STORIES
EXTERIOR WgqLL,LROOF
COVERING JLUCCO _ COVERING Rock
USE OF BUILDING AND WORK TO BE PERFORMED
attached double garage,
Plan 120A
I HEREBY ACKNOWLEDGE THAT 1 HAVEI READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AOREE TO COM-
THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
PURPOSE OF
ESTABLISHING A PERMIT
FEE ONLY.
BUILDING CONSTRUCTION.
VALUATION
SIGNATURE OF
PERMITTEE
PERMIT FEES
36.00
$ 15,571
PLAN CHECK
p
S 18.00
54.00
D
Dike
e & Olegrove, Inc.
AUTHORIZED AGENT
TOTAL FEE S
ER
JOB ADDRESS
DATE
NO.
'AP No. LOT 124
TRACT FIRE
ZONE
VALUE E
INSPECTIONS
Signature Date
TYPE
GROUP
ZONE
SOIGASL
SUBCONTRACTOR
PEPIA SIS
Date Number Si nature
WATER
Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON.
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND POWER E]
ROUGH WIRING
Heatina
and Vent.
TRENCHES UFORMS= STEEL REINF.
FLOOR SYSTEM
BOND BEAM STEEL REINFORCE
SHEATHING
FRAME AND FLASHING
LATHING — IN OUT
PLASTER, BROWN COAT
STRUCTURAL, FINAL
Electdc_
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST
ELECTRIC. FINAL
BUILDING, FINAL
i�
n
•1`1?
COSI'*MESRBUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
7405 4/25/79
APPLICATION FOR STRUCTURAL PERMIT
8.50. TU
For Applicant to Fill in Completely — Use Ink Only
R CEI D PERMIT
o .403
BUILDING SAOMy A`T/ n 1 L/���
ADDRESS jj / /�G Vl''
A.P. NO. -�
OWNER OR /r�-C ! ' /
TENANT
BUILDING /-Z7 nn
ADDRESS /V / O /ti ry-F Q Q
UNIT OR
SPACE NO.
MAILING
ADDRESS
TDRn O.
h D 01
BLK.
TEL.
CITU NO.
NEW
ADD ALTER
REPAIR
IMOVING1
DEMOLISH
CONSTRUCTION
LENDER
BRANCH
q
OWNE ES L v p 151
ADDRESS
�!) VALUE Q
USE .'AO E
ARCHITECT TEL.
OR ENGINEER NO.
ZONE
TYPE GROUP
ADDRESS
//
CONTRACTOR �` i2/I �JG �.�, �^/U C
APPROVED
BDATE
ADDRESS CJ �.-
CITY ��O1//� L
STATEO. CITV
LIC. N9/�' LIC. NO//'
APPROVED SETBACKS
SIZE
OF LOT
NO. OF BLOGS
NOW ON LOT
(FROM C/L STREET)
FRONT FT.
USE OF !' � VY LL
EXISTING SLOG. C
Separate permits are required for
electric, plumbing and heating work.
L. 51 FT.
/
REAR T. -
USE D/BUILDI NS'ii{Nr.D WIO R,sK�TO BE PERFORMED
�t (G
PLANNING ACTION
DATE
APPROVED
/
APPRO D
I hereby acknowledge that I have read this application and state
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 under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force and effect, or I
am exempt from the provisions of the State of California Business
and Professions Code, Division 3, Chapter 9.
Signature o� "[�
Permittee
SO. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VALUATION
S
PERMIT FEE $ 9 Q
�n r Q
PLAN CHECK $
TAX E
or a /L /J
Authorized Agent Date Ir e G� ` J
TOTAL PAID $ 5m