HomeMy WebLinkAbout3000 HARDING WAY - Building PermitsPP0.IECT'RODRES3: CALV
G OWNER'S N�ME: $�E
ROOflE53:
540-1642
RPCHIENGINEEN:
FODHESS:
INTEE
UNIT:
NEG.NO.:
UNIT:
PEPMITTEE: CALVIN MC INTEE ( 714 ) 540-1642
nooxess: 3000 HARDING
CM CA 92626
UCENSED CONTMCiOB OECIAMTION: I here6y affirm that I am IicenseU under D�ovisions ot Chap[er 9(commencinA w��� Section
7000� o� Divislon 3 01 �he Buvness and Protessions Code, an0 my license is in tull force antl affect.
CITY LIC.: STATE Ot.: C1A33:
Oate: Signature:
BKEBS' COMPEN8pTI0N UECIAIUTION: I hereby allirm Ihat I have a cetlificate of consent ro ulf-insure ar a cetlificate af Workers'
npensation Insurance, or a cetlifieA copy ihereof (Section 38110, Lab. C).
PoLICY NO.: E%P. 0�7E:
COMPRNY:
❑ Certifie0 copy is here�y fumis�e0. ❑ CertitieE copY is filed vril� ihe ciry BuilOing Division.
Oate: Applicanl:
E%EMVfION FflOM WOBNEPS' COMPENSIITION OECIAMTION: (ihis seciion nee0 nol be complele0 d erm i or one hunarea ($100) or kss�.
I certity that in he Oe�ormance of the work for which Nis permi� is issu I shall no ploy a y person i ny manner so as to �ecoma
su0lect ropthe ers' pComOensation Laws of Califomia.
-Wte: o �v/l V SiAnature:
NOTICE: II, aiter makinA �his tleclaration, you shoul0 hecome suhlect ro the WaBers' Campensatlon provisions af the Labor
Code, you must /otlhwith wmply with such pmNsians or th¢ De�mit sAall 6e Oeemetl revoked.
CONSTBUCTION LENOING IGENCY: I hereby attirm Ihat thera is a constmction lending aAency lor ihe OeMormanca oi ihe work for
which this permit is ISSueO (SeClion 3097, Civ. C).
LENUEN:
aooeess:
OWNEB BUILOFB OECtAMTION: I hereGy affirm that I am exemDt fmm t�e Cantractors' State license Law for t�e lollowinp reason
(Section 7031.5 Business and Pmiessional Caae: My city of caunry whic� requires a permit to consimd, alter, improve, �emolish, ar
repair any stmcNre, O�or to its issuance, also requires the app�icant for sucA Dermit to file a sipnetl sWtement I�ai he/she Is ticensed
pursuant ro ihe pmNsions ot the Contacrors' State License Law (C�ep[er 9(commencinp with Section 7000) oi Oivision 3 ai ihe Business
antl Pmfessions Cotle) or t�at Ae/she is erempt thealmm antl ihe �azis for Ihe allepeE exemption. My Wolation ol Section 7031.5 Dy
ry aDPlicantior a Dermit subjecis the appliwm ro a civil Denalry ai not more than M1ve hunEratl tlollars (f500�.
I, az owner of ihe pmperry or my emplayees vnih waAes as their sole comDensation, will ao tAe woB, anA the
❑ stmcwa is not intended or otteaa for sale (Section 7044, Business antl Pmfessional CoOe: The Contracrors' SGte License Law
Ooes noi apDry to an owner of a pmpeM who builAs or imD�aves Ihereon, antl wAa does such work him5eli/herseli or throuAh
' his or �er own emDloyees, D�ovided that such impmvements are nat intentletl or ottere0 for sale, tl, �owever the Euildinq or
imOrovemeni is solA witAin one year ot wmpleiion, the owner will �ave Ne �ur0en n/ DmvinA he/s�e Oid not build or impmve
tar tAe Ouryosa of ule).
� I, as owner at ihe propeny, am exclusively contracting with licensea contracmrs to constmct the Dmle�t (Section 7044, Business
❑ an0 Pmfessions CoAe: The Contactors' State License Law dces noi aDDy ro an owner ol property who hm10s ar imD�s therean
antl who wntracts tor suc� prajecis vnN a coniractor(s) license Dursuant to ihe Coniracrors' State License Law). I am aware
x ihat Dmof af their Worker's �mpensV a��n insurance shoulA he pmvidetl ta me.
� I am evemp[ untler Sectlon: r� 4 e. s� c,
,y,,,, WORK BY .Tiv�aER
for this re on:
Date: � � �D Ownec I
I Oa hereby certity tAat 1 am aware oi anU un0erstanOlhe requirements of Calilamia Health anU Satery CoEa Sections 25505, 25533, and
' 25534 an0 that 1 or any fuNre huiltlinA ocwpant will/will not (circle one) nee0lo comDty with sai0 state coAes anU the requiremenis for a
permit tor construc[ian or modilication irom the Nr Oualiry Manapement OisMct. Residential consimction applications are exempt tmm
ihese provisions. �
Oate: FpD�icani:
I hereUy ceNty that I have read ihis application antl state ihat ihe above inlormation is wrrect. I ap2e o com y wit� all ciry and counry
ordinar¢es anG state laws�p, latlng to Cuilainp consWction and AeaEy autho' Dresent � of this ciry ente u on the aDovrmentianetl
proDerry br insp ction Grposes. /� � 1 '
j p ie v
Date: � ✓� `�
Driver's License or Saial Secunty a:
1&OFa6 W�ite-6uil0ing; Grean—Cotle Enfortemant; Canary—Applice^C Pink—Revenue; Gdtlenro0—Asseesar
CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B, 098816
.- �
PERMIT NO: B 048816 PLAN CHECK NO: N GOVT:�id SUPP: N
CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION ; REI�LACE ORIG, GAR, DOOR SQ FTi 60
CLAIM VALUE: 60.00 CALC-VALUE; 60.00 GROUP OCC: M-1 /
COMMENTS: LEGALIZE CONVERTED GARAGE/GAAAGE DOOA
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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
------------ 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; 14113336 ZNE: REF NO:
PLANNING NOTES>
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iE 3E iE if i! iE if iE 3t jE iF �E iE iE 3f ik dk 3E * iE �E iE iElE if 3E iE ik 1t dk iE �It �E if iE it iE iF if if iE 3E �E 3E 3E iF iE iF iE if k it it iF ib iE �E iE aE 3E 3E 3tr dF dE iE �k jF IE iE iE 3(-3E �f 3F iE 3E iE * iE
D E V E L 0 P•M E N T S E R V I C E S R E Q U I R E M E N�T 5
ZONING APPROVED BY DATE: �
�, ' T_
BOILDING APPROVED BY : DATE:
APPLICATION ISSUED HY DATE: i!}3 Z.���D
iEiflfib�EiE�ltjkifiliFiEiEjFiElEiklFiE#ik-fF k i iFic . C`. `�'�i��iElE�EiFiEiE�lEiEiEiE��'it.�./�'h� �r.j4
iE-1EiEiEif�iFiEiEiEiEiFi('iEiE'1E'1f'1EiEiE.iP�ifikiEiFiliEiEiE')Eif'i�hifiEikifitltltwit'1Ej iFiEiliFiEiFiEiFiEiEiE'1E')EIF1fiEihiEik'IEiEl63fiEi616if�iEiEiFiEiEiE3EjEjE
LEGALIZATION:Y F E E S U� M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRI /MECHANIC FIRE SMIP/RES GRADING
PERMIT 30,00 SMIP/NON-RES
PLAN ,:_ .
ISSUE FEE
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL ' PAID DUE
TOTALS----> 30.00 0.00 � 0.00 30.00 30.00 ,00
r -.
REVENUE DIVISION TOTALS--> COLi.ECTED: 30,00 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
30,00
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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
ISFR 60 ALTER BY VALUE RESfIDENTIAL NOZONE 1.00 60,00
END OF FEES
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�� - , r'OOL & SPA �
. CONSTRUCTION AND PLANfv�,.0
/ APPROVALS - Permit #_ Date' Inspector 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-Undrgmd. 55. Electrical Bonding �
5. Steel Reinforcement . 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit�Undrgrnd.
$. Foundation , 59. Gas Pipe, O Undrgrnd., Test •
9. Water Pipe-Undrgrnd. " � 60. Backwash Lines, P�Trep, O Undrgrnd.
70. Structural Floor System 61. APPROVAL TO DECK ,
11. Property Sewer Line & House Connection 62. Backwash & Recepror-Final . `
12. Sewer Cap � `� 63. Heater & Vent�Final �.
13. Roof Drains 64. Plumbing SYstem - Final - �
14. Rough Plumbing . � •�� 65. Electrical�Final � ti
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. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditionin9 FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace APPflOVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & MonocOat 75. Dry Chemical
27. Frome and Flashing ��y�j �W 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. FinalElectric ,( Notes: �C a` �e A�.
34. Final Heating & Air Conditioning ''�' �W
35. Final Gas Pipe-Test t �
; �;
36. Hood or Canopy ' :I;, '
37. Final Factory Fireplace � ,
38. Final Plumbing
39. Water Service-Final
40. Gas Service�Final �
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation �
44. Landscape Irriga[ion Sysrem
45. Sound Attenuation
46. Handicap Regulations
4 . FINALSTRUCTURE&BUILDING .�_yQ �
48. FINALPLANNING �'
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co � jj
51. CERTIFICATE OF OCCUPANCY
No. Date
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 3000 HARDING WY
Suite:
Vicinity:
Parce� Number. 14113336
Applicant SORGE, DAVE
Address: CITY OF COSTA MESA
77 FAIR DRIVE
COSTA MESA, CA
Owner: OHARA, FUSAKO
Address 3000 HARDING WAY
Contractor:
Address:
Zip:
Arch :
Address:
COSTA MESA, CA
Zoning:
Phone:
Zip: 92626
Phone:
Zip: 92626
Phone:
License:
Eng:
Address:
ISSUED 8Y:
Status: ISSUED
Applied: 11/17/2000
Issued: it/17I2000
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
CONSTRUCT 15 L.F. OF BLOCK WALL PER CITY STANDARD. NO FEE. CITY PROJECT.
Plan Check: $0.00
Permit: $0.00
SMIP Res: $0.00
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $0.00
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existinn: o
NOTES:
Rear 0- 0
Rear 0- 0
Re uired: 0
FEESUMMARY
PLANNING 8 ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation
Right 0- 0
Right 0- 0
$300.00
so.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void it 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
requlred inepeetlone and Tinal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (774) 7545626
?aa�a5 (6/00)
WORKERS'COMPENSAnON DECLARArON:
I hereby aHirtn under penalry of perjury one oi lhe following declarations:
❑ I have antl will maintain a cenificate of consent to setl-Insure for workers' compensetion, es proviaetl for by section 3700 of the Labor COCe, for the paAormance of the
work for which ihis permit is issued.
❑ I have and will maintain woAcers' compensation insurence, as required by section 3700 ofihe Lebor Cotle, for Ihe peAortnance ot the work for which Ihis permlt is issued.
My workers' compensation Insurance carrier and policy number are: , � '
Carrier: Policy Number:
(This secfion need not be com0�eted i! fhe pe�mit is veluetl at one hundretl dollars ($100) or less.)
❑ I certify that in the performance of ihe Work for which this permit is issued, I shall not employ eny person in any manner so es to become sublect to the workers'
compensation laws oi Californla, end ag�ea t�et Ii I should become su��act to Ihe workers' compensation proNslons of Sedlon 3700 of the Lebor Code, I shall forthwith
comply wit� ihese provisions.
Applicant Signeture: Date:
WAPNING: FAILURE TO SECURE WORKERS' CAMPENSATIIXJ CAVERAGE IS UNLAWFUL AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRE�
THWSAND DOLLARE (E100,000), IN ADDITION T07NE COST OF WMPENSATION, OAMAGES AS PROVIDEO FOR IN SEGTION 3]OB OF THE UBOR CAOE, INTEREST, AND ATTORNE`fS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm Ihat I am licensed under proviSions of Chapter 9(commencing with Section 7000) ot Division 3 of iha Business end Prolessions Code, and my license is in full
torce and ettect. Lia N Class a
Coniractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hareby aNirm that Ihere is a constructiPn lending agency for the peRormance of ihe work for which ihis permit is Issued. (Sec. 3097, Civil Code).
Lenders Name: Lender's Atltlress:
ISignaNra: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aflirm that untler penalry ot perjury tPet I am E%EMPT FROM THE CON7RACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions
Code: Any city or counry which requires e pelmit to construcl, alter, improve, demolish, or repair any structure, prlor to its issuance, also requires Ihe epplicaN tor such permit
to file a signed stetement thet he or she Is Ilcensed pursuant to the provisions of Ihe Contracbrs License Lew (Chapter 9(commencing wlth Section 7000) of Divlslon 3 of the
Business and Professions Code) or ihat he o� she is exempt theretrom end ihe besls for tha ellegetl e:emption. Any violatlon of Seclion 7031.5 by any epplicant for a pertnit
subjects the epplicant to e civil panelty of not more then ilve hundred dollars ($500).):
❑ I, as ownar of the property, or my employees with wages as ihair sole compensatlon, WILL DO THE WORK, end the structure Is not intentlatl or oHered tor sale (Sec.
7044, Business antl Protessions Coda: The Coniractors License Law does not apply to en owner M property who builds or impmves Ihereon, and who tloes such work
himsetl or herself or Ihrough his or her own employees, provided that such improvemenis are not Intendad or offered for sele. Ii, howaver, the building or improvement is
sold within one year oi completion, ihe Pwner-Duilder wiil heve the burden of proving ihat he or she ditl not build or improve tor Duryose of sale.).
❑ I, as owner oi the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Businass and Professions
Code: The contractors License Law does not apply to en owner oi pmperty who builds or Improves thereon, entl who comracts tor such proJact with e contractor(s)
license pursuant to tha Contractors License Lews.).
❑ I am exempt under sec. Business antl Protessions Code tor this reason:
Signature: Date:
Owner ID venfied by drivefs license. ❑ Yes ❑ No Driver's License No.
Verification ot Ownership by (type of document, i.e. - properry tax bill or deed):
Expires:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cetlity that no excavation five (5) or more feat in Depth into which e person is requiretl to descend, will be ma0e in connection with work authodzad by this
pertnit, and that no building stmcture, sCaHolding, felsework, or Oemolition or dismantling �hereof, will ba more then ihiity-six (36) teet high. (Chap. 32, Gry 2, Atl 2, Sec.
341, Title B, Calitomia Adminis�ra�ive COde).
❑ As owner-builder, I will not employ anyone to do work which would require a permit irom ihe Division of Indusirial Salety, es notetl ebove, unless such person hes a
pertnit to do such work from the division.
SignaWre: Oate'.
Division ot Industrial Satery Permit Number:
CERTIFlCA7E OF COMPLIANCE AND AUTHORVATION OF EMRY: I cenity under penalty of perjury ihat I have read ihis epplication and steta ihat the in�ormation given is
correct I agrea to comply with all stete laws end ciry ordinances relating to builtling construction, end euthonze representatives of the Ciry of Costa Mesa to emer upon ihe
above-described property for inspection purposes. I egree not to occupy or ellow occupency of any building authorized by ihis permit until final inspection.
�Signature Oi L al Owner(s) I D e
� n o c2� r� ` 1� I"Z2 � Z�t�
And/Or uthon ApPlica D te
GOOE �. INSPECTIONTVPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Finel
200 Final Re-Roof
201 Finel BIocWRetaining Wall
202 Final Factory Fire Place
203 FinalSign
204 Final Demolition
o�re p{7II1SL5
e -u-o� �
cooe� ixsrecnoxTrve
206 Final Mechanical
208 Finel Plumbing
210 Final ElecMcal
212 Final Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
pAg 1t�LH
��.��Q- �,,
• T}p5 5 15 FOR AIFORMAt70NAL PURP066
ONLY. APPLIGM LS RFSPONSIBLE FOR PROVIDQJG
AN ACCVRI+7E RBRESiNfA770N OF TF�t PROPFATY
IN CASE'IHE SHAPE AND SI7� DO NOi mRR�4'OND
wmt rHE nvroxr.s,�noN ncovmEn oN n� sr�r.
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9E SETBAIX A7IFAS7 70' FROM FRONT PROPEItIY LINE
• SD[m WA115/}7�1JQ�5 StUIS. NUC IDC� 7 6• IN thlC�ii
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• VERII�Y DSTAN� FROM NRB TO PROPFRIY UNE
� � AND 4-IOW ON PIJNI. VF3iIFiG1ION FROM T'F� QTYS
.... INGQJEOiING DIVSfON 6 REQU6iFD. GIl. (111) 7545313
. - :.. POR INFORMATION.
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PLANNING DIVISION
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DECLARATION OF AUTHORITY
FOR AGENTS OF PROPERTY OWNER
TO APPLY FOR PERMITS • , ,
Bldg. Permit N
This Permit #
3000 HARDING wAY 141-133-36
Stree� Address AP Number
1. I(we), �-1/Gv�� �C`" TE� , declare that I am the Owner of Title
of the above referenced real property, and that I(we) hereby authorize:
C° �lC� T GN AS� ��,'� � 7 S S� -� o � 9
" V Y Name Telephone No.
/ ✓�
Street Address
Z�o
to obtain permits in my behalf, as owner/Ewildec, for l�/���'/ `%/% �-�-�1 `�--
at the above referenced property.
2. Should any person become an employee engaged in the improvement of the property, I(we) shall im-
mediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage
to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer [o any other per-
son, company or corporation.
4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless frorri any
claim resulting in damage or personal injury to myself or any other parties as a result of work authorized
by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that the foregoing is true and correct.
�/ ��j �p�a
Executed this �/ � day of '� � 19�, at `�-" " �s , California.
NOTE: This authorization does not grant authorization to perform the work as owner, it solely provides
for limited power of attorney to secure this permit in any behalf.
�n9<61pev. 7Nf)
0 2� TRACT 4 2 FE� RECEIUEU
', ' �_Jr>�''s.`�� � SEP 271961�
COSTA MESA BUILDING-SAFETY DEPARTMENT fINANCE DEPi�.
P. o. aox s�� COBTA MEBA. CALIFORNIA CITY OF COSTA MESA
For Applican+ fo Fill In Comple+ely APPLICATION FOR PERMIT
TYPE O PR T- �1 J�=� gU1LDING
BLIILDING �n�O K� • Ji O ��
ADORESS �� �
COSTA MESA. CALIFORNIA For Office Use Only
RECEIPT NO. PCPMIT NO.
OWNER K B� K DEVELOPMENT �O. INC. � ��,r �
____
MAIL -' """'""' "' "-' - :• "�^ REce [o ar onh cervso owre`issueo
ADDRE6S 1 Placentia A+?e. �— — 'tP 2? 7961
�in. P?0blport BeaCh No:r�i 6-3zz BUILDING
ADDRESS
OR ENGI EER NONE No. COSTA MESA. CALIFORNIA
ADDRE&S � _ FIRE .,.,@.
20NE TVPE' GROUP /
CONTRACTOR-' � K-.'� KO�.1 ' APPROVED
BY DATE
nooeess -1555 Placeni;ia :1ve. ZONING
-" ' � " .� ZONE I NO. OF U6E OF NEW S/i� �J�
f.'�'jy 1� A �. PUNS � BUILOING W
�;�TNo. 01195 No: rfi b-3zz7 DEBCRIPTION �� 2-y T� y z �-
HIZE �� I NO. OF BIDG6.
OF LOT � '� now oN �oT A p �,i0
USE OF None
EXI6TING BLDG. APPROVEO ALLOwED
BBTBACK LINH FaOM (CENTER LINE BTJ �(.
CeNTHR oR BTRCET � REAR YAftO � a � �-'
7 FRONT FT. IN.
SIOE YARD I LEFi I'�" I RIGHi �`�" R. SIDE �Q FT. IN.
DESCRIPTIOtd OF WORK L. SIDE � FT. Z �N.
NEW I hIIALTERATION I IIADDITION I —�
REAR z 3 FT. p IN.
I II I (IDEMOLISH I ByPROVEO `� [i DATE "IZ6/bJ
REPAIR MOVING p
BUII.DIN(��OOSQ:FT. NO.OF 8 1
SIZE ROOMS STORIES
EXTERIpR WA IROOF. ROCK
COVERING COVERING �
USE OF BUILDING AND WORK TO BE PERFORMED ��D
'r c � r^ " ci n ��
F��tatched Gnrage yt/o
PLAN No. 4A
� XEHEOY ALKNOWLEO6E THAT 1 XAVE REA� TXIB APPLIGT�ON {H6 AMOUNT BXOWN UNDER VqLUAT10N 16 FOP THE
AN� BTFTE THAT TXE ABOV¢ 16 CORRECT �1NO AGREE TO COM- pUIiPO6E OF E9TABL19HIN6 q peRsf�T FEE orvLv.
PLY WITH ALL QTY OROINANCEB AND 6TAYE LAWB RE6ULATINO
BUILDINa cONaTRUGTiON. VALUATION
81GNATURH OF /� �I� �, PERMIT FEE $ . ��'
PERMITTE $ � PLAN CHECK $ � / ,7 � n
AUTHORIZED AGENT r—i: rc
TOTAL FEE S� �J � 4