HomeMy WebLinkAbout3006 JEFFREY DR - Building Permits� CITY OF COSTA MESA �
BlIILpING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 • pt4) 754-5273 • Fax (714) 754-4856 � wviw G.cosW-mesa.ca.us
FOR INSPEC710NS CALL' (714) 754-56Y6
P�RMIT TYPE B_ROOF2
ApN: 41812104
PERMIT NUMBER: B08-00256
STATUS: ISSUED -
DATE ISSUED: 0 911 012 0 0 8
- ISSUED 8Y: RMD
JOB ADDRESS: 3006 JEFFREY DR CM Suite/Unit:
ViCinity: TRIPLEXROOF � - � �- �� - '� , - . �
Squares: 2500 � ' , , � , - . � Valuation: - 57,000.00
SCOPE OF WORK: TEAR OFF�.(E) ROOF.MATERIALS, INSTALL 1 LAYER OF 15# FELT ON A 5:12 PITCHED�ROOF AND REROOF
WITH 30 YEAR COMP SFIINGLES ON'A DETACHED TRI-PLEX APT BLDG WITH GAR4GE, APPROX 25 SQUARES. ' �
REpA1R AND REPLACE SHEATING AS NEEDED. REROOF OF DETACHED BUILDINGS TO BE DONE CONCURRENTLY. �
OWNER: CONTE, ROGER , �
PHONE: 310-9�7-4366 '
APPIICANT: TILL, BRANDON . - '
PHONE: 714-023-9228
CONTRACTOR: TILL ROOFING .
Address: 5791 SANTA CATALINAUnit:
City/State2ip: GARDEN GROVE, CA 92845
ARCHITECT:
E�f GINEER: ' ,
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
TqTAL FEES
so.00
$13925
$0.00
$139.25
� �Address: -- N FIRENZECT.
� � ' City/State/Zip: NEWPORT COAST, CA
Address: 5�91 SANTA CATALINA -
City/State/Zip: GARDEN GROVE, CA
License No.
License No.
� . License No.
PHONE: - ` 714-023-9228
CELL:
Unit:
Unit: :
833820
PHONE:
PHONE:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenLs under Califomia sWtutes antl related
regulatlons. (Ord. No. 92-28, § 1, 12-21-92) - '
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order tor the vrork authorized under this pertnit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. failure to obWin inspections and final approval will result in the expiretion o( this pertnit.
LRb� ixsvEcnoHTrr¢ p,� ixima�s 44� u+sr�cnoxTrre p� � ixTm��
1816 Fixed System Final Fire Prevention 206 . Final Mechanical
1268 Pool Spa Final 2(l8 Final Plumbing ' �
200 Final ReRoof 210 Final Electrical
207 FinalOiock/Relaining Wall 212 Final Fire Preveniion
�2 Final Factory Fire Place 220 Final Planning ApDroval
�3 Final Sign 222 Final Site
20q . 'Final Demolition 250 Final BuiWinyOccupancy
WORKERS' COMPENSATION DECLARATION� �
I hereby aKrm under penalty of parjury one of the following Declarations:
❑ I have and will maintain a certificate of consent to sel(-Insure for vrorkers'
compensation, as provitled for by sectlon 3700 of the Labor Code, tor the
pedormance of the work for whlcn this permit Is issued. � '
I have and will maintain worKers' compensation insurence, as raquired. by
section 3700 of Ihe Labor Code, for the peAortnance of the work for wfiich this
permit is issued. My vrorkers' Gompensation Insurance carrier and policy
number are: �� ��
Carrier: U
(Thk seCqn nttH rp! be tpmpetcd athe pemi4 a valuetl at me n�iMrzH Mlars (E100) aless J
Policy Number: �fJQ�t Z� Z� �b
❑ I certify [hat in the peAormance o( Ihe work for which this permit is
issued, I shall not employ any pefson in any manner so as to become subject
to lhe wnrkers' compensation laws of Cali(omia, and agree that if I should
become subject to the vrorkers' compensation provisions of Seclion 3700 of
t or Cotle, I sh � 'th comply with these provisions.
'r•/•• D$
Appliram's Si ure Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL4RS
(3100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DEGLARATION:
I hereby aKrm Ihat I am licensed under provisions of Chapter 9(commencing
vnlh Section 7000) of Division 3 0< <�e Business antl Professions Code, and
my license is in full force and e%ec1.
Lia# �338 zc� Class# G39
—� -(�� 9• /O. OB
Comractor's SignaWre Date
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn that there �s a constructbn lending agency lor the
peAormanca oi the Kork for which tdis pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty o! perjury lhal I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW �or the foliowing reason (Sec. 7031.5,
Business and Pmfessions Cotle: Any ciry or couny which requires a permi[ to
construct, alter, improve, demolish, or repair any struclure, prior ro its
issuance, also requires the applica�� 1or such permit to file a signed statement
that he or she is licensed pursuan[ to the provisions of the CoMrecrors
License Law (Chapter 9(commencing with Section 7000) o( Division 3 of the
Business and Professions Code) or Ihal he or she is exemp� therefrom and
the basis for [he alleged exempti0n. Any violalion of Section 7031.5 by any
applican[ (or a permit subjects the applicant to a civil penally of not more Ihan
five hundre0 dollars ($500).):
❑ I, as owner of ihe property, or my employees with wages as their sole
compensalion, WILL DO 7HE WORK, and the structure is not intended or
offered for sale (Sec. 7044, BusinOss and Professions Code: The Contracrors
License Law does nol apply to an owner of property who builds or improves
thereon, antl who dces such v.ork himself or herself or through his or her ovm
employees, provided that such imDrovements are not intentled or oflered for
sale. If, however, the building of improvemenl is sold within one year of
completion, the owner-builder will have the burden of proving that he orshe
did not builtl or improve for purpose of sale.).. ,
❑ I, as owner of the property, em EXCLUSIVELY CONTRACTING WITH
LJCENSED CONTRACTORS to constnict lhe project (Sec. 7044. Business and
Professbns CoEe: The contractors license Law dces no� apply to an ovmer of
propeny who builds or improves Ihereon, and who contracts fw such project with
a cantractp(s) license pursuant to Ihe Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
305]<6 (]/0])
Owner ID verified by dri�ense. ❑ Yes � No
Driver's Litense No. ExpiresY' ' . �
Venfication of Ownership by (rype of document, i.e. - propeRy taz bill or tleed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: �
❑ I hereby certify [hat no excavation frve (5) or more feel in depth into which a
person is required to tlescend, vnll be matle in connection with v.ork authonzed
by Ihis pertnit, and Ihat no building sWcture, scaffolding, falsewoik, a demolition
or dismantling Ihereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp
2. Art 2, Sec. 341, Title 8, Califomia Administ2tive Code�.
❑ As owner-builder, 1 will not employ anyone to do work whlch would
require a permit trom the Division o! Intlustrial Safety, as noted above, unless
such person has a permit to do such work !mm the division.
ApplipnCs SignaWre
Division of Industnal Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuNre building occupant neetl to file and
certi(y a Business Plan for emergency response to release or I�reatenetl
release of a hazardous malenal? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safery 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 reportetl
year a quanliry of hazartlous materials equal to or greater Ihan a weighl of
5�0 pou�ds, or a volume ot 55 gallons, or 200 cubic teet of compressed gas
at standard temperature and pressure).
2. Does or will lhe applicant or present or future building occupant neetl to fle
a registration form for awtely hazartlous materials? ❑ Yes ❑ No
(Section 25533 of the Calitomia Health and Salety Code, with some
exceptions, requires registration vnth the Cosla Mesa Fire Department by
each 6usiness which at any one time has on hand a quanti[y o( acutely
hazartlous materials equal [o or greater Ihan a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperaNre and pressure).
3. Does or will the applican[ or present or fuWre building occupant neetl to
prepare an RMPP (Risk Managemenl and Prevention Program for acutely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safety Code provides Ihat Ihe
Cos[a Mesa Fire Department may require the preparation, certification antl
fling wi�h ihe Fire DepaAment o( an RMPP by businesses which are required
lo regis[er acutely hazartlous ma[erials with the Fire Department.
4. If an RMPP is presently requiretl, has Section 25534 0( the Cali(ornia
Heal[h and Safety Code been fully complied with? ❑ Ves ❑ No
5. Does or will [he applicant or present or future builtling occupant require for
the wnrk vfiich is the subject of this appliwtion a permit for such conSWclion
or modification from the South Coasl Air Quality Management Dislricl or from
any other air pollution control tlisirict or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires Ihat Ihe requested
infortnation be fumished on applications �a non-residential building permits).
6. Will any part of the faciliry to be consWcted unCer this permit be within
7000 feet (rom the outer boundanes o( a school? ❑ Yes ❑ No
Qf yes", lhe (acility must mee[ [he requirement of Sections 25534 and 42303
o( the Calitomia Health and Salery Cotle).
7. If a permit from the South Coast Air Quality Managemenl Districl or other
air pollution control disMct or agency is requiretl for Ihe vrork which is the
subject of this application, have all of Ihe disclosures prescrihed by Califomia
Health and Safety Code Section 42303 been matle? ❑ Yes ❑ No
8. (If'yes", attach certificate of compliance from the appropriate air pollution
con[ml oKcer). - '
CERTIFICATE OF COMPLIANCE: I certify Iha[ under penalty of perjury lhe
infortnation given above is correct. I agree to comply with all state laws and
ciry ordinances regarding Hazardous Materials and Emissions. .
� Si9nawre Date '
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I
certi(y untler penalty of perjury Ihat I have read this application and state that
the informa[ion given is cbrtecl I agree b comply with all state laws and cily
ordinances relating to building consiruction, and authorize representatives of
the City o! Cos[a Mesa to enter upon Ihe above-described property for
inspection purposes. 1 agree not to occupy or allow occupancy of any building
authonzed by this permit until flnal inspection. �
/ ' naWreorL wne Date �
t. /o, o
Antllor Aul�onzetl APPIi[ant Oal¢ �!,
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 3006 JEFFREY DR
Suite:
Viciniry:
Parcel Number: 41812104
Applicant: CONTE, ROBER F
Address: 11 FIRENZE CT
NEWPORT COAST, CA
Owner: CONTE, ROBER F
Address 11 FIRENZE CT
ConUactor.
qddress:
Zip:
Arch :
Address
NEWPORTCOAST,CA
Zoning: R3 R3
Phone: 949-497-1984
Zip: 92657
Phone:
, Zip: 92657
Phone:
License:
Eng:
Address:
Status: ISSUED
Applied: 10/24/2002
Issued: 10/24/2002
ISSUED BY:
Phone: , Phone:
Zip: License: License:
. SCOPE OF PERMIT
REMOVE DAMAGED STAIRCASE AND REPLACE WITH A NEW WOOD STAIRCAISE FOR A TRIPLEX.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
pther:
Inspection:
7ota1:
$35.10
$54.00
$0.00
$0.00
$0.00
$0.00
$89.10
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0- 0
PARKING Exlstinq: 0
NOTES:
Rear 0- 0
Rear 0- 0
Reauired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Lek 0- 0
Pr000sed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
si,sao.00
$i,soo.00
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, 72-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandonetl
for a periotl of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be consideied legal, such work must comply with all applicable codes, and all
requlred Inapeetions and tinel epproval must be obtained. Feilure to obtain inspections and tinal approval witl result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2a4Fa6 (fl�00)
WORKERS'COMVENSATON DECLAppnON: � �
I hereDy ettirm unCer Oenalry of per�ury one oi the following tleclaretions:
❑ I have end will malntain e certllicete of consent to self-Insure tor workers' compensetion, es provided for by section 3700 0l Ihe Lebor Cotle, lor the paAormance of ihe
work for w�lch this permit is issuetl.
❑ I have end will maintain workers' compensation insurance, es requiretl by saction 3700 of the LaDor Code, for ihe pedormance ol Ihe work for which Ihis pertnit Is issuetl.
My workers' compensation ns enca carrier en pol y number ere: 'j��
Cerrier: � //� Policy Number: � 1 /
his sectlon need not be completed i! (he permit valued et one hundred dollars ($100) or /essJ
I certily Ihet in the performance ol the work for which t�is pertnit is issued, I shall not employ eny pereon in eny manner so as to become sub�ect to Ihe workers'
compensatlon taws ot� ' a, nd agree t �I aho ecom sub ect to the workers' compensation pmvislons oi Sectio 3700 oi Ne Labor Cotle, 1 s�ell forthwith
comply with the5g.p(ovisions. � � �
Applicant Signature: �/ Date:
WARNING FAILURE TO SECUR W RS' �pENSATION WVEMGE IS UNLAW FUL AND SMALL SUBJECT AN EMPI.OYER TO CRIMINAL PE TIES PND CML FlNES UP TO IXJE MUNDRED
TIKN/SM'D CIXLAFE (51CO.ODD), IN ADDli1Cl� TO h1E COSi OF COAIPENSAT!(NJ, DAA4IGES AS PAOVIDED FOR NJ SECTION3l� OF TNE LAHOR �DE, IMEREST, ANDATfORNEYS FEES.
LICENSED CONTRACTORS DECIARATION:
I hereby aHirm ihat I am licensed under provisions of Chapler 9(commencing with Section 7000) ol Division 3 ot the Buslness and Protessions Code, and my license is in full
force and ettect Lic. M Class a
Comrectofs Signature: Date:
CONSTRUCTON LENDING AGENCV:
❑ I hereby aHirtn that there is a construction lending agency br the performance ot the work for which this permit is Issued. (Sec. 3097, Civil Code).
LentleYs Name: Lenders Address:
Slpnelure: Date:
OWNER-BUILDER DECLARATIONS:
I �ereby ettirtn ihat under perielry of perjury that I am EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7037.5, Business end Protessions
Cotle: Any ciry or wunry,whichirequires e pertnit b consimct, elter, impmve, demolish, or repair any sWcmre, pnor to its issuance, also requires the applicant lor such pertnit
to file e signetl stetement that he"ar, she Is Itcensed pursuam lo Ihe provisions o! Ihe Contraciore IJcense Law (Chapter 9(commendng with Section 7000) ot Dlvisfon 3 0( the
Busines end Profeuions Cade) or thahhe othe is exempt t�eretrom antl t�e basis lor Ihe elleped exemption. Any vlole0on oi Section 7031.5 by eny apD�lcant for e pertnit
sub' s Ihe eppllcam m a civil penalry of nol�more than five hundred tlollars ($500)J:
I, as owner of the property, or my employees ivith weges as iheir sole compensa�ion, WILL DO T1E WORK, antl ihe structure is nat intendetl or offeretl lar sale (Sec.
7044, eusiness end Professions Code:-The Contractors License Law does not apply to en owner of property who builds or improves ihereon, end who does such work
himself or �erself or through his or her'own employees, provided Iha� such improvements ere not intended or oHered lor sele. II, however, �he building or Impmvement is
sold within one year oi completion, the owner-builder wlll have t�e burtlen of proving Ihat he or she did not build or improve tor purpose of sale.).
❑ I, es owner of lhe property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the proJect (Sec. 7044, Business antl Protesslons
Code: The conirector5 LICenSe LeW does not epply Io en owner of prOpeny w�o builtls or Impraves Ihereon, and who conlreCis tor 5uth prolect wII� e cOntractor(5)
license pursueM to t�e Contraclorg License Laws.).
❑ I p un er sec. Business and Pmteuions Cotle br this reason:
Signatu � / � – Date:
Owner ID venfied tlrivers license. .Yae ❑ No Dnvefs License No. ��`, Expires: ��.`'6
Verlfication of Ownership Dy (typa ot doCuAieni, i.e. - property tax bill or deed):
DIVISION OF INDUS7RIAL SAFETV P6pM17 CER7IFICATION:
❑ I hereby certity that no excavelion tive (5) or more feet in depih into which e person is requiretl to descend, will be mede In connection with work euthorizetl by t�is
permit, end thet no buildirg siruct�re, scaHWding, lelsework, or demolition or dismantlirig Ihereol, will be more then thirty-siz (36) teet high. (Chep. 3.2, Grp 2, Art 2, Sec.
341, Title B, California Atlministretive Code).
❑ As owner-builder, I will not employ enyone to do work which would requlre a Oermit Irom the Division ol Indusiriel Sefery, es notetl aDova, unless suc� person has e
pertnit to do such work trom iha division. .
Signature: Date:
Division of Intlustnal Safety Permit Number:
CEHTIFlCATE OF COMPLIANCE AND pUTHORVATION OF ENfAY: I certify under penalry of perjury Ihat I have read this application antl state that Ihe Inlormation given is
wrre comply with ell state lews and qry ortlinences relating to building construction, end authorize representativyyys of tha Ciry ol Costa Mesa to enter upon the
�-tles�bed p peny to ' ecti a 4egreanot to accupy or allow occupancy oi eny building authonzed by Jpis pbrinit uqlil Jinel ipspection.
�
������j�v f,
�—a� Signature OI Legal Owner(s) �— Date
AnNOr AVihOrizetl Applicent Dete
CO�E I, INSPECTIONTYPE
1616 Flaetl System Final Fire Prevention
1266 Pool Spe Final
200 � Finel Re-Rooi
201 FInaI8locWRetaining Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
PdIE Q�dLS S4PEi iNsrecnoxTrve
208 Final Mechanical
20B Final Plum6ing
210 Finel Electrical
212 Finel Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
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TriIANGUi.AR Ar�.E: =OP.MED 3Y TRE;iD.
RIS'ca AP�t� GUAr'.GnAI� SO THAT o-INCH
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NOTE: O�er shaaes may he acceo2ole if Ney arovide an ecuivalent gnpoing surtace.
See ihird pa2graon ai Sac�cn t003.3.3.8.
ACCE?TABLE SHAPES AND INSTALLATION�FIANORAII
14p IN. ��All
1�f2IN. �NIN.
NOTACCc?TABL=
Property Profile � �age 1 of 1
Properry Profile
� 2003 DataQuick Information Systems
This infortna�ion is compiled from public documents and is mt guaranteed.
Property Characteristics
Bedrooms:
Bathrooms:
Total Rooms:
Zoning:
Heating/Cooling:
Sale & Loau Irtformation
Transfer Date: 12-15-1995
Transfer Value: $276,000
First Loan Amt: $]96,000
Loan Type:
Primary Owner: CONTE,ROGER
Secondary Owncr:
Mail Address: 11 FIRENZE CT
NEWPORT COAST, CA 92657
Site Address: 3006 JEFFREY DR
COSTA MESA, CA 92626
Telephone Number:
APN: 418-121-04
Reference APN:
Census Tract: 639.081
Housing Tract Number: 9474
Lot Number: 4
Page Grid Old: 27-F4
Page Grid New: 859-05
Legal Description: N TR 9474 LOT 4
Subdivision:
Year Built: 1977 Square Feet: 3,255
Garage: Lot Size: 6,000 sq ft / 0.14 acres
Fireplace: Number of Units: 3
PooWiew: Use Code: Multi-family Dwelling (2-4 Unit)
Sellec
CosVSq Feet $84J9
Lender.
Interest Rate Type: F
Assessed & Tax Jnformation
Assessed Value: $295,530
Land Value: $132,161
Improvement Value: $163,369
Percent Improvement 55.28
Tax Amount $3,843
Tax Status: curren[
Document: 0000560134
Ti[le Co.:
Last Trans W/O$: ]0-18-2002
Last Trans W/O$ Doc: 0000902080
Homeowner Exemption:
Tax Rate Area: 15013
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� COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSYA MESA, CALIFORNIA 92626
For Applicant ro Fill in Completely — Use ►nk Only
BUILDING __ .
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LENDER
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FSepara[e permi[s are required for
� electric, plumbing and heating work.
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APPLICATION FOR STRUCTURAL PERMIT
ECEIVED Bv DATE RECEIVED �eTp �csuor
BUILDING
ADDRESS
FI
FiOV ED
lVE NO.OF
� PLANS
VARDS APPROVED
DI5TANCE BET
MAIN BLDCS.
VAR^qW�_� - i.
USE OF N W
BUILDING �
VARDSAP ROVED
ACCESSORV BUILDING
BET.
ACCE'
DATE
� I heraby acknowlad0e thai 1 �ava reatl this application antl atate
a thnt the obove Informallon is eorract and agree to eomply wIN
a ell lawz rapuletlnB bulltling Gonsn�cHon, antl 1 shall not amploy
z eny pormn In vlolotlon of tfie workmen's compansallon lawa of
� tha Stata of Californla. `
�r I haraby cartify that I am properly Iicensed as a contrector untler SQ. FT. s� �J
the SSete of Celifornie Businasa entl Professlone Cotle, Olvislon 3, THE AMOUNT SHOWN UNDER VALU,
C�aptar 9, and chat such Ilca�ws aro In full force antl eftoct, or I THE PURPO6E OF ESTABLISHING A PER�
em exempt from Me provlsiv�s of the State of Celifarnla BuslnaEs VALUATION
and Profezsions Co , Dlvialo� 3, Chepier 9. PERMIT FEE E
R pLAN CHECK S
s�e„ei�,e o, �% 7,eAI,_
Parmittea $/ / (J�(� TAX S
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
ADORESS 3006-A B C Jeffrey Drive, C.M
OWNER g��a,-g Sewell Inc.
aooAess 136 Rochester Stseet
TEL.
ciTv rnc7-a Maca 9�F�7 No. (,42-49
BRANCH
ADDRESS
AFCHITECT
CONTRACTOR
ADDRESS
CITY
STATE
�IC. NO, z
SIZE
OF LOT
�iAR—�i'fiPyt�,O� �72� V':t4i:���.�i�
APPLICATION FOR STRUCTURAL PERMIT
ftECEIVEDBV DATERECEIVED neTFicciiFn
PERMIT NO.
BUI�DING �D� , J�F�� �
aooaEss \/
TRACT LOT �
OWNER
FIRE
S't.� CAStd MESd ZONE
APPROVED
TEL.
NO.
CITY
LI4 NO.
INO.O LBF�
NOW ON LOT
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFOfiMED
I hereby acknowletlge that I have �eatl ihis application and state
thac tha abova Informaiion is corract antl egree to comply with
all laws regulatlnB builtlin8 con5ttuction, and I shall noi employ
any person in violation of ihe workman's compensation lews of
tha Stete of Celifornie.
I hareby certify thai I am properly licensetl as a conttecior untler
the State of Celifornia Business antl Professions Cotle, Olvision 3,
Chepter 9, antl thai such licenses are In full force antl affect, or I
em axempt from the provislons of the State of Californla Business
end Professlons Cotle, Divislon 3, Chapier 9.
Signacure of �� / // ��
Permittee � �-{�!L(
VALUE '
DATE
ZONE NO.OF USE OF NEW
PLAN$ BUILDING
VAR�SAPPROVED VARDSAPPROVED
MAIN BUILDING ACCESSORY BUILDI'�.
(FROM C/L STREET)
REAR FT.
DISTANCE BET. BET. MAW &
MAIN BLDGS. ACCESS.BLD
VAR. �I`- DATE
C.U.P.� APPROVED
APPROVED
�- iC `1 / � " - �
m
i
:
SQ. FT. rv
THE AMOVNTSHOWN VNDER VA�UATION IS FOR m
THE PURPOSE OF E5TABLISHING A PERMIT FEE ONLY: �
VALVATION PERMIT FEE S �
n
PLAN CHECK $ ^
a
$ TAX $ LL
E
U
TOTALPAID $ �