HomeMy WebLinkAbout642 HAMILTON ST - Building Permits0
CITY OF COSTA MESA
D�p MF q BI/ILDING D/VISION �
i�� 77 FAIR QRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 •�.ci.costa-mesa.ca.us
: �
� FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: BX09-00034
PERMIT TYPE B MISC STATUS: ISSUED
APN: 42221127 � DATE (SSUED: 04/29/2009
Zoning: , ISSUED BY: KJB
JOB ADDRESS: 842 HAMILTON ST CM - Suite/Unit:
Vicinity: PARKING LOT . - Primary Occ: �-' !� Const Type :??
S�. FT: 0 . . Valuation: � � $1,800.00 - � �,
SCOPE OF WORK: _
INSTALLATION OF (1) 19' HIGH-L'IGHT POLE�WITH ASSOCIATED ELECTRICAL�FOR "PAGE�PRIVATE SCHOOL".
OWNER: PAGE PRNATE��SCHOOL -' . Address:: PO BOX 10909' ��' ' .
City/State: COSTA MESA, CA �� - Zip Code: �� 92627-0909 .
Phone: � . :- . . . .
APPLICANT: HERERRq�,-RICK�. . � . � ��� -Address: � � . , - : .
City/State: � . , . - � � - Zip Code:. �
Phone: 774381 •0269 ,
CONTRACTOR: RALPH HERRERA CO � � .. , , „ . License No. , -387624 � - •' ?
Address: 2569 ROBINHOOD PL � � ' �- ' � , � ` - - Unit .- -,.�.
Gity/State: ORANGE.CA�:'' . -. ...�� �� "� :' � ` .' : . . � � .. . � . '� , .
ZipCode: 92867 _ ,� - Phone.� 714381-0269 ,_ ,- �,�. Cell:
ARCHITECT: . � � � - - - � .License No. - - � . -
Phone
ENGINEER:
Phone
�
c
G BAR7 STRYKER� �:
714-754-0433' .-
FEE SUNIMARY
Building Plan Check:
Building Permit: '
Electrical Permit: �
SMIPResidential� .
SMIP Commercial
Bldg Std Admin Fund
TOTALFEES
License No. -013795 � �
�$41:05 . ..��.
$63:15
$57.00
� � � � � $0.00 .. . ,
$0.50
$1:00
._ - � .516270.,,: -. .
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'� .�
Unit
Unit:
�;�. ..
Und
I I.. t:
.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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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 fnal approval will result in the expiration of,this permit.
Ofi0E1. INSPEC110NTVPE OATE INTITIAL CODE/ INSPECTIONTYPE OpTE�.,, INT71RL5
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 Blak/Retaining Wall 212 Final Fire Prevention "��
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 FinalSite
204 Final Demolition 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARA710N: � "
I hereby affrm under penalry of perjury one o( Ihe following declarations:
❑ I have and vrill maintain a certifiCate of consent to self-Insure for workers'
compensation, as provided (or by section 3700 of [he Labor Code, for the
performance of Ihe work for which this permi[ is issued.
❑ I have and will maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, (w the peAortnance o( [he work (w which this
pertnit is issuetl. My vrorkers' compensation Insur ce carrier antl policy
number are: I/1� O
Carner: �A�
(This sectn.r neea iro� ee mmpleree rt me pemrrt k value at one hunared cbnars (5100) a ress.)
Policy Number:
�certify that in the peAormance of [he work for which this permit is
i ued, I shall not employ any person in any manner so as to become subjecl
to the vrorkers' comp nsation laws of Califomia, and agree that if I should
become subject to vrorkers' compensation provisions of Section 3700 of
the Labor Code. I II forthvrilh wmply with these pmvi i ns.
2
! Iiwnfs5ignaWre Dale
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNL4WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL4RS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CADE, INTEREST, AND
ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereDy affirm that I am licensed under pmvisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Protessions Code, and
my licens �s in Qfull for/ce, ,and eRe t.
Lic. # O �-(� Class #
�^
. cmr's5ignaWre Dale
CONSTRUC ON LENDING AGENCY:
❑ I hereby a(fum that there is a constructbn lending agency for the
pedortnance of the wnrk for wfiich this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Signawre �ate
OWNER-BUILDER DECLARATIONS:
I hefeby 2Kfm lhai untler penal[y of perjury [hal I am EXEMPT FROM THE
CONTRALTORS LICENSE LAW for the follovring reason (Sea 7031.5,
Business anG Professions Code: Any ciry or county which requires a permit to
wnsWtt, alter, improve. tlemolish, or repair any strucWre,'pnor to ils
issuance, also requires the applicant for such permil lo fle 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 0( the
Business an0 Professions Cotle) or that he or she is exempt therefrom and
the basis for the alleged eaemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the appliwnt b a civil penalty of not more Ihan
five hundred dollars ($500).�:
� I, as owner of the pmperty, or my employees with waqes as their sole
compensation, WILL DO THE WORK, and lhe structure is not intended or
oHered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an ovmer of property who builds or improves
thereon, and who does such work himself or herself or through his or her ovm
employees, provided Ihat such improvements are not intended or oftered for
sale. If, however, the building or improvement is sold within one year of
completion, lhe 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
UCENSED CONTR4CTORS to constmct lhe projec[ (Sec. 7044, Business and
Professions Code: 7he contractors License law dces not appty to an owner of
property who builds or improves thereon, and who coniracts for such project with
a contractor(s) license pursuant to the Contractas License Laws.).
❑ I am exempt untler sec.
Business and Professions Code for this reason:
J05]<6�10]�
��.
�..,
Owner ID verified by drivef 5 Lcense. ❑ Yes ❑ No
Driver's License No. Expires:
Veri(cation o( Ovmership by (type of tlocumenl, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no eacavation frve (5) or more feet in depth into which a
person is required to descend, will 6e made in connection vrith work authorized
by this permiC and Ihat no building strucWre, scaHdding, falsewnrk, a demolition
or dismantling thereof, will be more than Ihirty-six (36) feei high (Chap. 32, Grp
2, M 2, Sec. 341, Ttle 8, Califomia Administrative Cotle).
❑ As owner-builder, I will not employ anyone to tlo vrork which would
require a permit from the Division of Intlustrial Safery, as noted above, unless
such person has a permit to do such work from the division.
AOPlitanfs Signalure Date
Division of Intlustrial Safety Permit Number _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
7. Will the applicant or present or future building occupant need to fle and
certify a Business Plan for emergency response to release or Ihreatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Heal[h and Safety Code requires, with some
excep[ions, lhaf a Business Plan be filetl with the Cosla Mesa Fire
Department by every business which has at any one time tluring a reported
year a quantity of hazartlous materials equal to or greater than a weight of
500 pountls, or a volume o( 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or (uture building occupanl need lo fle
a regislration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Cali(ornia Health and Sa(ety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one lime has on hantl a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
tempereture antl pressure).
3. Does or will the applicant or present or fuWre building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Ves ❑ No
(Section 25534 of the Cali(omia Health antl Safery Code provitles [hat the
Costa Mesa Fire Department may require the preparation, ce�ifca�ion and
filing vnth the Fire Department of an RMPP by businesses which are requiretl
to register acutely hazardous materials with the Fire Department.
4. I( an RMPP is presently required, has Seclion 25534 of Ihe Califomia
Healih and Safe[y Code been fully complied with? ❑ Ves ❑ No
5. Does or will the applicaN or present or fuWre builtlinq occupant require for
the work which is lhe subject of this application a permit for such constmction
or modifiwtion from the SouN Coast Air Qualiry Management Disirict or from
any other air polWtion control diSMct or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requested
infortnation be fumished on applicalions fv non-resitlential building pertnits).
6. Will any part of lhe Faciliry to be construaed untler this permit be vnthin
1000 feet from the outer boundaries o( a school? ❑ Ves ❑ No
(If'yes", the (aciliry must meet Ihe requirement of Seclions 25534 antl 42303
o( the Califomia Health and Safety Code�.
7. If a permit trom the South Coast Air �ualiry Management DisMcl or other
air pollution contml distnct or agency is required for the work which is the
subjec[ of this application, have all of the disclosures prescribetl by Cali(omia
Health and Safety Code Section 42303 been matle? ❑ Yes ❑ No
8. Qf'yes", attach certificate of compliance from the appropnate air polNtion
control offcer).
CERTIFICATE OF COMPLIANCE: I certify that untler penalry of perjury ihe
information given above is corzect. I agree to comply with all state laws and
city ordinances regarding Hazardous Matenals and Emissions.
SignaWre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify untler penalty of perjury that I have read this application and state that
the informa[ion given is correcL I agree to comply vnth all state laws and city
ordinances relating to building wnstruction, and authonze representatives of
Ihe City o( Cosla Mesa to enter upon lhe above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
au[horizetl by lhis permit until final inspeclion.
Slgnature of L al neqs) � Date —
AnG/orAut� nzeE Appl¢ani Da�
� . Applicant to till in all soaces exeept tnose within heavy Doreer �ines ana si9n all avv�opriate tleclarations.
CITV OF COSTA MESA CONSTR UCTION PERMIT PER IT No TRACT NO. LOT NO. �UNIT NO. �- .- - . �
� �/D �T A.P.# 2ane
Project Address �U � �n� LT��VJ �r 7 v S Main Building: ' Accessory Building: � �
AppliCant's Mailin`g A-ddre55 ��i�'✓- M1��°��R-T iR�-U� �� TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR E . . , Z
IJVLOIZ'�S N�.K .(�� � CONVERSION ❑ DEMOLISH ❑ OTHER 7 F�on[ Q
Owner's'Name. Phone DESCFIPTION OF WOR�1�� E OF LDG R- � On B Rear ' N
Address �'{� :-�laM��-TAI-� � ' . Rorc iw)L'rAll.�Yi{�S �d." oWFi.x � � v H P)2ooG . A 1
Arch/Eng. - LicenSe No. TYPE OF PERMIT GRADING ❑ FOUNDATIOfV O STRUCTURAL I C Right N
Addre55 ' " � ' � ❑ TENANT ❑ ELECTRICAL:O PLUMBING ❑ MECHANICAL� ' $ � Left - R
Contractor's NamaP��NN��-A ZER�F�614 Phone�4�� «� ��orHER : � , Ping.-Ref..# Parking Req./Provided E
PROJECT DESCRIPTION 5o: FT. ���� OCCUVANCY � Plannin Notes: ' �
Address (mailing) ��-�� N£wPo�ZT - gl� D . � � s � � - � nn
,�-�� � CONSTRUCTION�TYPE VALUATION$ 3YiC%I
City LicenSe No. �nnS ZONE GRA�ING CU. VDS. ACRES S.
LICENSED CONTRACTOR DECIARATION , � ' ' �
1 hereby aftirm that 1 am Ilcensetl untlei provision5 of ChdrtCr 9(commencing Rema�ks: ' .
^`` WIIh 52CI100 %040) O1 �IVISIOO i Oi IhE BU51lIC55 dfld Protessions Cotle, antl
� y my liwnse is in iCull f�rc� na etfect. y�O}o-� ELECTRICAL FEES
Licensf Cla,,ss -_� 5 I�iem o. �
Date(O� Si9nature PLUMBING - FEES P.uromatic Washer Transformer ❑ 15�50 KW ,,
� WORKEFS' COMPENSATION DECIARATION ! . - COnSt�UCtlOn P012 Sub. '� 5O+ KW '
I`^reby affirm tltat 1 have a certificate of consent to elf-i ure or a certiflcate Bar Sink Showefs
1 'orkers"Campensation Insurance, or a certi�i tl wpy thereof (Section Cooking Unit MCt¢r ❑up ro 100 ampi
,'Lab. CJ � - � � _ Backflow Preventer Service Sink
��;,c��_ $�y�-�-� FUiJ� � ' , Dishwasher � Meter❑over100amps.. ,
Poiicy No. � Company Backflow Irrigation Sewer Cap � � .
8Certifietl copy is hereby turnisneE.�. � . . Dryers ❑Gas ❑Electric Sub Panel '-• "
'Certifietl copy is filed with the ciry 9 �lyji�e • Bathtubs Sewer Connection - .
oate �o-( -h'i qppli<an � - � Fan Motors �0.1 HP �7'h - 8
EXEMPTION FROM WORKERS' COMPENSATIO ECL ATION Clafifiers $ol2c ColleCtOrS
(Thissection neetl not be completetl if the permit is r one huntlretl ($300) or . . . F.A.U. _ . Inc.Solar �9-15 HP 016-15+
iess). � + Dishwasher Solar Piping� �
I certify thal in tne periormance oi the work for which tnis permi( is issuetl, I . Fixtures Microwave '
shall not employ any person in any manner so as to become subject to the D�inking Fountains Sola��Tank
Wo�kers' Compensalion Laws ot Cali(o�nia. ,
� oate Siqnature Floor Drains Swimming Pool w/Spa ' Device Boxes . Pole Light '
NOTICE: If, after making this tle<laration, you shoultl become subject to the � Outlets Fiange
Workers' Compenwlion provisions of the Labor Cotle, you must forthwith FIoOr Sinks Urinal �
comply � with Such- prOviSiOns or tM1is - pe�mit shall be tl¢¢metl revoketl. - SwitCh¢5 � � �� �
CONSTRUCTION LENDING AGENCV � ' Ga55erviCe� Outlets WaterClOSet � Sign
I hereby affirm that there-is a construction leritling agency for the performance •- � . �
oi tne' work tor wnicn tnis permit is issuea (Section 3097 Civ. C.) Interceptors Water Heater Garbage Dispoul Standing Sections
Lentler'S Name � "
' �entlers ndaress - � Kitchen Sink . Water Service - Generator �0-5 KW �5-15 KW Trash Compactor,
. OWNER BUILDER DECLARATION - ' - . - �
I hereby affirT Lhat I am exempt fwm the Contlactor'S Lic¢nse I..aw tor the L3VdtOfi¢5 �' AUtO-W25h ' �
following reason (Section �031.5 Business antl Professional Cotle: Any city or, ' ., �
county which requires a permlt to constru<t, alter, improve, aemolish or repair P-Trap Laundry Trays.
any Structure, p�ior to its issuance, al5o reqW�es the applicant tor Such pe�mit
'�to file a signetl 5tatemenCthat he/she is licensetl pursuant to the provisions ot Roof Orains• �
.[he Contractor's License Law (Cnapter 9(commencing with Section 7000) ot �
� D'vk�ion 3 of the Business antl Professions Cotle) or that he/she is exempt . � Heinspection Fee $15 luue Fce $ 3
'?Y%� �!rom and the basis for the allegetl ex¢mption. Any violdtion ot Section �
��-%';y�-5 by any applicant for a�permit suDjects the applicant to a civil '
�„�,'ty of not more than five huntlretl tlollars (5500). - . .. $ 3 DEVELOPMENT SERVICES REQUIREMENTS:
��� I, as owner ot the property or my em0loyees witn wa9es as their sole Reinspeetion Fee $75 laue Pee . � Zoning Approved By � J� Date
mmpensation, will tlo'the work, antl the structure is not intentletl or-otferetl - ' �/ �---���-------
tor sale (Section �044, Business antl Protessional Cotle: The Contractor's , MECHANICAL ' FEES Building Approved By Dat�
Litense Law tloes nOt appty to an ownet of a property who builtls o� improves ' � •
tnereon, antl who tloes such wo�k'hlmsel(/M1e�selt or througM1 his o� her own -. Applifation IsSuad 9y �.._r=Det
employees, ptovitletl Iha[ such improvements are not intentl2tl ol offeretl fot B0112� � � HOOd Of Typ21 ❑
sale.df, however, the Guiltling or improvement is soltl within one y¢ar ot com- . Canopy Type 11 ❑ � SUryry��MpR OF FEES '' ,
pietion, me owner wiu have tne ourtlen oi oroving he/she Gia not builtl or im- Duct - Under Ground /�Z �.,�,
prove for the purpose ot saie). . BUILDING PEflMIT $�' SMIP $ •` �
❑ I, as owner of the oroperty, am exclusively contracting with licensetl con- Duct-Structural Refrigeration System ' PLAN CHECK $ PERMIT
Irattors to construct the project (Section ]044, Business antl Profe55ion5 Cotle:
The Cantracmr's.License Law tloes not apply�to an owner ot prapertywho Duci� Ventilatin9 ❑0.100,OOOBTU ❑100,OOOBTU PLUMBING $. ISSUANCE $
builtls or improves the�eon. antl who conf�act5 for Such oroi¢cts with a r.on. . � •
tractor(s license pursuanc m me Contractors License Law), i am aware that Exhaus[ System ❑ MWtiple ❑ System Repair/Alteration P�N CHECK 25% $ ENERGV P.C. $
proof o� their Worker's Compensatlon insurance snoultl be provitletl to me, ELECTRICAL $ GRADING $
❑ I am exempt untler 5ection B. & P. C. tor this reason Firepl/Fact. Blt. ICBO �k Fire Dampers pLAN CHECK 50% $ MICROFI LM' $ / �'
Date owner Heating System & Ducting Fiegisters � MECHANICAL $ (� �-S�
I hereby certity that I have reatl this appliwtion antl state that the above ❑0-100,000 BTU �100,OOOBT TOTAL FEE $
INormaHon is correcL I a9ree to comply with au city antl county ortlinances PLAN CHECK 25% $
antl Slate laws �ela ig to builtlmg con5truction, antl he�eby authorize repre- '
Sentatives ot th' city to en[e� upon tne dbove-mentionetl p�operty to� � ' ' �
inSpeGtion p p ' � .
Signature ' Date �6'�. ��C9 , . I
Drivers' License or 55 9f Reinspection Fee $15 Issue Fee , $ 3 �/.� �� l�l �Qa�2Jut-Q��+��3`` �Y�� _.,�"
r 4nT�: L�/Qb/89 TIi1c= 1G:�ii±
0865-46, rev. 5/80 White - BWltling; Cana�y - ApO��Canq Pink - ACCounLng; Gol0enro0 - Asse55or
�
r . ��• �: � -� _ •• . , ,
:CONSTRUCTION AND PI.pNNING � � POOI �� SPA '
-� � APPROVALS Permit# Date Inspector qppROVALS i .t# .Date Inspector
41. Temporary Electrical Service or Pole � , 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. , �• - 53. Steel Reinforcement ' �
3. Electrical Conduit Utility-Undrgrnd. ' 54. Forms i�
- 4. Electrical Conduit-Undrgrnd. ' � 55. Electrical Bonding " �
5. Steel Reinforcement �. . 56. Rough Plumbing & Pressure Tesi - �,
6: Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings - • � - � � 58. Electrical Conduit-Undrgrnd. "
8. Foundation , � � • 59. Gas Pipe, 0 Undrgrnd., Test '
9. Water Pipe-Undrgrnd. . . 60. Backwash Lines, P-Trap, C] Undrgrnd.
�
10. Structural Floor System '� 61. APPROVAL TO DECK •
11. Property Sewer Line & Hquse Connection • 62. Backwash & Recep[or-Final
12. Sewer Cap � . 63. Heater & Vent-Final
13. Roof Dreins . 64. Plumbing System - Final �
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit � 66. Solar System-Final
.J,6. Rough Electric Wiring 67. Fencing & Access Approval
•17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
�i8. Rough Electrical-T Bar Ceiling 69. POOL/SPASYSTEMS FINAL �
=19. Rough Fleating & Air Conditioning FIRE DEPT. REQUIREMENT
�20. Rough�Factory Fireplace � APPROVALS Permit #
i
21. Ducts; in Structure 70. Underground Hydro
22. Ducts;.1/entilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush �
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing { r � - .
/ 6 �0- !-� 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & 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 "� i
37. Final Factory Fireplace ` N
38. Final Plumbing ' -'
39. Water Service-Final
40. Gas Service-Final
-41. Solar pomestic-Final
42. �Backflow Preventer - .
•43. Backflow Irrigation . , i-� ,�
44. Landscape Irrigation System �'' ��
45. Sound Attenuation
46. Handicap Regulations �
47. FINAL STRUCTURE & BUILDING � �j ' .
98. Sner.ial Requirements Completed �
49. Electric Release to Edison �� �
i
50. Gas Release to Southern California Gas Co , �� r ,�} '•;
51. CERTIFICATEOFOCCUPANCY -�. CJ i"
No. Date �_ • "!
• ���' {: i? i: � ? .. �' .. .i T` a.� ���'a ,1 w�4'i66._._
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_o., emm m do e�oeom
Contractox• mS�Z.�
Addr�ss _ -,S"�•—� E"�..�.�
City Lic; i���" h� Io,
@aoo�asd���vo so�
S3ze of Lat/3 2 z 3oG AP;,' ���.� —%� C,3- S+'
Setbacksa C%%�`�reet � -earH o%�c is3 �
Su.� Yard m Rigr�t --'� - Lef�E ---f�%�'"
I hereby acimowledhe that I have xroa3
this applicaiior. anci stg%e Lhat the
atiove is oorrect and agrse tc camul��
with all City Grdinatw.es and State
Lsws re�aln2ing bufiding construct:,r�.ri
Signatura
of °ermittee
Agent
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� DATE 3-21—�i']
BUILDING PERMIT NO.
AP115-o63-18
L'' BLOCK TRACT Cement Block Wall
GROUP TVPE ZONE FIRE DISTRICT h766
INSPECTIONS
Footing Trench
Foundation Forms and Grade to
Rough Framing
Plumbing, Rough to Slab
Plumbing, Rough Complete
Temporary Pole
Wirinq. Rough
Sewer, House
Septic Tank or Cessp
La�hing,ln
i ring
Plumbing, Final, Fix'
Plumbing, Final Gas
Wiring, Final
Occupancy
FONM 210 3M 10-05
St.
e
DATE I SUBCONTRACTOR
PERMITS ISSUED
' I . NUMBI