HomeMy WebLinkAbout1710 IOWA ST - Building Permits 4,
CITY OF COSTA MESA 2
F 4��..`I, BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT PERMIT NUMBER /
'gym' M99-00143
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 1710 IOWA ST Status: 155 ED
Suite No Applied: 03/31/1999
Issued: 03/31/1999
Vicinity: HALLWAY CLOSET
Parcel Number: 13906114
Applicant MOLES, CARL
Address:
Phone:
Zip:
Owner DIMENT, PHILLIP & GLORIA
Address: 1710 IOWA ST '
Phone: .
COSTA MESA,CA Zip: 92626
Contractor: ANDREW C COOPER CO INC.
Address: 543 E CENTRAL PARK AV -
Phone: 714-991-4700
ANAHEIM,CA Zip: 92802
License: 220551
Arch(Eng:
Address:
Phone:
Zip: •
License: •
' SCOPE OF PERMIT
REPLACE EXISTING FAU WITH NEW UNIT IN SAME LOCATION.
•
FEE SUMMARY '
Quantity _ - Quantity
ISSUE FEE $22.00 Repair/Alt Absorbtion Unit $0.00 0 •
Inst FAU<100 k BTU $13.25 1 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0
Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance $0.00 0 Boilers
Fire Dampers $0.00 0 Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0
Floor Furnace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $35.25
COMMENTS/SPECIAL CONDITIONS
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
WORKERS'COMPENSATION DECLARATI .
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to sell-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.
❑ I have and will 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.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed it the permit is valued at one hundred dollars($100)or less.)
❑ 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,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions. . /�
Applicant Signature: !'LCL��V!ific�� Date: P /M/ f
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Busines and Professions Code,and my license is in full
force and effect.LJc.4 "'r+Ib-5 y C-- "
Contractors Signature: 0 Qr c lcC4 Date:4 7j/3 //97
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.(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 15500).):
❑ 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 Ucense Law does not apply to an owner of properly 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. 0 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,faisework,or demolition or dismantling thereof,will be more than thirty-six(38)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 Wit 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 ❑No
(Section 25505 of the California 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? 0 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 nit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑Yes 8er
No
(Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits).
6 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safely Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agencis 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.
QSignature Of LegalOwner(s) / /Y Date
��Or Aullforized Applicant • �• Date
Tat INSPECTWN TYPE GATE =ALS f:OQEJI INSPECTION TYPE [.pe,,g
1616 Fixed System Final Fire Prevention 206 Final Mechanical cit
1266 Pool Spa Final 206 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Anal Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy '
2446-48
A PROJECT ADDRESS: 1710 IOWA ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06658;
OWNER'S NAME: BUSHHOUSEN HELEN K TR
ADDRESS: 1710 IOWA ST PERMIT NO: B 066587 PLAN CHECK NO: N GOVT: N SUPP : N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
714 ) 548-6763
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF REROOF W/COMP, SHINGLES SQ FT: 4 , 100
ADDRESS: UNIT:
CLAIM VALUE: 4, 100 .00 CALC—VALUE: 4, 100 , 00 GROUP OCC: R-3 /M-1
PERMITTEE: SHARP ROOFING (714 )771-2225
ADDRESS: 20062 FRANK ST •
COMMENTS: REROOF 2500SF RESID & GARAGE W/CAL SHAKE SMOKE DET REQUIRED
ORANGE CA 92669 ***+F*** x****Er+E+E+,E****i'E+,E*eE*****+i****** +r****FREE+t+t***4+tx*Trar+ey6>f**+E**#*********ar***
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provision of Chapter 9(commencing with Section Z ON ING R EQU I R EMEN T S
7000)of Division 3 of the Business and Professions Code.and my 1��yeeepppnse is i II force effect.
/// ))) SETBACKS
pC�I LW.: 048266 STATELIC.: 57157 CLA
/I Pis ci 297 Isc' signature:_ MAIN BUILDING ACCESSORY BUILDING
'ORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.lab.C). LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
POLICY NO.: 1277589-93 EXP.DATE: 10/01 /9 4
COMPANY: STATE FUND � �=`�. PARKING REQ: PROV: PARCEL: 13906114 ZNE: REF NO:
tidied copy is hereby furnished. Certified copy- filed wi� city But rlsio . PLANNING NOTES>
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: s section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS
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:
NOTICE:II.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE;
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. VAN��
CONSTRUCTION LENDING AGENCY: hereby affirm that there is a`pnslruction lending agency for the performance of the work for AP PL I CAT ION ISSUED B Y: J DATE;
which this permit is issued(Section 3097.Civ.C). Lr 'OKE DETECTOR ********************************** AF *************************** **
LENDER: ...................................F4
********************************************************************** *** '***
ADDRESS: REQ 1'��JJ!! LEGALIZATION:N F E E SUMMARY STRUCTURAL S GMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State UAB ollowigg reBLDG 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,demdRSNss' PERMIT 72 .00 5 0
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 SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
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, wit 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----> 72 , 50 0 ,00 0 , 00 72 , 50 72 , 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
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS——> COLLECTED: 72 . 50 OVER/SHORT: . 00
for tnepurpose 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 72 . 00 . 50
❑ and Professions Code: The Contractors'Stale License Law does not apply to an owner of properly who builds or improves thereon
and who contracts fpr such projects with a contractor(s)license pursuant to the Contractors'state License Law).l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. I ND I V ID UAL F E E BR EAK D OWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: SFR 4100 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 4, 100 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Salety 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 state codes and the requirements for a
permit for construction or modification from the Air Ouality 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 inti • ation is corr'c 'agree to/with all city and county
ordinances and state laws relating to building construction and•r -by autbo epresentat'rn.s' .- to' •n the above-mentioned
p pert for inspecti purposes. ([
/ Date•
y `_'�`� �5 (� `Signature: - 't.L� 01 00157n6-00157967 TOT 72.50
DATE: 03/29/94 TIRE: 14:38
Driver's License or Social Security a:
1641-46 White—Bwldmg;Green—Code Enlorcemenq Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANNING Pt - & SPA
► APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole .t: 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. .. �t 53. Steel Reinforcement
-'J•,,Etectrical Concth utility-Undrgrnd;`' 54. Forms
i. �
•
o 'llectrical Condtnt:L}tidrgrnd. 55. Electrical Bonding
� •
6i t'%, el Reinforcement °••L' 56. Rough Plumbing & Pressure Test _
•
s Electrical UFE•F'X(jrnd. si' 57. APPROVAL TO COVER-GUNITE
^'7.t-footings - 58, Electrical Conduit-Undrgrnd, '-
, Foundation ~
8 59. Gas Pipe, 0 Undrgrnd., Test
6: Water Pipe•Undrgrnd. 60. Backwash Lines, P•Trap, 0 Undrgrnd. •
107 Structural Floor System - 61. APPROVAL TO DECK
1c, Pioperty Sewer Line-& House Conniction 62. Backwash & Receptor-Final
12. S:eoQ er Cap - - r63•- Heater & Vent-Final
,
13. Roof Drains rip, Plumbing System - Final
14. Rough Plumbirtsi a' • 65. Electrical-Final
�
15. Rough Electrictt-Conduit '
i.§a Solar System-Final
16. Rough Electric Wirin
9 9 67. Fencing & Access Approval
17. Rough Wiring Sign ' ' 68. APPROVED FOR PLASTERING
18. Rough Electrical=T Bar Ceiling ; 69. !IDOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20.,,Rough Factory FtLeplace i x 01A- -1 3 - , APPROVA'CS)oCPerrrtit# *
�• ..,T, .. d -, ^:• w 2 Q.: _C 2r-'r-. > - 2
•
27., ucf ,iQ.Str ictu E ,• F 5 r •
5 j _* , +-)0. tlnder`gi:i:al-iY Y-o , r
22. Ducts, Ventilating-'* n k .-. ` r^y_'i .� `21, Product i{ri ng LTCyds u'Oil
..• _ . !nil I
23. �aseripe-kough &•'finest ••_ -•-• 3.; ; '32, Underground Flu-s1F,
24.a.RoofFraming: rri ' -t-. _ft; x > 3 � t 573.4-Undergrnd?StorageTank OGas 0O1 ^�
25. Roc{f'Shtiathing .;:ii* ;�Yfo/'pt� i t 574.'Oyerhead Hvdro'� ,
26.2X-Baq Ceiling (Structural) & Monocoat i e �! a M* - 75,cDry Chemical `•'.d ; J
r - 1. • 5. - t.,_., .
27.`Fra e a d Flashin * so y a 'b " ' 7 ° T P,;:, r' - ••'
o S� (� .;� ;�, 7 ; 1. -r . 6. 11 y Stanr ipg 7
.28.'LatIbngc Siding Li r q,•. a .. . �•-� • -
-¢x r •• ••> • 77.e-FIXED SRr6TER9:FINAL°
29. Insulation ` cc! C' S ' '• .• v ' I • �1 't 78.5TFIRE PREY. FINA- 'y s -r ,Y
-'30, Drywall Nailing ?. • 1 i • „ r- Ir4EALTrl:DEPT?REQUIREVENT
r a
;:i1. Plaster Brpwn,Coai S ! mm I I, j „79.r'f INAL IN_3PECTIOiN ' t' D
�j2,cElectricaFPower Metier-Final ; -. w 1j , 1 +• . 090...-FOOD CEk CITE ISSUED J rr
33.FinalEleetric `� •• ,-rz• * • ; NOt :// e�.�/ sarn .t
1:44. inn He--r-t Pi--(.,,ditiot�iag� Q i 1 (,` 0 I i'ir- e•r.
35.LFinabGarPipۥTest _ MI
*- I � '' * - '-I I s ' - -:�'
,36. Hood orr.CanopY -,c: . , j ! I; -; z r :to
`37. iFinaliFacctor'v Fireplaces SIT' _ ; '° i V- - t ,;_
_
-J . .. .. D , :ti I 1r •• A •I.
;. 8. Final:Plurnbing •,i xI "t
.39. Water,Service-Finale. < - I I [' t - - 77C
T r 1 .. . N. 9. ?I •- y C
rQ0 Gas Service-Final "; Y
r < ,n .n I i a
i-):-.1
Al. Solar Domestic-Final r , •• ,r I h • ¢2 Z.
`42.•Backflox• Preventert.�, -- n' - , 1 - l' '
43. Backflow Irrigation cc:.-'� - 't -
. ? 1 S
_44. Landscape Irrigation:System a , a- : ,1 _ . ; - iZ {� .r. • ij .-.
$5. Sound Attenuation* - .-- C' 2 . L Y: "LA - _
•., .. .. _ "Ti N r• C• r1 •
'46. 'Handica(t;Regulatiorjs ` M •• •• ;r, �`v ••
47. FINAL STRUCTURE & BUILDING • y�g4ir 6�[f/ .i 0,03.- '
48. ,i✓INAL PLANNING 'n * 1 �, k �,
:3 ti '
49. •Electric Release to Edison r I 4: - ::i r ^
� 1 i• rJ ._.:G
5p, Vias Release td Southern Califorrrii&.Gas Co ‘, , . o-, •
51. CERTIFICATE OF OCCUPANCY' , •' � j - _
No. Date
:.ot 102
Cr 3722 _ 13030 FEE
COSTA MESA BUILDING-SAFETY DEPARTMENT /` RECEIVEDP.O.BOX 317 COSTA MESA. CALIFORNIA
�/ %.--2 --(o ��
4 FINANCE DEPT.
FOR APPLICANT TO FM IN COMPLETELY APPLiCAT!ONQF iRivit RMIT
TYPE OR PRINT BUILDING
ADDILREISSG 1710 Iowa Street
COSTA MESA. CALIFORNIA FOR OFF/CE USE ONLY
RECEIPT NO. I� t f�VII &O
OWNER K & E Development Co. , Inc. is'
MAIL RECEIVED BY DATEE,,RECEIVED. -I DATE ISSUED
ADDRESS 15 5 PLA CENT IA AVE AC- 0--- OL'1141960
TEL. / BUILDING
CIT 'NEWPORT FIFA CH NOMI 6-3??_ ADDRESS
AR. .ECT LIC.
OR ENGINEER NO. COSTA MESA, CALIFORNIA
_
ADDRESS FIRE ZONE
�I/
ZONE TYPE [! GROUP 'UJJy
ST // -
• .
CONTRACTOR K.W. KOLL LIC.ATE NO. 1041�5N1�� ,BYAPPROVED DATE
ADDRESS • . , _ _ ZONING
372 ZONE NO.OF USE OF NEW a .
LEGAL LO
DESCRIPTION I NOT 102 I BLOCK I THA�.T2 R-1 I � n
PLANS 2 ///'''I BUILDING/J� w/. att ga:.
APPROVED ,yATE• 10-10-60
A.P.NO. Inn none BY W. L. D. ��111
SIZE OF LOT 63x100 I NO.OF SLOGS.
NOW ON LOTYARDS LLS
0 REQUIRED ALLOWED
USE OF (CENTER LINE ST.)
EXISTING BLDG. NnNF FRONT 5-.- FT. IN.
SETBACK LINE FROM
CENTER OF STREET 50' REAR YARD 20' R.SIDE /0 FT. IN.
5! C-
SIDE YARD LEFT 5 RIGHT lO T L.SIDE FT. IN.
DESCRIPTION OF WORK
REAR 9-0 FT. IN.
NEW x'c II ALTERATION I II ADDITION I
REPAIR I ,.III�MOVINGNII DEMOLISH
BUILDING iV•�,.Sf ROOMS 7 STORIES I
EXTERIOR WALL ROOF Rock -
COVERING STUCCO (COVERING
. USE OF BUILDING AND WORK TO SE-PERFORMED
SIN,( F FAMII Y RFSDI FNCE
and Attached Garage
•
Plan 7-C
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLY WITH ALL CITY ORDINANCES A In-TATE LA C REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONST- CTION. , /
' SIGNATURE VALUATION
de PERM
FEE $
T
PERMITTEE • / �q $ /dal /' PLANICHECK $ 4//
•
' AUTHORIZED AGENT
TOTAL FEE $ SY-'