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Home My WebLink About1804 IOWA ST - Building Permits -- • CITY OF COSTA MESA t • BUILDING DIVISION >:1t DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �I /s . PERMIT ! itbeftistmso B01-01517 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1804 IOWA ST Status: ISSUED Suite: Applied: 09/26/2001 Vicinity: �j2A.c “-c—e- d- , z�wr-�-y-—e-te � Issued: 09/26/2001 Parcel Number: 13905106 Zoning: Applicant: ARENSDORF, JOE ISSUED BY: • Address: 1804 IOWA ST Phone: 714-546-2875 COSTA MESA,CA Zip: 92626 Owner: YOMTOUBIAN, HARON Address 2510 VISTA BAYA CIR Phone: NEWPORT BEACH,CA Zip: 92660 Contractor: OWNER-BUILDER Address: Phone: Zip: • License: 0 • Arch : - Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF OVER ONE LAYER OF COMP SHINGLES: 1 LAYER 30#FELT,APPLY 30-YEAR COMP SHINGLES. 1000 SQ FT FEE SUMMARY Plan Check: $0.00 Calc Valuation: $1,600.00 Permit: $57.05 Claim Valuation: $1,600.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $57.05 Inspection: $0.00 Total: $114.60 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: • 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: 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 2446-46(6/00) 0 . SW . DECLARATIONS WORKERS'COMPENSATION DECLARATION: ' I hereby affirm under penally of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-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: Cartier: 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: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED TFIOUSANO DOLLARE(51o0,000),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S 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 Business and Professions Code,and my license is in full force and effect.Lic.N Class 4 Contractor's Signature: ' Date: 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). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penally 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 pard' subjeets the applicant to a civil penalty of not more than five hundred dollars(5500).): V 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 License 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) liven: •ursuant to the Contr: ors License Laws.). ❑ I a Ompt unde / :usiness and Professions Code for this reason: /J Signatur:....,-# - , it_ Date: 9, O/ Own/Is verifi,• by drivers license. ❑Ves /. No Driver's License No. Expires: yen cation of Ownership by(type of document,i.e. property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 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,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O 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 Will 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 0 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? 0 Yes ❑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 end 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 ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Iyes INo (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will 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 Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is 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 abo scribed property for inspection purposes.I agree not to occupy or allow occupancy of any building authorizedzeby this permit until final inspection. Gitoj��/ ./ ature Of Le I Owner T�„ //O/ Date Y ��/ AnNOr Au ooze plicant `((, Date L.. BODE I INSPECTION TYPE 2AM MALI COOS If INSPECTION TYP8 263 umma 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof /VOA/ 4/G 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy DECLARATION OF AUTHORITY Bldg. Permit# • FOR AGENTS OF PROPERTY OWNER This Permit# TO APPLY FOR PERMITS Street Address:ren /k .��A ST. atS�,Q/11E3.A' AP Number: 1. I (we), i0141� f0,4ttJT�dBG/Ja , declare that I am the Owner of Title of the above referenced real property, and that I (we) hereby authorize: Name: •/ ,/. (/jn Telephone Number: 7/ 55/6--0_a 75 Street Address: //, S" 0 24 91/e, City: i cfl,•i ' : State: a Zip: 9aao to obtain permits in my behalf,as owner/builder,for fee F at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I (we)shall immediately 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 to any other person, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from 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 pena`lty of perjury that the foregoing true and correct. Executed this 247e £�/��day of e 20 0/ , at , California. Print Name: Z24' - 4 /4/11 Signature"- 1 0 C Date: �.�/ 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. 0779-46(rev.11/00) Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY-OF COSTA'MESA CONSTRUCTION/� PERMIT PERMIT NO. G TRACT NO. LOT NO. UNIT NO. -. Project Address 1503 IOWA p C. .S 2-. S3 ( 1 ` Applicant's Mailing Address It iso% PftLAfmLE 7/7 MR TYPE OF CONSTRUCTION ❑ NEVI( ❑ ADD LLALTERATI/ON UREPAIR '� Owner's Name ?L Pr� MAO/CP. Phone ❑ CONVERSION III DEMOLISH IYX"I OTHER 19x�6ROBf e'Ing Zone DESCRIPTION S F WORK/USE OF BLDG. A di /4 ♦ f Addresso 3 (O* l* C=M-! L ;a! - .1 I ♦ ACa a .. -•LE S Main Building: Accessory Building: Arch/Eng. • Ar/A. License No. TYPE OF PERMIT ❑ RAIDING M FOUNDATION '= STRUCTURAL E Front • Z Address pp�� A�� l(� a l[ ;al OTHER TENANT ❑I ELECTRI�aAL ❑ PLUMBING ❑ MECHANICAL B Rear N Contractor's Name Qfl/rt[Z/1 Phone Ird/ T S6 Ja' OTHER Q E.:mar A I W. PROJECT DESCRIPTION 50. FT. 7 ri OD occUPA Y C Right N Address(mailing) �7 (.6 ��L7r1.�w c- s•'I" t{.• aK G CONSTRUCTION TYPE VALUATION$ -7nIM's.Oa s Left City License No. (t 3 9 ZONE R LICENSED CONTRACTOR DECLARATION GRADING CU.YDS. ACRES Ping. Ref. # Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: G , with section 7000) of Division 3 of the Business and Professions Code, and M my license is in full force and of T License Class C.. ow��j�Bose No.33 1/ as S Date g'- PLUMBING FEES� -17 Signature�•y , WORKERS'COMPENSATION DECLARATION Bar Sink - Showers hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink ,800, Lab. C.) / ''� j� 1' /� Automatic Washer Transformer ❑ 15-50 KW PolicyPoNo. �(Pd17�) -V Company 5[• r(.•A1D Backflow Irrigation Sewer Cap 0 50+ KW yy Certified copy is hereby furnished. Construction Pole Sub. �Sf Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date Applicant Clarifiers EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for one hundred ($100) or less). . Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel 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 Drinking Fountains Solar Tank L_ Fan — Workers' Compensation Laws of California. Motors 00-1 HP 01',4-8 Date Signature Floor Drains Swimming Pool w/SpaF,A.U. NOTICE: If,after making this declaration,you should become subject to the -_ Inc.Solar 09-15 HP 016-15+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal "Fixtures comply with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet 'Device Boxes I hereby affirm that there is a construction lending agency for the performance Pole Light of the work for which tryi5 yermit is issuetl (Section 3097 Civ. C.) Interceptors Water Heater Lender's Name R Outlets Range Lender's Address Kitchen Sink - Water Service OWNER BUILDER DECLARATION • Switches Sign I hereby affirm thabJ am exempt from the Contractor's License Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap LaundryTrays any structure, prior'to its issuance, also requires the applicant for such permit Generator ❑0.5 KW 05-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains - the Contractor's License Law (Chapter 9 (commencing with Section 7000) of 'Division 3 of the Business and' Professions Code) or that he/she is exempt lerefrom and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subjects the applicant to a civil - - ' penalty of not more than five hundred dollars ($500). LJ I; as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 • compensation, will do the work, and the structure is not intended or offered - for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Reinspection Fee $15 Issue Fee $ 3 License Law 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 DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground prove for the purpose of sale). Building Approved By //:.1r�t�/A_Data_�/� J AY ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-SKUctural Refrigeration System Application Issued By /�1 71 /�` ` L/ U / tractors to construct the project (Section 7044, Business and Professions Code: Dat.+ The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU builds or improves thereon, and who contracts for such projects with a con- — SUMMARY OF FEES tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ 2 5- co SMIP $ 0 '-5D proof of their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ PERMIT IDI am exempt under Section— B. & P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $ Date Owner Heating System& Ducting Registers ENERGY P.C. $ ❑0-100,000 BTU ❑100,000BT PLAN CHECK 25% $ I form hereby certify that I have read thismapplication all and state that the above GRADING $ information is correct. I agree di g const with all anddy ande y countyh rite repre- sentatives nces ELECTRICAL $ and state laws relat ins to uiltlin9 construct)ab v - entioy du thoper yfor MICROFILM $ of t s ci y enter upon the above-mentioned property for PLAN CHECK 50% $ inspection ur s--7_g7 MECHANICAL $ TOTAL FEE .$ ZS-50 Signature Date / O Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ Drivers' License or SS# _ CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND_PLANNING POOL& SPA Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit # 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 OF ER 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, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 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 20. Rough Factory Fireplace APPROVALS Permit# _ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 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 PREY. 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 40. Gas Service-Final 41. Solar Domestic-Final • • 42. Backflow Preventer 43. Backflow Irrigation ' • 44. Landscape Irrigation System I ' 45. Sound Attenuation 46. Handicap Regulations y , 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed • ' 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY No. Date _ _ • Dura Ridge -- 'STALLATION INSTRUCTIC i -/C15 0 Ridge Manufacturing — (818) 768-8014 Ridge Unit 2. Install "STARTER" Unit at 3. Install Ridge Units by nailing fold. leading edge of Hip or Ridge. through the dimensional fold. /111111Mmilraiak • • 8 inch exposure /a inch overhang •/ inch overhang tallation, the nails are covered ^\ ` 111 is 8 inches with a, /a inch ich,.dimensional fold. S' IN HIGH WIND AREAS: • .h installed Ridge Unit )f cement or . . . b) Lay out Ridge Units, correctly position and surface nail through dimensional fold. HELPFUL HINTS FOR THE DURA RIDGE INSTALLER • I for installation should be galvanized and of sufficient length to penetrate roof boards at :h or through approved plywood if roof boards are thinner than 3/4 inch. ♦ 147.4 n...il.. nr.. e.I.Wr a n+fnr rnnfinn and 44 r1 oro c...ffinin..♦fn.. na... ........♦r....♦:._- 13681 F E RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT .IAN 1 31 P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE DEPT. C4 OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING Alai DDRESS 1803 Iowa Street • COSTA MESA. CALIFORNIA For Office Use Only RECEIPT NO. •A5Ia: 110. OWNER Trojan Land Co. '-� �_[[- MAIL 1533 Baker St. RECe�VED BY DATE REC^^E ��IVED DATE ISSUED ADDRESS //�- -//-6i (JAN 1 R 54A4 TEL. BUILDING CITY Costa Mesa No.KI. 9115 ADDRESS ARCHITECT Carlson,MiddlebrookTEL. OR ENGINEER :..- NO. COSTA MESA. CALIFORNIA yr- CONTRACTOR ADDRESS Garden Grove ZONE TYPE I/ GROUP O✓^ r • _ APPROVED ^ BY DATE I ADDRESS i 33 Baker St. ZONING t�� CITY • Ill ZONY�JJ I NO.OF l USE OF NH PLANE USE BUILDING !�' m. 167293 TNEf: LEGAL DESCRIPTION T,nt, 52, Tr. 31 (),3 SIZE OF OF LOT •• x loo ••- A.P.NO. n'lq rte^-' USE _ YARDS EVES EXISTING LDG APPROVED ALLOWED SETBACK LINE PROM 35i31 SO( page, Q5t (CENTER LINE ST.) .c-C2 FT. "1 1^t CENTER OF STREET REAR YA L FRONT .c-�/ R /J N. • SIDE YARD I LEFT 51 I RIGHT 51 R.SIDE 1 FT. IN. DESCRIPTION OF WORK ,� FT. N. L.SIDE IX ALTERATION I II ADDITION / NEW REAR 9) FT. IN. - REPAIR II MOVING I I DEMOLISH I APPROVED .) V ,!/ 7 61 BUILDING, NO. OF 64-n SIZE 1551 soft. ROOMS 6 STORIES 1 EXTERIOR WALL ROOF COVERING $t13cco I COVERING wood shingle USE OF BUILDING AND WORK TO BE PERFORMED I Sin:le famil residence with I - attached garage. Plan 41B I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE PURPOSEE OASORFT SHOWN ESTABLISHING A PERMIT UNDER VALUATIONIS FOR THE FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATINGBUILDING CONSTRUCTION. VALUA710N SIGNATURE o PERMIT FEE $ 36• PERMITTEFe^ pp a $ 16,014.99 PLAN CHECK $ 1U• AUTHORIZED AGENT Dike & C le:rove Ino• 54. o - - TOTAL FEE $ 4