HomeMy WebLinkAbout3025 HARDING WAY - Building PermitsPPOJECT ADOHESS: 3 O 2 S HARD I NG WY �
OWNEfl'SNRME: PLATT, PAUL J
no�ss:3025 HARDZNG WAY
COSTA MESA,CA 92626
719) 957-3187
UNIT:
AflCNIENGINEEfl: . NEG.NO.:
P�UHESS: UNIT:
PEFMITTEE: PAUL PLATT (719)957-31$7
nooxess: 3 0 2 S HARD I NG WAY
C,M CA 92626
IICENSE� CONTflFCTOfl OECLAPATION: I hereby allirm tha� I am licensee untler pmvisions o� Chaprer 9(commencing wil� $ection
70001 ol DMsion 3 af Ihe 9usines5 an� Pmiessions Cotle. antl my license is in full force and eifect.
CITY LIC.: STFTE UC.: ClASS: EXP ;
Daie: SignaWre'.
wOWIEBS' COMPENSp7lON OECLANA7ION: I hereby aifum �hat I nave a certilicate oi consent m seli-insure or a ceniticate ol Workers'
Compensation Insurance, or a cenifietl coDY �hereoi �Section 3000. Lab. C).
POLICY NO.: EXP. DFTE:
COMPANY:
❑ Cetlilietl copy is hereby fumi5�e0. ❑ Cenilietl copy is �ileA wi�h �he ciry Builtling Division.
�ate: ApplicanC
E%EMPTION PflaM WONMERS' COMPENSATION OECLABATION: (This sec�ian neetl noi be compleietl il Ihe permit is �or one �unOfeO ($100) ar less�.
I cer�ily thai m the pedormance at the work for whic� Ihis Dermi� is i55ueA. I n e"fploy any pe an in any manner so as to become
su�le�,� /�/o�y W ker ' Comp �rn, ulaws o�x�j liloryrya 1 / _
�y'�i.C.lr,�' �UecsLl—Sgnazfe:9y , /,,��I V � �,�
JNOTICE: If, after making �his declaraiion. you should become su6lect �o Ihe Workers' Compensation pmvisions of Ilre Labor
Cotle you muSl lorihwilh tomply wilh such provisions or �his permit shall Ue Oeemetl rewketl.
CONSTPUCTION LENOING pGENCY: I hereby afiirm ihat ihere is a constmction lending agency for the DeMormance ol tAe work lor
whiCh IhiS permil is issued (Settion 3097. Civ. C�. .
A�DNE55: SMOKE DETECTORS ARE REQUI
REMOVE ALUMIN, COVER
OWNEP BWLDEfl OECLANATION: I hereby ailirm Iha� I am e�empt �mm the Comractors' Slate License Law for ihe following reason
(Seclion 7031.5 Business and Pm�e55ional Cotle'. Any ciry oi coun�y which requires a permi� to construct, alter, impmve, demolish, or
repair any 5�mciure, prior lo its Issuance, also requires �he applicant tor such De�ml� to flle a signed statemen� ��at he/she is licensetl
pursuanua ��e pmvisions ol the Comractors' S�ale License Law (Chapter 9(commencing wiih Sec�ion 7400) ol Oivision 3 ol i�e Business
ano Pmlessions Code) or Inat he/she is exempt Iherefrom antl ine hasis for ine allegetl exemption. Any violalion of Section 7031.5 by
any applican� b� a perm�t subjec�s ��e aDPlicantlo a civil penalty ol not more lhan tive hundrea dollafs (5500�.
I, as owner ol the pmpetly or my employees with waAes as ��eir sole compensa�ion, will Uo Ihe work, and �he
❑ slmcWre is noi imentled ar olieretl for sale (Section 7�44, Business anA Pmiessional Code: The Contractors' State License Law
does noi apOty to an owner ol a pmperty w�o builtls or impmves [hereon, and who aoes such woM himseltlherself or ��rough
nis or her awn em0layees, pmvidetl that such improvemenis are not intentletl or o�leretl for sale. If, however Ne 6uiltling or
impmvemeni i5 5014 wilhin one year oi tompletion, ihe owner vnll have ��e burtlen oi pmving he/she Jid noi bui10 or improve
lor Ihe purpose ol sale�. '
I, as owner o� Ihe propetly, am exclusively contrac�ing wiih licensetl conVacbrs to cons�md the pmject (Sec�ion 7044, Business
❑ antl Pm�essions Code: The COnVaclors' Staie License Law Aoes no� apply IO an ownef o� proOertY who builtls or imprOveS �hereon
antl who conlracls �or such projecis wi�� a[ontractor(s) license pursuani to Ihe Conlraclor5' Sta�e License Law). I am aware
that pmai ol Iheir Worker's Compensa�mn insurance shoWU be pmvieed to me.
� am exempl untler Section� B P 7 � q q B 8 P. C.
j rmisreason: OWNER/BUILDER /) �
oa ei ' � �" !/ �/ 7 � Owner: / /� � �•
I do hereby cemty ihat I am aware ol antl untlerstanA Ihe requiremenis of Cabfamia Health and Satery Code Sections 25505, 25533, and
25534 antl ihal I or any fu�ure bulldmg occupan� wlll/will not (circle one) need �o comply wl�h saitl s�9�e codes anA the reduuements for a
permit lor consimclion or mo0dicaiion Imm ��e Air Ouality Managemen� �islrict, flesitleniial cons�mction apDlications are exemp� �mm
I�ese provisions.
�a�e�. NpplicanL
I hereby cer�iry tha� I have read �his application antl s�a�e Ihal I�e above intormalion is correci. I agree to comply wi�h all ciry antl counry
aremancesandslalelawsrelatmg�o�uiltlingcanslmctionantl0erebyauthoriz���tttGGGpppresen�ativesallhiscix� �o nteruponlheabove-mentione0
pmoeny lor inspec�ion purposes �/% / ,/ J
� y J I�'
� ` ,`,"_ ___-
yEfe' I� � SignaWre' � �
o�ivers ucense o� sociai secu�ny a:
t64L46 Whue—Bmlding: Green—Coae EnlorcemenL Canary—Applicanl; Pink—Revenue; Goltlenmtl—Assessor
CITY OF COSTA MESA - BUILDING PERMIT
PERMIT NO: B 068611 PLAN CHECK NO: 03207-94 L
CONSTRUCTION TYPE; V-N PERMIT TYPE: STR
�PEAM NO: H 068611
I
GOVT; N SUPP: N
PURPOSE: ADD
JOB DESCRIPTION ; CONST. SOLID ROOF PTZO W/SKYLZGHT SQ FT: 1,000
CLAIM VALUE; 1,000,00 CALC-VALUE: 9,280,00 GROUP OCC: R-3 /
COMMENTS: CONST. 169SF SOLID PATIO W/3 2'X4' SKYLIGHTS I.C.B.O. it 3933
�rrt*+�x�x�**�t+�***+t****��x�**�x�**�rx��rx�*+r�r�r*�r*+�+r*+�*******+r************x�*+r***+�*****�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
------------ MAIN BUZLDING ---------- --------- ACCESSORY HUILDING ---------
FRNT; FT IN REAR; 12 FT 7 IN FRNT: FT IN REAR; FT IN
LEFT; 19 FT 1 IN RGHT; 19 FT IN LEFT; FT IN RGHT; FT IN
�
PARKING AEQ; PROV; PARCEL; 14113319 ZNE; R1 REF NO:
PLANNING NOTES> PATIO COVER (26'10"X13') ATTACI-IED TO SFD,
i
*����,��*��**��*,�,�,���*���,«*,�#,�,�,��****�*+�,�+�*+�*,��,��+�,��,���**+�,�*��,�,�***,�*****�*****,�
D E V E L O P M E N T S E R V I C E S R E Q 0 I R E M E N T S/' �7
ZONING APPROVED HY • DATE: / C.. J ���
BUILDING APPROVED BY ; � C•I-�� DATE: � ��
APPLICATZON ISSUED BY; �-� DATE: �\
**�t�r*�r*+r**�t*�ti�-�t�r�*x�x��r�r�'�r'�3F�**����'3F'i'r+�*x�� �r 3F�t���f�***�r+�*x�*�r* �r * *
fFiEfElEit1lfEiEfkfE1likfllEfflfiElEfEflfFfliEftfflEfEik1liElfifiEiEiEiffFiliFlkiEillEfFiEikifiliEiEiEfkikiEiflkiliFfF�1Efl�E�EiFjElEiFiEiE iElEffiEiE�E1f3E�E
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 117,00 ,g3
SMIP/NON-AES
PLAN 76,05
ISSUE FEE
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 117,93 0,00 76.05 193.98� 193.98 .00
REVENUE DIVISION TOTALS--> COLLECTED; 193,98 '�OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
117,00 ,93 76.05
iE i! if iE i! if iE if i! 1t 3f !t it iE 1! iE iE iF iE iE if fE �Elt k!E IE iflElE iE ft iE iE i! iE iF �E fflf iE iE �1f if iE �E fE fF fE iE k fElE iE fElf iE if if iE iE iF iE iE it if if if jE ik iE fF iE iE 1E iE iF iE jE
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 QNIT COST TOTAL COST
SFR 600 AES-PATIO COVER-POST & TRELLIS
SFR 400 ALTER BY VALUE RESIDENTIAL NOZONE
END OF FEES
14.80 8,880.00
1,00 400,00
Qi npt�6Si7-00166574 T�� T 193.ov
OATE: u8/24!">4 7IfIE= �9:f9
�CONSTRUCTION AND PLANNING PC-JL & SPA
APPROVAlS Permit # Date 'Inspector qPPflOVALS Permit # Date inspector
t.�Temporary Electrical Serviceor Poie 52. Pooi & Equipment �ocation �
Z Soil Pipe�Undrgmd. 53. Steel Reinfoccement
3., Electr.ical Conduit Utility-Undrgrnd. 5A. Porms i
4. E�ectrical Conduii-Undrgrnd. 55. Electrical Bonding I
5. Steel Reinforcement 56. Rou9h Ptumbing & Pressure Tzst -!
6.-E;IectricalUFERGmd. 57. APPROVAITOCOVER-GUNITE ,
7. Footin s 3 p (/ 58. Electrica! Conduit-Undr md. � y
9 �`"-/` l_� � �Y � 9 I
8. Found2tion � 59. Gas Pipe, O Undrgrnd., Test � i
9. Nlater Pipe�Undrgrnd. 60. Backwash Lines, P-Trap, C? Undryrrd, �
i
10. Structural Floor System 67. APPROVAL TO �ECK ;
17. Property Sewer Line & House Connection 62. Backwash & Receptor�Fina! ' '
i
12. Sewer Cap ' 63. Heater & Vent-Final 4
i3. Roof Drain4 64. PWmbiny System � Pinal
74. Rough Plumbing 65. Electrical-Fina� i
15. Rough Elecvicai-Conduit 66. Solar SYstem-Final �,
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Aough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electricai-7 Bar CeiGng 69. POOUSPA SYSTEP,9S FINAL
19. Rough Heat�ng & Air Conditioning FIRE DEPT. REQUIREMENT I
20. Rough factory Fireplace ' � - APPROVALS �� Permit #
- (
21. Ducts, in Structore .. . . � � � - �
70. Underground Hydro '
22. Ducts, Ventilating 71. Product'Piping OGas L70ii I
23. Gas Pipe�Rough & Test -� . � , 72. Underground Flush �
24. Roof 'rraming � � - , - 73.' Underymd. Storage:Tank � Gas ❑ Uil I
25. floof Sheathing ' �27�t/ ��� 7q. Overhead Hydro �
7
26. �T�Bar Ceilin9 (Struaural) & Monocoat ' 75. Dry Chemical � �� �
i
27. Frame and Flashing L%�7 ��,' 6� 76. Dry StanCpipe �. �
t
28. Lathing-& 5idin9 " 77. FIXED SYSTEM FINAL -
29. insulatiqn . ' � .- � 78r FIRE PREV. FINAL •
30. Drywali Nailing �. � � � HEALTN�DEPT. REQUIREMENT
.37. Piaster Brown Coat . ' .79.�PINAL INSPECTiQN
32. Ela,ctrical Power MeterFinal . � � 80. FOOD CERTIFIGATE ISSUED
33. Fina� Electric � � ' Notes: . �
� 34. ,Final Heating & Air Condttioning ' � ;
35. Final Gas PiPe�Test � � � , ` '
36. Hood or Canopy �
�37. Finai Factory Fireplace _ ' . � �i
38. Final Plumbing � � '-
39. Water Service�Final . ' ,�
40. Gas Service-Pinat � - �
41. Solar pomestirFinal ' � �
42. Backflow Preventer " ' � . � �
43. Backflow Irrigation � , • ' � , i
A4. Landscape Irrigation Systzm , . � . �
45. Sound Attenuation - � �
46. Handicap Regulations - • .
47. FINAL 57F1UCTURE & BUIIDING !}��Gj,�' ��_
48. FINAL PLANNING
49. Electnc Release to Edison �
50. Gas Reiease to Sovthern California Gas Co
51. CERTIFICATE OF OGCUPANCY
No. Da2e
9
NOTE� SHOW AND DIMENSION PROPOSED
PATIO COVER AND YARD AREAS
. �s' �
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O. �O PR�CFED INITH'PLAN CHECK.
� THIS U�CS NOT CON3TITUTE FINAL
F�qldUn'= �iQpRnvni
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b E d 1� 0 a Nait Is nd camnenced an0 maNraNed ac8re
M�ptmdayaa�
PLOT PLAN
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SEE DETAILS ON REVERSE SIDE
ROOF SHEATHING
OVERHANG
�X � RAFTERS
AT��O.C.
�/�p /
� --L %S.L_ BEAM
yo-2� x �Z'�-T-$TRAP EA. SIDE
FOR POST-BEAM
CONNECTION.
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CONSTRU TION���1��j�'�{S,pF� o
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CflY OR COSiA MESA "
PL4NNIIJG C�T, Z
SIDE E E 10� �`DO• °�• � / LL
oA�z�-�,Y:
� oar�oa o� r�wd�ao .
CONSTRUCTION DETAILS
�r
,;li
C,:'7:
D1GLL'P�
a
201t+s.R00F CONNECTION
DETAILS
CON7.
LEDGER
CONT.
LEDGER
O�ID BLOCK
�I/2�� OIA. % 5�� LAG SCR
AT 32�� O.C.
DETAIL I
CR 9 C���TECO�
GRIPS OR JOIST
HANGER
3�g° DIA. X 5�� LAG SCR.
AT �b" O.C.
DETAIL 2
�avaoPn�rr
SEIZVICEs DEFAIrIME[�PP
BUIII�ING SAF'EPY DIVISION
OWNER:� �r� ;l , !"Z� �'-�
ADDRESS� �o�-� ,/�s�rzo�iLs ��9'�
CONTRACTOR:
ADDRESS�
RAFTERS
CARPORT, PORCH OR PATIO
NOT SUPPORTING CEILING
SIZF SPACING SPAN
2"x4" 12"O.C. g'_6"
16" 8'-0"
24" 6'-6"
32" 6'-0"
48" 5'-0"
2"x6" 12" 16'-6"
16" 14'-6"
24" .. 12''0„
32" 10'-6"
i.cn o�_nn
IO�e.60R LIGHT WEIGHT ROOFS I4
ONLY CONNECTION DETAILS
X FACIA-MIN.REO.
RAFTER
APPROVED METPL
HANGER •�
�-- �
DETAIL 3
s
32" � 13'-6'=
48" 11'-6"
"x6" 24" 17'-0"
32" 15'-0"
36" +.2�4=-0-'
��x8�� pp�� i?lll�.Do
3 2 " �1.191'X:Ow
36�� p�iW_���
4"x10"
32"
36"
48"
72"
21'-0„
PATIO COVER
TYP PLANS ��
DATE�
PHONE:7i/ 9j'� �/ a' �
LIC. N0.
PHONE �
RAFTERS pPpROVED FOR
LIGHT WEIGHT ROOF COVER OF' BUILDINC PERMIT
LATH, FIBERG[.ASS, ALUM. By Date
SIZE SPACING SPAN
2"x4" 16"O.C. 9'•'-6"
24�� 8 � _���
32" 6'-6"
48" 5'-6"
2"x6" 16" 16'-6"
24" 14'=6"
32" 12'-0"
48" 10'-0"
Z��XB�� 24�� 19�_���
32" 15'-6"
:.i�IiZ�'� �SD L�Q=7u"�ll�
:7 A�'cS3 =�fl YTE�?
LIGHT WEIGHT ROOF
9
4x8 10'-0"'
4x10 12 =b�"�
S�Y
����tAI. NOTES:
1. These plans must be
kept on the job at
all tlme during
construction.
2. All framing to be
Douglas Fir N4 �
grade minimum.
3. Raftets may not
attach to facia ex-
cept for IO�roofs
as shown an details;
20�y�roofs must use
a continuous ledger
attached as shown
on dekails �klt�k2.
4. Light weight roofs
may a[tach to facia
for 14' span max.,
spans over 14 mus[
use a con[inuous
ledger as shown in
detail 113.
� UCII�U�O
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� �L� ��,�.
�N OF BUII,DING SAFETY
%�ZY OF COSTA MESA
N, APPROVED
��v ���ue m7 � m atteratian on same wiVroUt �--.�
��� ��g arM Satery. Gry ot Costa
..�.wa._�_i_ t �- - � .. C/'� �
�=s 0�15 end permu sha9 exp'rce by ('rtniW6on antl pecome null and wid N
:6 DuAdig ot work is npt ewnmenced antl maiotaroetl ac'ive ner UBC §303
:41 �dn 180 days of issuance.
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ON OF BUIl..DING SAFETY
CITY OF COSTA MESA
APPROVED
�
Thy cet af pla and ��� be k on� is iob at ail tlmes
� �y6 � �Y or at;era5o or �q }�ioyf Y�rdt�il
p� from Ne Division of Buildng and Safery, iry o1 Costa Me�a. �
mp ytmnpin f Ihis plan dn0 Specifica�6y� SHALL NOT be held to permd
�� pB � rova e�o tion oFyny f" � S City ot Costa
���,�`���� �'���
il�eseD� ��� • , _: �- - u an d
8ie buflding or work is not commerxed antl maintained acte+e per UBC §303
(� wiNsi 780 da d issuance.
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AP No. 141-133-19 LOT
INSPECTIONS
501 L
GRS
WATER
ROUGH PLUMBING
PHOP. SWR. LINE � NOUSE CON. �
SPRINKLING SYSTEM
MISCELlANE0U5
ROIIGM MEATING ANO AIR CON�ITIONING
TEMPORlHY SERVICE OP POLE
UNOERGROUNO � POWER �
ROUGH WIRING
TRENCHES [ FORMS STEEL RE
FLOOR SYSTEM
BON� BEPM n STEEL REINFOFCE �
$HEATHING
FRAME ANO FLASMING
LRTHING - IN n OUT �
PLASTER. BROWN COAT
STFUCTURA�,FINAL
HEATING, VENT., REFRIG. RNO A.C., FI
PLIIMBING, FINRL ANO GAS TEST n
ELECTRIC, FINAL
BUILOING, FINAL
SUBCONTRACTOR
I.7�Iv2[�l
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
A P C
For Applicant to Fill in Comp/etely REc i
BUILDING (
ADDRESS �O d
OWNER � �. A.P. NO.
- BUI�DING �
MAIL a AO�RESS
Z ADORE55 O (
W W COS�4 TEL TRAC�
d U CITV NO. -
Z
Z Q CONSTRUCTION W
ON LENDER
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J � BRANCH
-� N OWNER
m J ADDRESS
J m AfiCNITECT TEL. S
a OR ENGINEER C N
V Q FIRE
w � ADDRESS ZONE
d w APPROVE
P1D 9.50
�CT-3-74LX5,OO 155+` *****
TION FOR BUILDING PERMIT
AT C V D D EISSUE
r �
PE IT NO.
% /"
�,�,3,� LOT BLOCK
VALVE
wZ CONTRACTOF � BV DATE �G �
J Q
m Z •
w W ADDRESS S �. � O4± ZO E NO.OF USE OF NE N1 .
ZF CITV L- O c5' NO�. 'a � P�� BUILDING
� STATE CITV Y/>FlDSAPPROVED VARO APPROVED
w� LIC NO O O lIC NO MAIN BUILDING ACCESSORV BUILDIN�
�
�� SIZE NO.OF BLDGS. (FROM C/L 5
OF LOT NOW ON LOT FROM
USEOF DWG S
E%ISTING BLDG.
H SIZE OF NO. OF
Z NEWBLDG. .ROOMS STOflIES LSIDE
U EXTERIOR WALL ROOF
COVERING COVERING REAR
J VSE OF BUILDIN AND WORK TO BE PERFORMED DISTANCE BEl
a U �O MAIN BLDGS.
a
Q � VAR. #
O � C.U.P.�
F APPROVED
N
z
�
UI hereby acknOwletlge t�e� I have reatl Ihis oDPlice[ion antl state
� that the a0ove intormation is corroct nntl aprae to comply wlth
� all laws repulatlnp builtllnB co^siruction, antl I shall nOt employ
F„ any person in violatlon of tha workman'� compenzetion laws Of
y the State af Cnlifornia.
zI hereby cer[ity [ho[ I am ptoDe�ly licansetl as e cOniraciOr un0er
the State of Californla B�siness ontl Profossions Cotla, Dlvlsicn 3, THE AMO
Chapter 9, antl [har such licenses ere In full forca anC etfect, or I THE PURW
am ez¢mp[ from tPe provisions of [�e S[ete of Californla Business VAIVATION
antl Professions Cn<�e, Division 3, Chapror 9.
SIp^atura ofy (J� A /� n��,,,/� /�.. _
Permittee 1" �/�"�"""aN g Y�/1/'17
Au[horizatl Agant
FT.
BEf. MAIN &
ACCE�. BLDGS.
DATE
APPROVED
• `�� 0
0
JN UNDER VALVATION IS FOR j
ABLISMING A PERM�T FEE ONLV: ¢
m
PERMIT FEE S _ �'
7
m
PV1N CNECK S E
� o
LL
TOTAL FEE $
�a 30_� TFtALT �z z FEE RE�klvtu
- _� �:, <,�� � StP 211961'
COSTA MESA BUILDING•SAFETY DEPARTMENT FINANCE DEPT.
P. o. eoX 8�� C09TA ME6A. CALIFOfiN1A CITY Of COSTA MESA
For Applicanf fo Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT , BUILDING
BUILDING � � �o
A�ORE58 �O� � �� .K /O�
C05TA MESA. CALIFORNIA For Offite Use Only
RECEIPT NO. I� PEpMIT NO.
OWNER � r =+. d`Q
MAIL HECE 0Y I DATE CEIVE� � OATE IBSOED'
AD�RESS A ' � '" � [
TEL. BUIL�ING J�r "l' � �9U1
CITY f � B NO. � - Z pDORE55
ARCHiTECT 7E�. CpSTA MESA. CALIFORNIA
OR ENGINEER NON NO.
ADDRES6 FfRE � //J� �
ZONE TYPE / GROUP�✓
CONTRACTOR T A�'PROVED
BY �ATE
ADDRESS 1 Placentia �V2 ZONING
ZONE NO. OF ''J USE OF NEW �� '
(�'�'ry Nev��ort Beach ��, PUNS l� BVILDING��
/ LEGAL ��J%� f L
LIC.TNO. V�.1 No: hii �� 22 DEBCRIPTION `� 1 � d �� ��
SIZE I NO. OF B1D08.
OF LOT � X� OO � rvow oN LOT Q p, p, NO.
USE OF YARDS EVES
EXIBTING BLDG. APPROVED ALLOWED
BETBAGK LIN! FROM 1�I� � �� ���t (CENTER LIN[ BT.1 ��
c¢NTER OP STiEET `f`F REAR YARD FRONT FT. IN.
SI�E YARD LEFT � O���� I R�GHT � � 11 R. SIDE s_ FT. / IN.
DESCRIPTION OF WORK � S,oE /o F7. � IN,
NEW I IIAL7ERATION I IIADDITION I REAR �� FT. `� IN.
REPAIR I IIMOVING I IIOEMOLISH I BYPROVED (,V�g, OATE �/i�
BUILDING NO. OF p
SIZE F ROOMS U STORIE6
EXTERIOR WAL?�tUCCO �ROOF ROGK
COVERING GOVERING r/
USE OF BUILDING AND WORK TO BE PERFORMED �
Sin le Famil R i �
n fl
i
�=ttatshed G2ra e 5
I HEREBY ACKNOWL6D08 THAT i HAVE HEAo TN19 MPLIGTION }�{g AMOUM BNOWN UNOER VALUATION 18 FOR TXE
AND BTATE THAT YXE ABOVE ib CORReLT /�ND AGR6H TO COM- pURP06E OP, ¢BTABLIBH�Nc w vExen�i Fce ON�V.
PLY WITX ALL CITY OR�INANCEB AN� eTATE LAWB RE6ULATINO
BUItDINa CONBifiVLT�ON. VALUATION
PERM17 FEE
�
81GNATURE OF � � ' $ � Y
PERMITTE ` L
S I��� PLAN CHEGK $ �� J 6
]
AUTHORIZED AGENT �� � !�.-� �
TOTAL FEE �