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Home My WebLink About2240 JEANETTE PL - Building PermitsADo��ant to till in all spaces except tnose within neavY �oraer Iines ana sign all approoriatv aeclaratians. Ci7Y OF COS7a MESA C NSTRUCTION PERMIT �• Project Address �� • Applicant'sMaili ress �/ Owner's N__, ==�� /�+r� � �hone Y �I� . �, � Address ��"`"'� Arch/Eng. Licenu No. � Address Contractor's Nam �� _Phone Address (ma'��nl City License No. LICENSED CONTRqCTOR DECLARATIOIV I he�eby a(firm tha[ 1 am licensetl untler provi5ion5 of Charter 9(commencinq with section ]000) oi Division 3 oi the Business �Pr fessions Cotle, antl my license is in tull force and effect. License Class � o. Date Siqnature WORKERS'COMPENSATION OECLARATION I hereby afiirm that I have a certiticate of consent to self-insure or a certiTicate of Worke�s' Compensation Inzurance, o� a ce�tlfietl coOY the�eot (Section 3800, Lab. CJ � �� olicy No. Company �� Certiiied copY is hereby furnishetl. Certifietl [opy i5 filetl with [he city Builtling Division. oate Applicant E%EMPTION FROM WORKERS' COMPENSATION DECLARATION (This section neetl not be completetl if the per ' is for one huntlretl (E300) or less). A I certify tnat i the p¢rtormance of the wo pr h"Ch is perm�t is issuetl, 1 shd11 o 9�n qY� y person in any man f t ecome subject [o the Woyf< r G �6ation Laws oi Calilor Datd Signature 'NOT CE: If, after making this tleclar ion„ ou shoulC become subject to�the Workers' ComOensation provisions ot the.Labo� Cotle, you must torthwith comply with Such provislons o� thiz permit shall be; tleemetl revoketl. CONSTRUCTION LENDING AGENCV I hereby afflrm that there Is a construction lentlin9 a9ency tor the pertormance of the work tor which [his permit is issuetl (Section 309] Civ. C.) L.entler's Name Lentler'S A�Cre55 OWNER BUILOER OECLARATION I hereby affirm that I am exempf from the Contractor's License Law for the tollowing reason (Sectlon 7033.5 Business antl Protessional Cotle: Any ciry or county which �equires a permil to const�uct, alter, im0/ove, tlemolish o� �epair any'structure, orior to its issuance, also requires tne applicant for such permit LO 1112 d 5191ICd SLdI2rt12f1� thdl IlC/ShC IS IICEOSfC OUISIIdlIL f0 LFIE pIOV1510f15 O( the Contractor's License Law (Chapter 9(commencing wit� Section ]000) ot Division 3 of the Business antl Professions Cotle) or that he/she is exem0� tberefrom an0 the baiis to� Ihe allegetl exemptiOn. Any violation oi $ection 70 5 by any applicanl to� a permit zubjects the applicant to a civll - alty of not more than tive huntlretl tlollars (y500). . ,� I, as owner of the property o� my employees with wage5 as thei� Sole ' penzaHon, will tlo the work, antl the ztructure is not intentletl or otferetl '� fo sale (Section 7044, Business ana Professional Gotle: The Contractor's License Law tloes not apply [o an owner of a p�oparty who builtls or improves tne�eon, antl wha tloes such wo�k himself/herself or through his or h¢r own employees, proviCetl that such improvements are not intentletl o� offe�eE for sale. It, howeveq the Guiltlin9 or improvement is soltl witnin one year oi com- D�etion, the owner will have tne burtlen of provin9 he/She tlitl not builtl o� Im- p�ova tor the pu�pose of sale). ❑ I, as owner of�tM1e proper[y, am exclusively con[racting wlth licensetl con- bactors to construct the oro�ect (Section �044, Business antl Protessions Cotle: The Contrattor's License Law does not apply to an owner of property who builtls or improves tM1ereon, antl who contracts for such 0/ojects with a.con- tractor(s license pursuant to the Contractor' - License Law). 1 am aware that proot o� their Worker's ComPensation ins ce Sho..u�l"tl be provitle0 to me. � ❑' I am exempt untle� Section cyr,a P. C. for this �eason Date insoecuon our u � Si9nature Drivers' License or SS � CMF OB65-46, rev. 10/84 Owner �JL ive reatl mfs aob��catio vee to comolv with all the rte.that tne above county ortlinances iy auM �ii�{ repre- �nea opeqiY,fpr TVPE OFCONS7RUCTION ❑ CONVERSION ❑ I �:QF$CR}j�'JON OF VXOR TVPE OF PERMIT LJ C�RADi ❑ TENANT ❑ ELECTRIC ❑ OTHER PROJECT DESCRIPTION 5(i. F7 D � _ ALTERATION REPAIR NG L�FOUNDATION LJSTRUCTURAL AL ❑ PLUMBING ❑ MECHANICAL CONSTRUCTION TVPE VALUATION $. ZONE GRADING CU. VDS. AC Remarks: Sink kflow Preventer kflow Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Droins Reinspection Fee � $15 Duct- UnderGround Duct - Struciural Duct - Ventilating ExhaustSVstem ❑ MWtiple Firepl/Fact.Blt.IC60# ' Heating System & Ducting ❑a100,0008TU 0100,000 Reinspec[ian Fee � $15 Whi[e - Builtling; Cana�y - qpplitdnt; Pink - Accounting; GOltlenrotl - ASSe55or Showers Service Sink Sewer Cap Sewer Connectian Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto�Wash laue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑0.100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Isue Fee $ 3 FEES 5 3 A.P. iW S Main Buildi E T Front B Rear A C Right K Left S Ping. Ref. # Planning Notes: 903�: 3/?0/q$ — 6'I Z — zo�a Accessory Building: ys' O� � �tl Parking Req./Providcd ELECTRICAL Automatic Washer Transformer ❑ 75�50,KW Construction Pole Sub. � SO+�KW Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Bozes Outlets Switches Garbage Dispoul Generetoi 00.5 KW 05-15 KW Reinspection Fee � $15 2oning APProved BY— Building Approved 8y Appliwtion laued Bv_ Meter LJup to 100 artips Meter ❑over 100 amps Sub Panel Mators�0.7 HP�1h-8 Inc. Solar 09-15 HP 016-75+ Pole Light Range Sign ; Standing Sections Tresh Compactor luue Fee c4o4:9 FEES $ 3 Z O N I N G R E Q M T S SU ARV OF FEES BUILDING PERMIT $ • O SMIP $ '• 5 � PLAN CHECK $ � • �' � PERMIT PLUMBING ' $ ISSUANCE $ PLAN CHECK 25% $ ENEfiGY P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM $ '( MECHANICAL $ TOTAL FEE $ 2' •�[ 3 PLAN CHECK 25% $ , �� -CONSTRUCTION AND PLANNING _ POOL & . . � APPROVALS Permit # Date. Inspector � qppROVALS Permit # Date � Inspector - . 1.'Temp;�ary Electrical Serviceor Pole � 52. Pool & Equipment Location � 2. Sail Pit�e-Undrgmd: � � 53..Steel Reinforcement " ,� 3. Electric� I Conduit Utility-Undrgrnd.: 54. Forms ' � . - � 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding � 5. Steel ReinfOrcement � � , � 56. Rough Plumbing & Pressure Test 6� Electrical UFER Grnd. - -� 57. APPROVALTO COVER-GUNITE 7. Footings, a. 2�Jgy 58. Electrical,Conduit-Uncfrgrnd. �8; Foundation ' � � 59. Gas Pipe, � Undrgrnd., Test � 9. Water Pipe-Undrgrnd. " � . 60. 8ackwash Lines,�P�Trap; � Undrgmd. 10. Structural Floor System 61. APPROVAL TO DECK � . 11. PropertY Sewer Line & House Connection 62. Backwash�& Receptor-Final . _ - -12. Sewer Cap � . 63. Heater & Ve�t-Final �' . ' 13. Roof Drains � 64. Plumbing.System -.Final - ' � � 14. Rough Plumbing - � 65. -Electrical-Final 15. Rough Electrical-Conduit 66. Solar Svstem-Final �- • � --, 16. Rough ElecYric Wiring 67. Fencing & Access Approval . - 17. Rough.Wirin9 Sign 68. APPROVED FOR PLASTERING ' 18. Rough Electrical-T Bar Ceiling . � 69. POOL/SPA SYSTEMS FINAL - 19. Rough Heating & AirConditioning FIRE DEPT. REQUIREMENT �- 20. Rough Facmry Fireplace APPROVALS Permit # - 21. Ducts, in Structure 70. Underground Hydro ' 22. Ducts. VentNating 71. Product Piping O Gas �❑ Oil 23.'Gas Pipe-Rough & Test 72. Underground Flush ' -� 24. Roof Framing � , 73. Undergrnd.StorageTank �Gas ❑Oil ' 25. Roof Sheathing • - � � 74. Overhead Hydro 26. T-Bar Celling (Structural) & Monocoat - 75. Dry Chemical ' 27. FrameandFlashing , � 76. DryStandpipe� � - � 28. Lathing & Siding � � 77. FIXED SYSTEM FINAL � 29. Insulation � • 7S. FIRE PREV. FINAL 30. Drywall Nailing . HEALTH DEPT. REQUIREMENT ' � 31. Plaster BroWn Coat 79. FINAL INSPECTION � - ' �' - 32. Electrical Power MeterFinal , � 80. FOOD CERTIFICATE ISSUED 33. Final Electric � , ' �Notes: 34. Final Heating & Air Conditioning . 35. Final Gas PiUe-Test . ' , . . � . � ` 36. Hood or Canopy � - 37. Final FactorY Fireplace ' . 38. Final Plumbing � , ' ' " 39. Water Service-Final � . � - 40. Ga's Service-Final � 41. Solar pomestic-Final 42. Backflow,Preventer 43. Backflow Irrigation . ' 44. Landscape Irrigation System 45. Sound Attenuation � • - � 46. Handicap Regulations , � ' . , , � . 47. FINA� STRUCTURE & BUILDING � ' g' � �:�� , . - 48. Special Requirements Completed ' . i ' , - , . 49. Electric Release to Edison � . ' . . . . � 50. Gas Release to Southern California Gas Co '� , � • 51. CERTIFICATE OF OCCUPANCY ` "- � � . . . . .. , .� . . , � � No. Date . , �� 6 � W W t � M J � V �tW[MK ZZ40 STRUCT�RAL APPROVAL ONLY SEP�iRATE Fi.RU!!TS ARE REDUIRED F(lR E!F.�7RlC.4L. PLU�fBI�:G, fi�rlrl�a, t+cfdiil_tiiiNG APJD �iei�iil;is;;i�*;n;,� , :.�iK � � �t's`�� :'_.-I _._:..�(�1�_�{ TH;.; i:i.'�.F"-. .�:i .. . �'.!'P _;•;i?hNY I fi�:...�_ *,.?i,:�. ,..��,��5"iS t_._�._...___._ �.. ..._... __ .... __.� .__�� OR EUILCIIId�:? �. . •��tii.'!vS t��hF. T� BE Ef�?Pi.ii'l7i . � E:ir':;;;J � ..'�.T ;"n(!STA�'r.'OF CAUepRIJ:.;.::r:;c.;�:Ft Ut� i":;:U_;'i:?i;;: SA;E?Y 6E C6NiJl.(E�G FOF ACL`lTI�NdL . P,E�UIREMFfJT$. �{�IO�MC[ �Z�j (p �cuo�ra � 11ri" 1L��AJ Cn� H�(�jk-1 '�L.CGK \�(A cm oF cosra n�sa PLANNING DEPT. SU8IECT TO BIDG. DEPT. REO. BY ��'IG,L DATF 3 - Zo -� DIRECTOi OF FUNNINO J��,,.�C'�'r"� SiREET � _ _ ♦� F W t F N T Y PI CAL 6" CONCRETE BLOCK FENCE Camenc capinq ov�ioml � CMnnelBbck With Ono �3r� Nori:onW Tap o/ MI � Penas For Fenm 6' a Lw Vart. Ban 3/8'� tl 4' �0" O.C. for Finas HigMr Th�n 6' — Veh. 8ws 3/8'�/ at 32" O.C. fill Celb Solid With GroW — Where Steel Ocwn Rsintorcing Staal SMII Conform to S�c.A•1539 A.S.T.M. All Steel to Es L�ppsd 16"�or W�Cod� - � � NATUNALGRADE wsm= _ • �� -O . TWO 7/!" BARS e � CONTINUOUS TOV 6 BOTTOM .� � � r c o� I�-�- WALL HEIGHT s � z :� —wio� SEE CI ��ow THICKNESS OF FOOTING DEPTH OF EARTHTOOTH SPACING OF EARTHTOOTH REQUIREMENTS 6 � 5' 4' 14 14" 12 10� 10' 9 12�� 4�� 16 GENERAL- NOTES MORTAR: On� Par1 Plosfic Gm�nf, ond Thres Parf� Sord GROUT: , pne Part Cemenf Tiru anA pw Holf Po►is S�ond COPING: On� Port Gmenl, ThrN Parts Sond � CONCRETE: Wall MiYep �: 2;� i sS�i Mar. ol 7/2 Gdlons ot Walu Per Sack of C�mant OROUi MAY BE POURED FROM TME TOr OFTNEfENCE CE LlE AND AREAS OF NDNIZONTAL REIN- FONCEMENT SNA Ll 8E CLEAH, CIEAM • fItEE Of ALL MDRTAN DEBRIB, ETC. eowos s►u�� ee raovtoco ev urua BLOCKS IN STqETCHER COUHSES SO TMAT VERTICAL JDINTS A�TENNATE IN EACM COURSE. fN OF E4pTNTCOTH I/J TME MEIGTM OF FENCE �ECOW BOTTOM Oi FOOTING. SCALE: 1/2" • I' 8� 12' 16� OWNERS NAMEL _ _ ` City of Costa Mesa, California �� AODRESS: _ _ _ _ _ _ _ _ _ _ _ _ _ _ Building .Department , . . Applicant to tlll in all �paees axcapt t�ow wit�in �aarY �arGar Iinn anC siqn all aO��oDriab E�clantlom. •. � PER ITNO. . TRACTNO. LOTNO. � UNITN . ' ;.r ' ' . �:J�.i�i ;jli.:/.:J•.t �. ' �1+�•,_ � li � CITY OF COSTA ^ME�.S�p�J�C NST �U�$(� ION PERMIT , � � � �- , - � � . , . , _ - . . Prolect Addras �+.wC�V �,��}i+�� ' . O� O '�, G Z ' I D -�"'r- . . . . , ; j ` : � i r . � . _ i � ApplltenYS Melliflg f1. s2u ' �` `l''�' - � � ' ." . � ' "' TYPE OF CONSTRUCTION � EW ; ADD ALTERATION REPAI R � �i � �� „` . % v - J� _ ❑ CONVERSION ❑�DEMOLISH ❑ OTF{E� q,p,.� 7�, � ��, _ � ZOM . � Ownm's Name . /'/L!. •. �L"'1-- -' � '�--ahone � (A . ✓<<, ` .,. �� - �� ,- . }-'�" . i. FQE$ CRJ PTION OF WORK USE OKBLDQ'.; � , Address • �(`�`•' �� v l%t-!iY! 0...�" �C f,f _+:::e y_ S Main Building: � . Accessory Building: � Alth/Eng. ' � LiCBnSB Na: �T_' ` ' TVPE OF PERMIT � ' GRADING �FOUNDATION STRUCTVRAL " : - . T FfOnl ' � • � L�� ; ' i ' ' i Q Address - � � � ' �- � � � � � , � �'Q TENANT ,� ELECTRICAL ❑ PLUMBINO �O MECHANICAL �� I B RBef , � � ' . ' ; n , • � -� I �' � N '� Contractor'slNam � � � �' ❑ �OTHER � ' ' • '. �C � � � � : A • . , � . � , � •. i � � ,hone � f � -�! i... . O Ripht .. I � . '�' : ' , ' „ - � ' i N � . � � . . � � , ' � , GHQIECT DESCRIPTION ' SG. FT. �'`" •f � ' J "' ' OCCUPANCv �_�— K .. G Address (mA �'�a� � % � � � 1 - - . � , - . i CONSTRUCTIONTVVE I . � ..- VAWATION S � ! i l. g Leh - . � I 1 I �Ij � :. . . ' " " � , fl � �City'License No. i . . � ' - ° _ , ' � � � I ZONE . : , GRADING CiJ. vDs. � ACRFe. ' PI�. Ref. 5W : . '. ' Perking Req./Prw�ded �' j " � . � E ' LICENSED CONTAAGTOR DECLARATION �' .• � - � � 1' �ereby affiim that I am ticensetl untler proviilons ol C�arter 9(commandng i qam+rkc I � � � � �� Planning Notes: �-� � }�' �� }?L�'�� `�,��L �.: .`- � j M 1 , Iwitn sectlon! 7000) ofI Dlvislon 9 ot tne Business antl' R'qfezslonz CoOe, antl � - . . , � � . T, mY Ilcense is In lull lorce ana effect. I.� � �, /1; I I I � � � I�: i ` i'. 1 � � - i � � I I .7 .i. � y� 1 Llcense�Clau I�� i I Wcen�f�p��.. I j ' � . . ' ' '' . j 11 I. S I .' � .' i � ; i I i � . ;� PWMB�NG. FEES i � � ' :� � 1 " . Data , .. � � �519natura" �. �. :` � WORKERS' COMPENSATION DECLARATION i � �' �� • . t ' � I ' � . ' � ,. '� � � - � � 8er Sink j , Showars� , � , � : � E E ' , ' i � � LECTHICAL i � � FE S � I hareby ailirm [nat I �ava a�cerUflca[e o/ consent to salHnsum ar a carll/lwte j � -•� ' � � � � � . � .' A Worken' �Compensation � Insurance, or a certHieO coOY �tnerfo/� (Sactlon ' gatkflow PieveMer - � - � �� Service Sink i � � - ' • - ' ' .. . ..._�-». . , � lBOo. L'aD: c.)... '....� ._i " �" I I � ' . . AutometicWasheF' �-T"' ' Trensformer-O'75-50KW�7' �-�� i" �� Poliry rvo.' � I � � � Company � � � � ' � � � Backflow Irrigation � I I ' $pwer Cap� � � ; `�"� � ' Construction PaIeSW. � � � � ❑ 50+ KW � I j Certifietl copY Is �ereby furnlshatl. ; ! � � � t � B'Certlfietl coOY �s /IIaA with t�a dty Bulltlin9 DlvislOn. I I. 4 I j Beth�ubs j � � j � 1 Sevyar Connectiou � � j � Cooking UniO 1 I I. Meter �up to 700 emps � � � I Date � APVlicant � � � ' • - ; . � I E%EMPf10NFROMWORKERS'COMYENSATIONDECLARATION � , � ClerifieR I � � � $pl8!�IIeCtOfs� ! � � � Dishwasher� i ; : I ! MBtOf Oover,100amps�_ i� � ; f (Thiisettiomneetl.nat De com0letetl N the parmlf Is for one hunGmtl. (5300) or -' - ; � , � �� F icss). � � � , Dishwasher'� � ; ! $oler9iping , ; Dryers OGes ❑Electric � Sub Panel � � ( ; i � 1 certryy Ihat t�e parformance ot t�e work'fo�4vhlcl��thli DerfnR Is IssueE I� � � � ' • snau, noq em oy,any parson in any mannen sd•a to n� sub7ect m ti�e i � Drinking Fountainz i Solar Tenk � � ! � Fan ' i ; i ' Moton 061!HP �7 K j 8 � � � `� Work}r! tO�iBentation Laws of Callfo�nia:.�✓j��'� � � ; I I . . � , ' . � � ' . . DMe! � � Slynature ' r Floor Draint � � Swimming Pool wlSpa �, , F.A.U. � � f � � InciSoler �9;15 HP 01615+ ' � � 'NOTICE: If, a/tar making [�is Oeclantlon,�you shoultl becoma sub)acl to t�e � . � � , � I Workers' ComDonsatlon provislons ot tha Labor Cotle, you must tortnwith ' Floor Sinks� .l. . i . Urinal � -�� - _�• `✓�• � ' Pixhrer:� • i�" �--�-j- •�- Mittowavm "i"" I"` j"" i' , �, comply' wIM such provBions or this perrimit s�all be ticematl �ravoketl.�� ' � �' � � � . • : � . � , CONSTRUCTION LENDINC' AGENCV t' , . ' ' � �� 1 � � � ' � ; ' �� I - f ' 1 nareby a/ll�m lhLl t�ere IS i Conft�uctlan Ientlln9 a9a��Y �o� the parlormanu I �� Ges ServiGe 1 v'Outlets '. � �� Wet�r Closet � Device Baxea � i. � i Pole Light � I � ( � � j � ol the i w0/k tOr whlch [Ms Oermlt Is'. ISSulO (Se[tlOn 3087 �Civ. � C.) �. i In2erceptors -�-, Wa[er Heacer .' i� � "�^� Outlen � � � j Range � � � i ' ! � �AOdC1'S i`�dTC. ' . • . � ' . � � �,� ' LenOer's Aatlrass � ' ' � , � � ,�: � - � ' " � ! � � Kitthen Sink i � - � Wete/ Servite i ^ ) n � ' Switthes � ;� � j ' ' OWNER BUIIDER UECLARATION I � I I I � 5�9� I � I � � i I �ereby afflrm lhat I am eaempl }rom the Conlractor's Llcanse�La�w tor the I ' Lavataries� �� '� ��. . ��- %� followin9 reason (Sectlon 7031.5 Buslness anE Professlonal CoAarAny Ury or'i �. AutO-Wesh �� 1 Garhage Dispoul ; � ; Standing Sectioro I i-� I �. county w�lcn requires a permit to construct alter Imprave. tlemollib or rapalf P-Tre ' i. � Le rMr T�e f � i � �' � P V' '' G t ❑0.5 KW �5-15 KW ' ix ; ; any structwa, prlor to Its issuance, also roquirez t�e applicant lor such Dermit ' y Y anera o� T�ash COmpettOr I , 'to /ila a slgne0 itatement lnat he/she Is Ilcensatl pursuant to t�a proviilons of Roof Drairm * • � � � % . � " � � � ' ; � 1 � � Ihe Contractor's Ucanu Lnw (C�aptar 9 (tommencing wlth Sacllon 7000) ot r . � • ' � � { , �i � � � ! -Dlvition 3 of l�a Businass anE Profeisiant Cotle) or that ha/ihe Is exempt � • � � . ' 1 ' therefrom anC ihe ba5i5 for t�e allagetl exemptlon. Any vlolatlon o1 SecUon , . '� � -�` � �• ��- I I ' 1 ! � I 1 I . �Oj1.5 by any aOP��nl .tor a permit subjocti t�q.appllcanL lo.a civll. � ' � � � � 7 � � , ' , . � ' ! I �alty�of nol mora than five hunAretl'Callars.(f500): � �. � � � r� �';, � ' ��. "' 3� I i � • j ' � I f I � � i I, as owner o7 ibe proPerty or my'employaes alt�.wa9es as thelr sole� � Reinfpection_Pea� I � S75 -��q . Issua Fee� � � ��s� ' ' , � . cOmpensdtlOn will tl0 the work, and [ha Slrutture Is nol IntenGeG O/ O/fB�etl ; � {jpiOfpBCtiO� FB! � §7$ IpuO FN � � ' � S 3 for ule (Sec�lon:7044, Business antl Pmfessional Cotle: The Contrattor's,- , � MECHANICAL ' • i I �FEES License� Law Uoes not apply to an ownar of a property who bull0s or.improves � � ,i thereon, antl who aoes zuch work hlmsaN/herself or thmugM1 �is or her own � � � � ' HOOd Of Type I ❑• '..� �.•+ � DEVELOPMENT SERVI1�$ NTS: employle5, p ovlOad ��at SUCh ImOrovemenl5 a�a not IntenOeO or offaroE /or � Boiler � •, �; • fJ( ' ' Sale. 1(, �oweva�, [he Duildln9 or Improvamanl is solA within ona year of com-, � I Qgp ��_ T�� I� ❑ � �: �'� I �� A�ro1rod By r'�'� �� i I ( bU �• �� platloq the ownar will haw t�e EurCen ot�Provin9 ha/ihe tliE not builtl or Im- DucF- Unde� Ground � � I �.'�' ; j�; � � � guildinp ApD�owd By j ' � ' i'-`ti,' '' � � Aata� �rov� fo� the Purpo:e Of sale). � . . : � . � � " . , : ' i I � 1 ' LJ I, as owner ol ine prooerty, am exclusively contracting with Ilcensetl con• Duct - Structurel !� � �� RBf�igaretiOn Sy51em � � M � � i Appliotion Inwd By! � � � �''� � I nate �. r<� tractorsto <onstruct the proJect (Seclion 70A6, Buslness antl Professions Cotla: � ' � '- , , The Contractor4 LI<ense Law does not avP�Y �o an owner ot property wha' ' Dutt - Ventilating I. i � �Ol1i)0,000 BTU �0100,000 BTU I � � ' � � SUMMAHV OF FEES I I I � i bullas or ImDrovas tneraon, anC who tontracts for suth projects wllh a con-1 � _ - i � ( ',t ,._:l i � i � �,�� tractor(s111censa pi�rsuant'm tne Contractor'i Llcense Law). I am aware;thaL Exhaust S Stem � Multi le � S ate:n Re ' BUILDING PERMIT � S� ,SMIP $! y p y peir/Alteretion proof of their Worker's Compensatlon insurance shoultl be provitlo0 to me: � ' � •, �A �: ' � PLANCHECK � S "' �PERMITI � I ; ❑'.1 am eaqmpt uns(or Saction Br 6 P. 0.(or tnls reason � FirepUFact. Blt. ICBO �, Fire-0empers ' � � ' � � • i i .. �� [f ; . � . . _ , . . � PLUMBING . S ! ! , I, ISSUANCE S � �, Dafe ` �%-- owner -' ` � ' � � , Heating System & Ducting � RegistMs � ' . � i � ' � p�qN CHECK � Y5%' $ � � ' � iENERGV; P.C.j $ � i � I har¢by Clrtlty that I bave matl tni5 apD��cdtlon antl stdta thal th0 above.'� ' ❑P100,OOOBTU �100.0008T - - , � - ' In/armation Is corract.•I agree to comply wiln a11 tlty antl countY oralnances I ' ''� i 1 � j ELECTRICAL I �� IGRADING � S j ana state laws relating to �ulltlln9 conitruCtlon, anE �araEy autharize rBDro- . � , � i i � f i ' i i MICflOFILM ' S� � ' sentativas of tNs city to enter uDon [he above-manUoneO;P�q�fty, for i • . ' 1� � � � i PLANICHECK +5096 $± ' I � , � 1 1` ` InsOactlon purOosei " � � � � � �1 �� , � f, 1 , ;- , � %/, f 1 � MECHANICAL � � E TOTAL FEE 1 5� SignaWre Dat�% i � � � I' • orivars' ucenm or 55 � ��-•, •� � �� ' � ' � Rsinspeetion Fw 516 ; laus Fe� • � S 3 PLAN CHECK 25% $ I� GMF 0865-46. rev. 30/8.: White - BuilEln9� Canary " APPllunt; Pink - Accountin9: Goltlenrotl • Assessor � J . . � . � �� -' '`fi. :r` %�,t .� , .. .., . . � . . ._ .. . ' . ' " � " ' '. � - . _ . �i �, �.-- ---------� ----'--"--' --- --�-'-.__-' --'---'-POO� ------_..--- � --- � -� _ �CONSTRUCTIONANDPLANNING::-_ ='�_ - -;• -s. ".c' ��':-�„'.-L .PA _«.n�.-��_ � -• --: :�-_•. - � ;Date .� Inspector_>�� -" -`` �-`�� `'-^:�'.-�_ - '..Date� Inspector � APP_ROVALS ;, Permit�h - " ;°APPROVALS=��'�Permit�#'� - . ' ) _ __ _ ^C .y`'_ _ _ _ ' 1:�Temporary Electrical Service or Pole v:• r -' - - - ` � � � ' � E< _ _ � � ^ -' _ _ : 52. Pool & EquiDmerit`.•t:ocation _ _ - - - ' - s o - � `t "i ` 2. Soil Pipe-Undrgmd. � � ? =o : ' ' £ _ < - j < < `�. ^>` ' � ' 53.�SteelJReinforcement � - - �� ~ _ -' , _ _ , _ - 3. ElectricaiConduitUiiGry-Unurgrnd.�:,=; -� _ �.. ^..54.>Forms _ _- _<<__-' . __ . . _ ,,:t� �4. Electrical Conduit�Undrgind:- ` = c <' _ �� -' _ �55.�Elect�ical�8onding� = ,=' - � � - �• : 5. Steel Reinforcement. .� _ `- - - 56.- Rough Plumbing-& Pressure l'est; " � - - " - . ,' - "�,. � � . , � �6. Electrical UFER Grnd. �� -; - � � " `-- - `' - � 57.`APPROVALTOCOVER-GUNITE � � � � � --= - - nE - `� - �-.. r- �._ - . ';7. Footings � , i _ � _ �. = ''�.. ; 58._Electrical_ConduitUndrgmd:-' _ -- � �; �_ i ��'� "=8. Foundation � . � � . � , c �; - .: , + =; , ':r `� 59. �Gas�PiPe,�� Undigrnd:; Test ' _ - - � � � � - � , i : 9. Water Pipe-Undrgmd. � _ - �" - " _' � ;,_ _ gp, gackwa;h Lines, �P-Tiap, � Undrgrnd.- � � ' . � ' � ? � ' 10. Structural Floor System �; _ � _ - �' . � ❑ - � � 61.. APPROVAL`-T.0 DECK`:.',': _�=- _`. >� �� ,; . � ' _ ° _ � . �11. Property Sewer Line & House Connection . ' ° : .o : � "62-. Backwash-&.Recep?orFinal `°<< s�q � �V � ' r .12.SewerCap � � � �' ' ;= . -63: Heater�'&�Yenf-Final _ • _°• - ,,- . . "" � - - - � - - i � c � 13. Roof Dreins � � - - _ _ . _' ' 64: Plumbing System.-_Final : �,' -� L- ^ _- _ _ - � 14. Rou hPlumbin �-' ' =o - � ` � F="r� V ��_ �- q I- - � � E 9 9 , .. . ,65:.Electrical-Final-_.. • cc � . . . . ��:.,:.- _ . _ 'a.._15.:ROugh.Eleci�ical-Conduii___. �..._-._.�.�__��_ -66--SolarSystem-Final--,-r--� �.�--��- �- E `� . � 16. Rough Elec[ric Wiring ' � - --- I ' ' � • ' • : . � + "----'. i - - i f': -� ' - ' � _-- - �;67.-:Fencing & Access-Approval`�- =:-.-.-�.� - -- �-;- ; 17. Rough Wiring Sign�` . ' � i j:._ ; - ' < . = - � ;Sg. APPROVED FOR PLASTERING � ^ ^ ` i _ . i � ,r 't'- �' '1` - i : _ • 18. Rougfi Electrical-T'Bar Ceiling 4; f ; �.'_' ; ' � ' _ � -� � .. 69,'P00 VSPA SYSTEMS FINAL ` � = j"', �: ; � ' � � � � ! � , 19. Rough.Heating & Air Conditioning _1 I � � � j i ;�:' � � ' ;FIRE DEPT. REQUIREMENT , " !'� � � � � , � - . .= � - � � c. � . � . , : j : _ . i ^ . �-R : 20.�Rough.Factory Fireplace � i �! ; � - � � � � . APPROVALS Permit # '' E �� ' � � '^ i �' i „ � ; r ' ' � � �- � . 21. ,Ducts; in Structure ' . � , �; { � � , � � i �70. Underground Hydro"``; P � , j - � � .� =� - i"' 22. Ducts, Ventilating�� i ' ', '�� i ��,7�. Product Piping!OGas; OOiI � �' � z� I � .s 23. Gas Pi� e-Rou h & Test ' � . --`' - - ---- -";�7-- - � ' � L- :�_ --�-'--�--- I -• - - _ P 9 - � T. "72: Underground Flush'��;,:,-. � `.i' � �� 24. `Roof Framing �_ ' _' � � ; `�. ; ; �, ..� -? _ �73. Undergrnd. Storage Tank O�Gas ❑ Oil�. _ � � 25.�:Roof Sheathing .. .. ,. -_ i._ . = _� � �..� t: � - _ ,74: �Overhead Nydro � - -_ � . ,-�- = ` +, - � ' ir' ' ' ' G 26. :T-Bar Ceiling �StructuraU & Monocoat ' '` � 21 -_ _ .- . :75. Dry.Chemiral � ; � � •; '� _ �. � �� , ' _ � � � i. 27. •Frame and Flashing; _ � � � e � , ' ` � ; � j76. Dry Standpipe i j < �� ; � � � ; ' � j i - I � � �,�; � 28. iLatFiin & Sidin � � :. ' , '' i .i , t . '� � , : : � .. . _ _ ' . r- 1 i ! ' i ` ' 9 9 :� . �i �. I .� �=; i-�77.� FIXED SYSTEM FINAL ;='- •- ,�. �: i i � �. 29.�ilnsulation - ; - ' < � '. �4� � � � i I 1 � �;7g, FIRE PREV. F,INA'L , f r� � � � � i �� i-30.'D�ywall Nai_ling �� - , I'; �; � j i-� ,; � j I' iHEALTH DEPT. REQUIREMENT� � j__ ' �- o_ . �. ' ' �� .. � : , . . . ' z.-31.'Plaster.BrownCoat' I � � i ri---"�-' r- --"-r-'r"79:"FINAL�INSPECTION- v '�¢._`.�.:"- �� ,r ��_._...� ��. ♦ i .� �� , I � 4 I. {" �� 'j. � 5 Y.. r.. .^i f Ilr-.l ; 1 1 ' :'i � 1 "" i 1 � . V ; � 32. �Electrical'Power Meter-Final : !:m.'� .� -0 { � � � � �80.� FOOD CERTIFICATE ISSUED � � „ i �� . • . . . � , __.. .� _._.._,. , . i � ��...h , r-�-- --'(--� -r----�----__�'-_ -{ . -----�---_.^..--t - , 33. `Final Electric + � ; � �, . � � � i � ;Notes: . j � 4 ; f , I I j ' . '� ;: � �. � � � ,.. ,.. _ . _ ...__..._.__..._..__ �_�.�.-_:. _ _ - - -- -r--- -------------_.-------- r 34. Final Heating & AicConditioning '; i �.� ; � T I � �l�� . � - .� c I� � � i � IA i ' �� 4 . -.-r--.-_,--; ... f �• _ . �.. ..-_ � i �,. � �_.' _ - .. � 35. Final Gas Pipe-Test :, i _ i.- � , i i� ;,� � i o _ ''�. ; . i' I o^�. ;.�T � ' � i i � ` �" �o �'i ' 36. HOOd Of.CanOPY � � o ! :, I � ; 1 4 : - { � 1 ' �' � { :` � " � � i i s � : ' < `. N - C l - ' _ r _ � - '< 37. Finai Factory Fireplace f ' j j � f ' ( � � __ � ' - � - i I � -'�_ _ �i .� I � :_ " � j, _ ' ti s = �- - - f ,. .. t i � � .i �=6.. �. + b • q : 38. Final Plumbing � i 'i j .. �4 � � " i - I i � i � f i'-I -: I �.I I � .� g i � �% �� 5 '� ' � � 39. Water Service-Final! � � �) � :� � -. i . ' . i } ' � � i-' � � ;. - i i t i t � � i 1 �'- I I '�. �� ^. .. t�i 40. Gas Se�vice-Final � �� ! " I .� � � ; � � � .i � I � � { � i � � � c � c' ! � `.�� :. w �. „ n� s �e s. t 41. Solar pomesticFina� ! � • t �; _ � i � j � -, � I � � I � � � � i ( ` � 9 � � . . ' t . �. f, i I 7 ..L._........_ __ ....-� . ._.1_._....-.._�.a.--...,«...... : t'.� . 42. BaCkflqw.Preventer� .� �I � I •� f I i j I � � � 1 i i � i � ` '! �M-� ' ;I'< ` � � � �i � � ��` i 43. Baekflowliiig`ation"`l;� i i��.r`- .i5_�� '�� '�) �� 1¢�'�yl=:i'-i � 7 1--�� I i?�� f i! E��t� .� 44. ,Landscape Irri9ation SYstem i � ' �' � � ` � " � ` � � n� ; �. � - � - - � � � -. � �1� r � ' � � . . i Y i - i- :'^M�� 1� I =�"� � � �'�� im �i: � �- T 45. Sound Atten'uation' ' M � 1 y I - � � ' ` � � _ � ' � ' � ' I ! � `� ' ` ' 1 � ' j I`II n `; m.,° `' _ �r[�. I � 1� 1 �y �I d' � � � � 1 1 � 0. I^ ` 11 46. Handicap,Regulitions � z � '.l �'; -�: �o I � z i;� ` �; � t i o � I I � j .{! " s.. � � $ 47. FINALSTRUCTURE & BUILDING� :j ;��-�'f,� �� ',,� � '� 'I I ! � ! I � � :� � � �I� "� � y '� r� P 48. Special Requirements Completed� �4 ! � � ( � I � � n i i I � � t � �� 1 � � ` "� " "� � �" v `d � 49. Eleanc Release io Edison' . � _,,_ � __ �_� ' � � ' ' ' � ' � � :�._!=d � ' '�' � t � � � "7' - ..'1_,�.5. "1""'"'7-";-'-`i-'j- 7i i ��!i�. � t� 50. Gas Release to $outhern'California Gas Co i,� � � � � I f � � � �.i j P�� i �'f I ' 1� o 51. CERTIi_FICATE OF OCCUPANCY � I 1��_ �� Y�_�^� i' ; � SII i � i I!"' � No. y . .. _...Date � � � �t � � : � � ' � � ( _ i i 1 � t _�._ .�- AOG��cant to fill in ail svaces exeept those within neavY bortler Iines anO sign all appropriata tleclarations. CITI�oF COS7A MES CONSTRIJCTION PERMIT ��Ft� ddress ,Z,2'�O J�ane-}�e�r . G.m. . Applicant'¢Mailin Address �SnmE � t7wner's Name ky��—'�1% j.(�J�i� Y�ICf"YI Phone �� Address ('Sl4m Arch/Eng. License No. Address Contractor's Name Phone Address (ma'�'�;� Ciry License No. LICENSED CONTRACTOR DECLARATION 1 hereby a�/irm that I am licensetl unCe� p�ovisions ot Charter 9(commentlng witn seclion 7000) of Division 3 of the Business antl Professlons Cotle, and my license is in /ull torce antl eifect. License CIa55 Llcense No. Dale S�9�ature WORKERS' COMPENSATION DECLARATION I hereby aHirm [hat I have a certificate of consent lo self-insure or a certifica[e � Workers' Compensation Insurance, or a certltietl copy thereof (Section 0, Lab. G.) ��icy No. Company BCertifietl copy is bereby furnishetl. Certilietl copy is flletl wilh ttte cily Builtlinq Divislon. �ale Applican[ E%EMPTION FROM WORKERS' COMPENSATION DECLARATION (This seclion n¢¢tl not be completetl if the pe�mit i5 for On¢ huntlre0 (b100) o� less). I certity thal in Ih¢ Perb�mance of the work to� wltich [hi5 pe�m�t is iszuetl, I sM1all not employ any person in any manner so as to become subject to the Workers' om ensa4��7 Laws of Califo ja. �ate ��r" O`� Si9natu�e ��s�L K1ni��. _ NOTICE: H, alter makin9 this tleclaration, you shoultl become subject to tne Workers' Compensation provisions of the t�bor Cotle, you must tortbwith comply with such p�ovi5ion5 or tnis Oe�mil Shall be tleemetl r¢voketl. CONSTRUCTION LENDING AGENCV 1 hereby a((Irm that there ls a mnstruction lentling a9ency for the oerformance of the work Por which this permlt is issuetl ($ectian 309] Civ. CJ lentler's Name Lentler's AtltlreSs OWNER BUILDER DECLARATION 1 hereby atfirm lhat I am exempt from the Contracror's License Law tor the following reason (Section 7031.5 Business antl Profe55ional Cotle: Any city or county wnich requires a Oermit to construct, alter, Improve, tlemollsM1 or repair any structure, prior to ils issuance, also requires the applicant lor such permit ' lo fil¢ a sign¢d slatement Ihat he/she is licensetl pu/suant to thC Provisions ot the Contractor's License Law (Chapter 9(commencing with Sectlon ]000) o( Oivision 3 0l Ihe Business antl Protessions Cotle) or [hat he/5he is exempt re/rom dntl Ihe ba5i5 (O/ t�e all¢9¢tl exemptiOn. Any viOldtion ot Sectlon 'y'•"'d1.5 by any applitant fo� a permit subjects the appllcant to a civil ^`�alty of not more than five huntlre0 tlollars (5500). I, as owner ot the property � � , will tl0 the work, antl Ne St�uctur0 I5 not Intentlea o� o(fer¢tl tor sale (Se<lion 7044, Business antl Protessional Cotle: The Contractor's LicenSe l.dw aoes not apply to an owner of a property who bulltls or improves tM1ereon, antl who tloes such work himself/nerself or tnroug h his or her own employees, provitletl [hat such improvemen[s are not intentled or offeretl for SdIC. If, howevlr, the bWltling ar improvement i5 Toltl within one year of Wm- pletlon, tho owner will have tne burtlen of provin9 he/she tlltl not builtl or Im- prove tor the purpose ot sale�. ❑ I, as ownm of the property, am exclusively contracting with licensetl ton- t�actor5to conslruct the p�oject (Section ]044, Bu5ine55 antl Professlons COtle: The ConVactor's License Law tloes m[ apply to an owner of property who �uiltls or imoroves Ihereon. antl who mneracts ior such oroiects with a r.on- tractor�51 license pursuan� to tne ConVaGtor'S LicenSe Law). I am awar¢ thai proof o! lheir Wotker's Compensation Insu�anCe shoultl be provltletl to me. ❑ I am exempt untler Seclion B. & P. C. for tnis reason o i ' - o ln �� I hereby certity that I have reatl thiz application antl state Nat the above in(ormation is torrecL I agree to comply witn all Uty antl couniy ortlinances antl state laws relatin9 �o builtling construction, antl nereby authorize repre- Sentatives o/ this city to enter upOn Ihe dbOve�mentionetl p�op¢rty fo� inspectlon pu�qose5. �/ Signature I Ji 1F i� A(•�la�t.� Date [J',u0'�q Drivers' LI—�� ,",1.,,.�. ^ ..�........ __..._. ..,.,�,..,. A.P.# E il TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR S Main Buildi E ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T Front DESCRIPTIONOFWORK/USEOFBLDG. IA Rear 1 C Right TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL � K ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL g Left ❑ oTHER Ping. Ref. # PROJECT DESCRIPTION 5�. FT. OCCUPArvCV Planning Notes: CONSTRUCTION TVPE VALUATION $ ZONE GRAOINGCU.VDS. ACRES Remarks: Sink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Roof Dreins Reinspection Fea � $15 Boiler Duct - Under Ground Duct - Strucmral Duct - Ventilating Exhaust System ❑ Multiple Firepl/FacL BIL ICBO # Heating System & Ducting ❑ ai oo,000 sru O t oo.000 Reinspec[ion Fee � $15 0865-46, rev. 5/88 White - Builtling: Canary - Applicant; Pink - Accounting: Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Utinal Water Closet Water Heater Water Service Auto-Wash Laundry Tra'ys laue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑a�oo,000sru ❑ioo,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES $ 3 FEES $ 3 Automatic Washer Cons[ruction Pole St CAoking Unit Dishwasher GlfCl Dryers �Gas ❑EI Fan F.A,U. Fixtures Device Boxes Outlets Switche5 Garbage Disposal Generator �0.5 KW 2one Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors �0.1 HP 01 h- 8 Inc Soiar 09�15 HP �i6-15+ Microwave Pole Light Range Standing Sections 5 KW Trash Compactor I Reinspeetion Fee !$15 I I Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: 2oning Approved By Building Approvad By Apolieation Issuod Bv � FEES $4' N I N G R E Q M T S. SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PEFMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% 5 ENERGY P.C. $ ELECTRICAL $ � GRADING $� PLANCHECK 50% $ MICFOFILM $ MECHANICAL 5 TOTALFEE $ ��D PLAN CHECK 25% $ C�i GC."+6�33-^C�35233 n O�; _. _ D!.`c: 06i2oj59 TIf9E: 1,7:•, ��ONBTRUCTION AND PLANNING POOL ?A PPROVALS Permit# Date Inspector p,ppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole � � • 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement 3: Electrical Conduit UtilitY-Undrgmd. � 54. Forms �4.,Electrical Conduit-Undrgrnd. 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. . 8. Foundation 59. Gas Pipe, O Undrgrnd:, Test � 9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P-Trap, O 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 1,B. Rough Electric Wiring 6 7 67. Fencing & Access Approval 17. Rough Wiring Sign 6S. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Condiiioning " FIRE DEPT. REQUIREMENT � 20. Rough Factory Fireplace ,__i APPROVALS Permit # 21. Ducts, in Structure J 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑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 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: C!j<o�� lO�A 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 pomestioFinal � 42. Backflow Preventer - _, :i, 43. Backflow Irrigation ��-�i ' � �� 44. Landscape Irrigation System 45. Sound Attenuation � 46. Handicap Regulations 1 � 47. FINAL STRUCTURE & BUILDING � j 48. Special Requirements Completed � �, 49. Electric Release to Edison ' "j 50. Gas Release to Southern California Gas Co �! •.+ , j 51. CERTIFICATE OF OCCUPANCY � 1 , '; • :1 �. , , No. Date � 1 � �.� �'� � " 'l� �•� i?: � i�'. I., CITY OF COSTA MESA BUILDING DIVISION OWNER-BUILDER VERIFICATIfJN A city or county, which is required to give notice pursuant to Section 19630, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner-builder verification. Attention Property Owner: An 'owner•builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued un[il this verification is received. t. I personally plan to provide the major labor and materials for construction of the pro- posed property improvement. � Yes ❑ No 2. I ave ave not) h� �g signed an application for a building permit for the pr sed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address Phone ( City Contractor's Lic. No. _ 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: I� , �fT'iT� Address Phone ( CI� Contractor's Lic. No.. 5. I will provide some of the work but I have contracted (hired) the following persons to pro- vide the work indicated: Name Address Phone Type oi Work I hereby affirm that I have received a copy of the information set (orth in Section 19830 of the State of California Health and Safety Code and have completed the above information to the best of my per- sonal knowledge, i�j�}ompliance with his State law. Signed: , (//�� o ��2,.st., Date: � "�.�"��i Name: � I J I�� f5 (a S'�l�t,¢.2 (Printed or Typed) � C.D.L. # or S.S. # � 754-5273 ,o.z.e Appllcant to flll In all sDaces except lnose within heavy Dortler Iines anE sign aIl appropriata tlaclarations. p�Mlj ry0._ _( TRACT NO. LOT NO. UNIT NO. CI7YOF�oS7AMESa, CONSTRUCTIONPERMIT ,�y� ��,fl�Q� A•P•# Pre!jectAddress 2z�fo .►�anerr� �IacE �:1,1r. �UGJI : S Main Bui{di AppliCant'S Mailing Addre55 TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR E — ��1�� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T Front Owner'sNa/m�e, 'f PhonesG��s� DESCFIPTIONOFWORK/USEOFBLDG. IA Rear Address �f�� ia� E KaSTneR ; C Right ArCh/Eng. LiC2n5e No. TVPE OF PERMIT GRADING FOVNDATION STRVCTV RAL '� K ❑ TENANT �ELECTRICAL ❑ PLVMBING ❑ MECHANICAL . $ �eft - Address . Pti p ❑ �OTHER Ping. REf. # Contractor's Name PROJECT DESCRIPTION 50. FT. OCCVanNCV Address Imailingl Planning Notes: CONSTRUCTION TVPE VALUATION $ CilyLicenseNo. ZONE GRADINGCV.YOS. ACRES LICENSED CONTRACTOR DECLARATION I hereby affirm tbat I am licensetl untler provi5ions of Charter 9(commencing WILh SECII00 JO�Q) O( Division 3 Oi 1118 BUSIfI¢55 d�tl PfOfCT5�0(IS COdC� dOd my Iioense is In full force antl effect. License Glass Li<ense No. Oate Signature W00.KER5'COMPENSATION DECLARATION ' hereby atfirm Ihat I have a certificate ot consent to selt-insure or a<ertificate Workers' CompensatiOn InSurance, o� a certifietl cOpy the�eof (SeCtion l0, Lnb. CJ Policy No. Company BCer[ifietl coOY is hereby furnishe0. Certifietl copy is filetl with [he dty Builtling Division. Date Applicant � EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This seciion neetl not be complet¢tl it [ne p¢�mit is fo� One huntlretl (E300) or lesz�. I cer[ify that in the pertotmance oi Ih¢ wo�k to� whiGh thi5 per�nit is issuetl I shall not employ any person in any manner so as to become subject to t�e Workers' Compensation Laws of Ca1lPomia. Date Si9naWre NOTICE: It, after making thii tle<Iaration, you Shoultl betOme suDject to the Workers' Compensation provisions o( the labor Cotle, you must fortnwith comply with sucn provisions or tnis permit zhall Ee tleemetl revoketl. CONSTRUCTION LENDING AGENCV I M1ereby affirm tnat there is a mnstructlon lentling agency for [ne performante ot tne work for whiGh this Oermit is i55uetl (Section 3097 Civ. C.) . Lentler'z Name iLentler's Atltlress pWNER BUILDER DECLARATION i herebv aHirm lhat 1 am exempt from the Contractor'S License Law for the es a to i' to tiie a Nat •retrom antl the basi2 IOr the allegea exemp[ion. Hny vima��on o� aecuon 31.5 by any applicant for a pe�mil 5ubject5 Ihe aooncanc [o d clvil �alty of no[ more than five huntlrea tlollars (5500). I, as owner of tne pro0erty or my employees with wagos as their sole compensation, will tlo the work, antl lhe structura is not intentletl or otferetl for sale (Seclion �Oa4, eusiness antl Protessional Cotle: The Con[ractor's License Law aoes nol apply to an owner o( a property who bulltls or improves lhereon, and who tloes such work him5elt/her5elt Or th�ough hls Or he� own employees, p�ovitletl Ihal such imP�ovements are not Intentletl o� otferetl fo� sdle. H, howevet, the Duiltlin9 0� imprOvement iz To1G within one y¢a� of COT- pletion, the owner will have the buraen oi proving he/she tlitl not builtl or Im- provaforthe purpose otsale). ❑ I, as owner of the pro0erty, am exUusively contractlng wi[h Iicensetl con- [�ac[ors to conztruct the project ($ection 7044, BuSin¢55 antl Prote55ion5 COtle: The ConVactor's License Law tloes not apply to an owner oi vrooerty who builtls or improves thereon. antl who mntracts tor such oroie<ts with a con- tractor(s) hcense pursuant [o me Contractor•5 Ucense Law). I am aware [hat proof ot tneir Worker'z Compensation insurance snoultl be provitletl to me. ❑ I am exempt untler Section B. & P. C. Po� IhiS reason Dt '� � o i^C�d �- I-hereby certity that I have reaE Ihis application antl state that the above information is correct. I agree ro comply wi[h all tl[y antl couniy ortlinances antl state IawS relating lo builtling ConSVuction, antl nereby duthorixe �epre- sentatives Of this cily IO en[e� upon IhE dbove-mentionetl pro0erty f0/ inspection pur s¢5. 1/ Signature i'.1 nAe .Q Date 6-13-£�9 Drivers' License or 55 � �'�� -.�� Remarks: Sink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks GasServic.e � Outlets Interceptore Kitchen Sink Roof Drains Reinspaction Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact.Blt.iCBOdk � Heating System & Ducti ❑4100,000 BTU ��,000 Reinspection Fee � $15 0065-46, rev. 5/88 White - Builtling; Canary - APPlicani; Plnk - Accounting; Goltlenrotl - qssessor $hoWers Service Sink Sewer Cap SewerConrn Solar Collec Solar Pi g Pool w/SPa Urinal Wa{er Closet Water Heater Water Service Auto�Wash Laundry Tra'ys Issue Fee Hootlor ypel ❑ Canopy/Type II ❑ 2e igeration System aioo,oaosTu ❑ioo,000 System Repair/Alteration Fire Dampers Registers laue Fee FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device B e $ 3 FEES $ 3 Dispoul r Oas Kw zone Accessory Parking Req./Pravided ELECTRICAL Transformer ❑ 15�50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps •Su6 Panel Motors �0.1 HP �1'6 - 8 Inc. Solar �9-75 HP 016-15+ Microwave Pole Light Range $ign Standing Sections 5 KW Trash Compactor FEES N I N G R E � M T S. � Reinspection Fee '$15 � � Issue Fee I �/,{ I DEVELOPMENT SERVICES HEQUIREMENTS: Zoning Approvad By Date Building Approved By Date Application Issued By - -T Dat SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ��UANCE 5 PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ � GRADING $ PLAN CHECK 50% $ MICROFII.M $ ��///��_ MECHANICAL $ TOTALFEE $ ^� � PLAN CHECK 25% $ i7. C�!1`s5746-OCD3526G i r_��F ._._ 6�T�: OS/t3i£S TIi�:� i0:�� " �CONSTRUCTION AND PLANNING ' POO SpA � APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector �1. Temporery 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 UFE�R Grnd. 57. APPROVAL TO COVER-GUNITE ' 7.: Footings 58. Electriral Conduit-Undrgrnd. 8.' Fdundation 59. Gas Pipe, O Undrgrnd., Test . 9; Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgmd. � �. 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 OGas ❑Oil , 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing � 73. Undergrnd.StorageTank OGas ❑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 SYS7EM 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 CUnditioning 35. Final Gas Pipe-Test ' 36. I?ood or Canopy �- r 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 Irrigation 5Ystem , 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING • 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southem California Gas Co .- -' ,' 51. CERTIFICATE OF OCCUPANCY No. Date � � - , , � Applicant to fill in all spaces except those within �eavy �ortlGr linas ana sign all apP�ooriate aeclarations. ` PERMIT NO. TRACT NO. LOT NO. UNIT NO. CITY OF COSTA MES,AI �CONSTRUCTION PERMIT/+ yy'� A P� Prr�jeR.Address aZ"1�- T�C�hP'rTf �CF 1.��1�. _�� (SA�FI ' Applicant's Mailing Address '/ �,/ �`�'� � �� Owner's Name ��A 4 N� ^AS'E N E-K/ Phone s¢1��5� Address �ARo�.Ei —�n)�H,� KfiCTIlF� : Arch/Eng. � � � License No. Address Contractor's Name �"J ( �� Phone Address (mailingl - City License No. - LICENSED CONTRACTOR OECLARATION - 1 bereby allirm tha� 1 am licensetl untle� provi5ion5 of ChaclC/ 9(commentlng with seclion ]000) ot Division 3 of the Business antl Profe551on5 Code, antl my license is In tull lorce antl effe<t. License Class � License NoC Datc Signa[ure ' � WORKERS' COMPENSATION DECLARATION � J.,I�ereby ailirm that I nave a cercifitate oi consent to self-insure or a tertlticate "+:�.aWorkers' Compensation Insurance, or a certitietl copy thareof (Settion �'T'�i0. Lab. CJ 9' -a:. _ '�olicy No. Company 8 Certi/ietl copy Is hereby fumishetl. " Certifietl copy is filetl with the city Builtling Division. Date Applicdnt EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section neetl not be com0let¢tl if [he pe�mit is tor One huntl�etl (E100) or IC55�. � I c¢rlity lhat in the Per�Ormance ot the wo�k fo� which this pe�m�t is Issuetl, I shall not employ any person in any manner so as to become suCject to the Workers' Compensation Laws oi Califomia. Date Signature - ' NOTICE: Il,�a�lar.making lhis�tleGlaratiOn, You Shoultl b¢COR12 sUbjec[ to the Workers' Compensation provi5ion5 of the LabOrCotl¢, you-must.fO�tnwith„ comply with such provisions ot tM1is permi[ shall be tleemetl revoketl. �CONSTRVCTION LENDING AGENCV '�, 1 hereby alflrm that there is a construciion lentlin9 a9ency for the pertormance � o/ tne work for whicb [his permit is issuetl (Section 309] Civ. C.) Lentler's Name - Lentler's Atltlress ,OWNER BUILDER OECLARATION 1 hereby aHirm ihat 1 am exemp[ from lhe GonVactor's,License Law for the - tollowinq reason (Section 7031.5 Business antl Pwfessional Cotle: Any dty or county whi<h requires a permit to cons[ruct, alter, improve, tlemolish or repair any structure, prior to its issuance, also requires the applicant for such permit to tile a Signetl statement Ihat he/sh¢ is licensetl pu�suant to [he provisions o1 the Contractor's License l.aw (Chapter 9(commencing with Sectlon ]000) of nivision 3 ot the Business antl Professions Cotle) or that he/She is exempt!� ��refrom and the basis for the allegetl exemption. Any violatlon ot Section )1.5 by any aOPliCanl tor a petmit subjects th¢ applicanl t0 a civll �alty of mt more than five huntlretl tlollars (5500). 1, as owner of the property or my emp�oYees witn wages as [M1eir sole compensation, will tl0 [he work, antl the structure is not intentletl o� Oft¢rCtl for sale (Settion 7044, Business antl Professional Cotle: The Contractor's License Law tloes not apply to an owner of a property who builtls or improves thereOn, an0 who tloes sucM1 w0/k him5elf/herself o� through hi5 or her own employees, provitletl [M1a[ sucn ImProvemen[5 are no[ Intentletl o� ofleretl tor sal¢. If, however, Ine Culltlin9 Or imOrovemeni is soltl within one yea� ot cOm- pletlon, tne owner will have the burtlen oi proving he/she tlitl not buiitl or Im- prove forthe purpose oisale). ❑ 1, as owner oi Ihe property, am exclusively contracting with Iicensetl�<on; tlaclors lo con5lrucl [he project ($ection 7044, BuSinesz antl Profe55ion5 COtle: The ConVactor's License l.dw does not apply to an owner o1 p�Operty who builtls or Improve5 Ihermn. antl wbo conVacts tor Sucb oroiects wlth a r.on- tractor(s) Lcense uursuan[ to ine ConVactor(s License Law�. I am aware thac -proof of Iheir Wo�ker's Compensation insurance shoultl be provi0etl to me. ❑ I am exCmpt unUe� $ection 8. & P. C. to� this �eason �- I ' O � �?n � Ac.M�p'. I hereby certify that I have reatl Mis application antl state that Ihe above iniormation is correct. I a9ree to comply with a11 city antl county ortlinances anG state laws relating to builtling construction, and M1ereby authorize repre- Sentative5 Of this city to enter upon Ihe above-rtlentionetl prop¢rty for inspeGtion purppiCs. � :519nature 1)�a,... knt{i.t2 `Dale (o'13-R �. Drivers' License or 55 � �.� -�—_ �-.��---- 0865�46, rev. 5/88 � %�U / 1 " . . S Main Building: TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR E ❑ CONVERSION ❑ DEMOLISH ❑ OTHER � � T F�ont ' DESCRIPTION OF WORK/USE OF BLDG. � A Fear TVPE OF PERMIT GRADING FOUNDATION ❑ STRUCTURAL I C Right ' K ❑ TENANT �� ELECTRICAI ❑ PLUMBING ❑ MECHANICAL S Left ❑ �OTHER � Ping. Ref. # PROJECT DESCRIPTION 5�. FT. OCCUaANCV Planning Notes: CONSTRUCTION TVPE VALUATION $ ZONE GRADINGCU:Y�S:� ACRES Remarks: `��f(�'�,�� L(„/ ,, 1�{/t� � I PLUMBING Bar Sink Showers BackflowPreventer Service5ink Backflow Irrigation Sewer Cap, Bathtubs Sewer Conn� Clarifiers c Collec'� Dishvuasher 'Pi ing Drinking Fountains - � Floor Drains � � � Swimming P ., Floor Sinks / i �� Gas Service Outlets / 4'V��f jJQset Kitchen Sink Weter Lavatories P-T�ap Foof Drains Reinspection Fee $15 � Boiler . Duct - Under Ground Ducc - Structurel Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt ICBO # � Heating System & Ducting 00.100,000 BTU 0100,000 Reinspection Fee � $15 White_- Builtling: Canary - Applicant; Pink � Atcountlng; Goltleniotl - Assessor Hea[er Service ..- Haod or laue Fee Type I ❑ Type I I ❑ ietrigeretion System J�4too,000eru ❑too,0ooeru System Repair/Alteration Fire Dampers ES Automatic Washer Construction PoleSub. Cooking Unit DIShW85h2f � Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures Device Boxes OOL�CLS•._ $ 3 FEES Garbage Dispoul Generator �0-5 KW �5-15 / zone Accessory Building: ELECTRICAL � Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 700 amps Meter ❑over100amps Sub Panel Motors OPl HP � 1'f, - 8 Inc.Solar 09-75 HP �16�15+ Microwave Sign Standing Sections Trash Compactor Fee �$15 � � Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: 2oning Approved By Building Approved ByY Appliwtion Issuetl By - - SUMMARV OF FEES BUILDING PERMIT $ SMIP PLAN CHECK ; $ PERMIT PLUMBING - $ ISSUANCE PLAN CHECK . 25% $ ENERGV P.C. ELECTRICAL $ L GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL� $ TOTAL FEE PLAN CHECK 25% $ $ FEES N 1 N G R E Q M T S. IssueFee I $ 3 I I _,--^_ _.__..{iZ-QflFJ��b��1i��J�4� ��'� i�.i�_. I � .. .. -.-"_'_'..— '. .—'.._ �- "� �iT�': �u/:3/&9 Tlrc� 1J�4' CONSTRUCTION ANDPLANNING POO PA APPROVAL$ Permit # Date Inspector AppROVALS Permit # Date Inspector f. 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Cpnduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, � Undrgrnd. 10.,Structural Floor System 61. APPROVAL TO DECK 7 7. Property Sewer Line c4� 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 Elearical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Condltioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing . 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing . � 74. pverhead Hydro _ �' 26. T-Bar Ceifing {Structurall & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. �athing & 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 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 Irrigation SYstem 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 57. CERTIFICATE OF OCCUPANCY No. Date OWNER FAHRE CONSTRUCTION CORP�. ' DATE 12 JOB ADDRESS 7?LO Jesnette Place � � BUILDING PERMIT NO. 6070 AP. No. LOT 10 'ruac'r 324z PutE zorrE DESCRIPTION OF WORR GROUP I& J Typg V ZONE R PLAN NO. I' ''ECTIONS � DATE � SUBCONTRACTOR and coat Nina� Gas Test Co tion Pc Unac�uround _z-,-r�r„_-rrr.,,.rw.., y __ i;�-2-r� i i.a��z J ' � ' 609� CJSTA MESA BUILDING DEPARTMENT ..p. O. BOX 319 COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN 2240 JEAT3ETTE PLACE COSTA MESA. CALIFORNIA OWNER FABRE CONSTRUCTION CORP, MAIL 3404 Via Lido ADDRE55 .,; - - . _; ��, G�o �� u �� `-, � 7 � r(f�F1iiCE DEP�I. �� CITI' OF COSTA �IESA APPLICATION FOR PERMIT BUILDING � FOR OFFICE USE ONLY OSTE ��r� Newport Beach TNo: OR-3-1240IqDDRe�ss ' �',' OR ENGENEER Raymond Levanas No: C. �47 COSTA MESA. CALIFORNIA 3432 Via Uporto N. B. F'RE IADDRE55 � ZONE ZON CONTRACTOR Lido Constr. O1TY No: 7520 q nooaess 3404 Via Lido TNoOR 3-1240 gyPR� LEGFL LOT 1 �ESCAiPnOrv NO. 1� BLOCK TRACT 3242 A.P. NO. /V(�. OF LOT ��oo $�y'�t• I�O.OF e�o�s.None NOW ON LOT USE OF EXISTING BLDG. SET9ACK LINE FflOM i �. NEW REPAIR BUILDING SIZE 1 E%TERIOR W, COVERING USE OF NEW BUILDING litAhi YAXI 5' LEFT SI DESCRIP710N OF WORK X ALTEflATION ADDITION MOVING DEMOIISH �%p �(�.ft� ROOMS 6 STORIES ]. � i._.WOOd ROOF Cl.:_...1,. Dwelling v CORRECTIONS rexra. ..cKn�w�r��t r „r� I ,t;<, 1�0,_1�I;Yh'KUVtU /o" �"� STATE TMAT THE I.BOVE IS CORRECT hNO �GNEE TO COMPLV W!TM iLL CITY OROINANCE$ ANO $TnTE L�WS REGULaTING BUILDING CONSTRUC- TON. VALUATION SiGNATURE OF PERMIT FEc S 3O'� PERMITTEE PLAN CHECK S /.S� S `�� '.. �eMr AUTHORIZED AGENT TOTAL FEE 5 �S .t�