HomeMy WebLinkAbout395 FLOWER ST - Building Permits(714) 754-5273 • Fax (714) 754-4056 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
i
395 FLOWER ST
11729324
Applicant: GUS BAHOU
Address:
'�i - -
� �- � � � �
Owner:,'. DICKINSON, TIMOlHY ALLEN
Address - 21431 SEAFORTH LANE
HUNTINGTON BEACH, CA
Contracror. PRUDENTIAL ELECTRIC INC
Address: 23121 LA CADENA
UNIT H
LAGUNA HILLS, CA �
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fizts
Recept Outlets .
Switches
Non Res Appl, �'. �
Res Appl �� ,, ,
Service to 200a
Service to 7000a'
Service over 1000a ,
Motors to 1 hp
Motors to 10hp
Motors to 50hp
Motars to 100hp
Motars aver 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
Fhone: 949-837-1198
Zip:
Phone:
Zip: 92646
�Phone: (949) 837-1199
� Zip: �92653.
License: 680295
ISSUED BY:
Status: ISSUED
Appiied: 12/10/2001
Issued: 12/10/2001
�
SCOPE OF P_ERMIT , _
SERVICE UPGRADE TO 100AMP. . - - j..
0
Quantity
523.50
$0.00
$0.00
$0.00 0
$0.00 0
$0.00 0
$0.00 0
�-,,��$0.00 0
\$0.00 0 .,-
� $Oi00;. i-<•-. p•, _
- $0.00 �' - 0
� �830.50'= .' - 1
- $0.00 � � 0 � ,
$0.00 0
$0.00 0
50.00 0
$0.00 0 ,
$0.00 0
$0.00 0
$0.00 ' 0
$0.00 0
$0.00 0
50.00 0
50.00 0
$0.00 0
FEE SUMMARY
� - Quantity ,
Temp Dist System / Lighting � $0.00 0'
Busway /100 k $0.00 0
Standing Section $0.00 0
Misc Electrical Equipment $0.00 0 �
Transformers up to 1 kva/kw $0.00 �0 � ,
"� : .:. :.:::........up to 10 kva/kw $0.00 "<0
.......:..:.:....up to 50 kva/kw $0.00 � � 0 �
............::_.upto900kva/kw $0.00�;�%0
..................over 100 kva/kw.<. , $0,.00, � 0- �-.
Low Voltage Equipment' ��' - - $0.00 0 �
-Low Volt Wiring System / Ckt -�$0.00 �� ` 0
Misc:�Conduit �,- $0.00 �, 0
Misc. Conducto� � � $0.00 � � 0 -
Circus ( gen or ride) � $0.00 � 0� .
Circus (mech ride or lights) $0.00 0"�
Chrislmas Tree Stand $0.00 0
Fireworks Stand $0.00 .� 0
Other Electrical Fee $0.00
Investigation Fee � $0.00
Plan Check Fee $0.00
Reinspection Fee . $0.00
TOTAL CALCULATED FEES $54.00
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regula[ions. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspeetlona 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
zaasae (a�oo�
WORKERS' COMPENSATION DECLARATION: �
I heraby aHirm under penalry of perjury one of the tollowing tleclaretions:
❑ 1 have end `will maintain a certificate of consent to self-Insure for workers' compensation, es pmvided for by section 3700 of the Labor Code, tor the performance of Ihe
work for which [his permit i5 issued.
❑ I hava antl will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the petlortnance of the work tor which this pertnit is issued.
My worker�s' mpensatlon Insurance c rrier antl policy number are: / / �Z
Carner: �"/ % F�/N / Policy Number: I �h � / � (7 — p I
(This section need not be cample�ed i! fhe permlt is veluetl e( one hundred dollers ($100) or less.)
❑ I certify that in ihe pedormance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subiect to the workers'
compensation laws otCalifPmia, and egree Ihat ii I should become suDject to ihe workars' compensation provisions of Section 3700 of the La6or Code, I shall toRhwith
camply with these p�[n 'u' as.--___� /
� Applicant Signatur�C % � Data: D e � � � � � � ����!
WARNING: FNLURE TO SECURE WtlAKERS' COMPENSATIIXJ CAVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND qVIL FINES UP TOONE HUNwto
TFIOUSMlD OOLLARE (3100,000), IN ADDITIQY TO THE COST OF CAMPENSATIIXJ, DAAMGES AS PROVIDED FOR IN SECTION 3)Ofi OF THE LABOR fADE, INTEREST, AND AiTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm ihat I am licensed under provisions of Ch�ter 9(commencing with Section 7 00) oi Division 3 of the Business antl P of ssions Code, and my license is in full
torce and eHect. Lic. p �.� l� _�9 y � Class # �� O
� Contractors SigneWre: �'�}n�s�-y�s=»r.� / Date: nP r_ _ 1 u— m I
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm ihat there is a constmction lentling agency for the pedormance of ihe work for which ihis permit is issued. (Sec. 3097, Civil Code).
Lentler's Name: Lendefs Adtlress:
Signature: � Oate:
OWNER-BUILDER DECLARATIONS:
I hereby attirm that under penaity ot perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Professions
Code: Any ciry or county which requires a permit to construct, alter, improve, tlemolish, or repeir any stmcture, prior to its issuance, also requires ihe applicant for such permit
to file e signed statement thet he or she Is Ilcensad pursuant to the pmvisions of the Contrectors License Law (Chepter 9(commencing wiih Section 7000) of Division 3 ot iha
Business and Professions Code) or ihat he or she is exempt therefrom end the basis for the ellegad exemption. Any violation of Section 7037.5 by any epplicant foi a pertnit
subjects Ihe applicant to a civil penalty ot not more than tive huntlretl tloltars ($500).):
❑ I, as owner of ihe properry, or my employees with wages as iheir sole compensation, WILL DO THE WORK, and the stmcture Is not intentlatl or oflered for sale (Sec.
7044, Business and Professions Cotle: The Contractors License Law does not apply to an owner of property who builds or improves ihereon, and who does such work
himself or herseN or through his or her own employees, provitletl ihat such improvements are not intendetl or oHered for sala. If, however, the building or improvement is
sold within one year ot completion, ihe owner-builder will have ihe burden of proving that he or she ditl not build or improve for puryose of sa�e.).
❑ I, as owner ol ihe property, em E%CLUSIVELY CONTRACTING WITH LICENSEO CONTRACTORS to construct ihe project (Sec. 7044, Busines5 and Professions
Cotle: The contractors License Lew does not apply to an owner ol property who bullds or improves thereon, end who conirects for such pwiect with e contractor(s)
license pursuant to ihe Conl�acbrs Licensa Laws.).
❑ I em exempt under sec. Business antl Protessions Code tor this reason:
Signature: Date:
Owner ID verified by dnvers licensa. ❑ Ves ❑ No Drivers License No. Expires:
Venficetion of Ownership by (typa of tlocument, i.e. - propetly tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cenity that no exca�etion five (5) or mora feet in depih into which a person Is required to descentl, will be made in connection with work authorized by this
permit, and that no building sWdure, scaflolding, falsework, or tlemolition or dismantling �hereof, will be more than Ihirty-six (36) feet high. (Chap. 32, Gry 2, An 2, Sec.
341, Tltle 8, California Atlminisiretive Code).
❑ As ownerbuilder, I will not employ anyone to do work which would require a permit irom the Division of Intlustrial Sefery, es notetl above, unless such person hes a
permit to tlo such work from the division.
Signature: Date:
Division of Indusirial Sefety Permi� Number:
CERTIFICATE OF COMPLIANCE AND AUTHOHIZATION OF ENTRY: I cetlity under penelry ot perjury ihat I have read this application and state thet ihe infortnation given is
correct I agree to comply with all s;ate laws and ciry ordinances relating to huilding construc�ion, and authonze representatives of Ihe Ciry of Costa Mesa to enter upon ihe
ebove-described property tor inspnction puryoses. I a9ree not to occupy or allow occupancy ot eny building authorized by this permit until final inspection.
I� i n8�� Of Legal Owner(s) j
� �
pnd/OrAuthonzedApplicant �
.� . . - �.. �'
1616 Fi:ed System final Fire Prevention
1266 Pool Spe Finel
200 Finel Re-Roof
201 Final Block/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
�•AI�L'l1uCiR�7
CO�E I INSGECTION TYPE
206 Final Mechanical
208 Final Plumbing
210 Finel Electrical
212 final Fire Prevention
220 Final Planning Approval
222 final Site
250 Finel Building/Occupency
�1111.
i
/ �I��
«
AVo�iwnt to fill in all zoaces exceot tnose witnin neavY Earaer Ilnes antl sign all avVrovriate tleclarations.
CI7voP COS7A MESA CONSTRl7C"fION PERMIT
ApplicanYs Mailing Address
Addre55 X C� *
. �
Arch/Eng. ' License No. � '
Address SA�MG_
Contractor's Name � Phone
Address (mailing)
City License No. '�
LICENSED CONTRACTOR DEG ARATION '
1 hereDy atfirm tnat I am Ilcensetl untler provisions ot Cnarte� 9(commencing
with section ]000) of DiviSion 3 of the Business antl Profe�sions CoOe, antl
my license is in full torce antl ettect.
License Clazs � License Ya.
Date Signatur¢
WOf1KER5' COMPENSATION DECLARATION
1 hereby aHirm that I have a certiticate ot consent to self-Insure or a certlticate
•f Workers' Compensation Insurance, or a cer[ifietl copy [hereof (Sectlon
800, Lab. C.) - ' �
Policy No. � Company �
8 Certifietl copy is �ereby turnishetl. �
Cer[itied copy I5 Bletl with the city Builtling Dlvision. i
Date Applicant �
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(ThiS sec[ion neetl not bo completetl if the permit �Is fo� one huntl�etl (5100) or
less).
I certity that in tne performance ot the work or whlcn tnls oerm�t is issueA, I
shall not emDlo any person in dny manne 5o,a;1 becema Sp ubjec[ [o Ihe
Workers' C p n Laws of Califor �,L�u .
. Date Signature I
'NOTICE: t, af er aking [his aeclaralio ou shoul become subiect to the
�Workers' ComOensation provisions of Ih Labo� Code, you must forlhwith
comply with such provislons o� lhis ermit�shall b¢ tleemed revoketl. �
CONSTRUCTION LENOING AGENCV �
1 hereby affirm that [here is a constructlon lentlin9 agency tor the performance
of the work for which thi5 permit is Issuotl (Section 3097 Civ. Cj
Lentler's Name
Lentler's Atltlress
OWNER BUILDEH OECLARATION '
I hereby affirm that I am exempt lrom the Contractor's License Law for tne
following reason (Section ]031.5 Business antl Vrofessional Cotle: Any city or
county which requires a permit to mn5truct, al[er, improve, Oemoli5h or iepai�
any"5lructu�G, p�io� to•its Issuance, dlm requires the aOPlicanl for such Oe�mit
to file a slgnetl Sldt2ment tnat he/she I5 IicenSetl pu�suant t0 the provi51on5 ot
tne Contractor's License Law (Chapter 9(commencin9 �+��M1 �ction ]000)�.of
' Division 3 ot Ihe Buslnes5 antl Professlons Cotle) o� that ne/she is eaempt
'hereirom antl the basis tor tne alle9e0 exempfion. Any viola[ian of Seclion
131.5 by any, applicanl tor a pe�mi[ subjects Ihe applicant to a civil ,
nalty of not more [han tive huntlretl tlollars (§500). , '
� I, as owner ol the pmperty or my employees witn wages as thelr sole
<ompensation, will tlo the work, ana the structure Is nol intentletl or otteretl
'for 5ale (Section 7044, Business and Professional Cotle: The Contrac[or's
License,�aw tloes not apply to an owner ot a property who builtls or improves
thereon, antl who tloes such wo�k nimseli/nerselt or through his or hGr Own
employees, provltletl lhat SucM1 Improvemen[s ar0 not intenaetl or offeretl fo�
sale. I(, however, lhe �uilCing or improvemon[ Is soltl within one year of com-
pletion, the owner will have the burtlen ot proving he/shc tlitl not builtl or im-
�rova tor the Outpose of Sale).
I, as owne� ot the property, am exclusively cont�acting with Iicensetl con-
[factors to constru[t the prqect ($eclion 7044, BuSin<55 antl Protes5ion5 COtle:
The Contractor'z License Law tloes not apply to an owner ot prooerty who
builtls or improvez thereon, antl who contracts for such projects with a ron-
tractor(s) license pursuant�lo lhe Contrattor's Lirense Law). I am aware that
proof oi tpeir WOrk¢Ys Compensa[ion Insu�ance shoultl be prOvitletl to me.
❑ 1 am exempt under Section-r-.B. 6 P. C. tor tnis reason '
I•ti:a� �r�1r�r=�7!ZLLL
5�9�a����
CMF 0865-46, rev.
i this plicatlon Sntl state that tne above
comp wlth all tlty antl county ortlinances
9 con uttion, antl hereby authorize repre-
upOn tho abOve-mentionetl .p�oper1 y to�
1 I � 9 I f1/
TVPE OFCONSTRUCTION LJ NEW IJ AOD lJ ALTERATION IJ REPAIR.
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG. _
TVPE OF PERMIT LI GRAo1NG U FOUNDAT1oIV LJ SrRUCTURAL
❑ TENANT -❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL .
❑ OTHER
PROJECT DESCRIPTION Sa. FT. OCCUPANCv_
'CONSTRUCTION TVPE VALUATION $�
ZONE GRADIfVGCV.vOS. �ACRES_
Sink
Prevenrer
Irrigation
A
Drinking Fountains
Floor Drains
FloorSinks '
Gas Service . Outlets
Interceptors
Kitchen Sink
Lavamries' � �
P—Trap
Roof Drains
�
Reinspeetion Fee
$15
Duct- UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact elt. ICBO �
Heating System & Duciing
❑0.100,000 BTU 0100,000
55 � `_'�.�— Vo � ( I I Reinspection Fee � I $75
14- White - 8uiltling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
$hOw¢�S
Serviw Sink -
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool wlSpa
Urinal
Water Closet '
Water Heater
Water Service
Auro-Wash
-LaundryTrays -
Issue Fee
Haod or TYPeI ❑
Cenopy Type II ❑
Refrigeration Sys[em
❑aioo,000eTu ❑ioo,000eT
System Repair/Alteration • �
Fire Dampers �
Registers
luue Fea
A.P. #
S Main Buil
E
T Front
B Rear
A `
C Right
K
g Left �
Pln9. Ref. #
Plannin9 Note�
_��_
din9:
- Aummatic Washer - - �
Consttuctian Pole Sub.
Cooking Unit
Dishwasher
DrYers ❑Gas ❑ Electric
Fan
F.A.U.
Fixtures . � -
Devic¢ BOx¢5
OuHets
Switches � '
Garbage Disposal
Generator �0.5 KW �5-151
$ �3
Fee
FEES
�DEVELOPMENTSERVICES
i , 2oriing Approved By
Building Approved By —
Aooliptian Issued Bv_
$ 3
$15
5171 II,OH/05
. 21035 TL
Zone ��
3 i
2
O
, N
�
N
� , G
7TTU� R �J
Q
� M ,
T
S
ELECTRICAL
Transformer � ❑� 15�50 KW
�: 50 + I( W
Meter ❑up to 100'amps
Meter ❑over 100 amps ,
Suh Panel
Momrs OO-1 HP O7 % ��6
Inc.Solar Q9�15 HP �16-15+
- � Microwave -
Pole Light
Range
Si9n "-
; Standing Sections '
7 Trash Compacror �
Issue Fee
SUMMARV OF FEES
BUILDING PERMIT $ � � �C� SMIP
. PLAN CHECK $ �Q� `�_� PERMIT
• PLUMBING S ISSUANCE
PLAN CHECK 25% $ ENERGY P.C.
ELECTRICAL $ GRADING
' PLAN CHECK 50% g� MICROFILM
, MECHANICAI S TOTALFEE
PLAN CHECK 25% $ '
FEES
� I ��
$ 3
ta �
IB c
[e ��
$ , . �
$
$
$
�
$ Zl . `i S
-' � ¢ONSTRUCTION AND PLANNING POOI ,PA .
qPPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
1. Temaorary 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 Conduit-Undrgrnd. -
'�8:"Foundation �` 59. Gas Pipe, O Undrgmd., Test � 7
9J 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. Sewei Cap 63. Heater & Vent-final �
13. Roof Drains 64. Plumbing System - Final �
14. Rough Plumbing � 65. Electrical-Final
75. 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 O Gas ❑ Oil '
23. Gas Pipe-Rough & Test 72. Underground Flush
24: Roof Freming 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
.26. T-Bar Ceiling��Structural) & Monocoat 75. Dry Chemical
27. FrameandFlashing 76. DryStandpipe
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: S '.'p� " C' iT
34. Final Heating & Air Conditioning . _�, y� S. ,..
35. Final Gas Pipe-Test � a-- � �d�� . �� �i �
36. Hood'or Canopy , �
37. FinallFactory 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 �
' a
45. Sound Attenuation � ,,..-� l4
46. Handicap Regulations � . � �
47. FINAL STRUCTURE & BUILDING !
48. Special•Requirements Completed .
49. Electric Release to Edison . �� �
50. Gas Release to Southern California Gas Co
:51. CERTIFICATE OF OCCUPANC�' .
fVo. Date
. qs a esa g epa ent
. �+� 771 EAST 20th STREET
� j '- � � �� COSTA MESA� CALIFORNIA
FOR APPLICANT TO FILI. IN
naaress.3/�� ��/f�L=i �%f•
Costa Mesa, California
Nearest
Cross St �U.J i/N ���
_ _ ' �, i
L�L�
�
-'�O /
Lot
Tel.
City Lfc.
�a`� ryO } l 7 —�93 � 2 %`
Metes B'ounde �
No. of Bldga
,ot �O x/ Z� Now on Lot �
/� No.of No.ot u
Bldg. I\L.SiOnnCr- Familles� Rooms/
Linefrom 1S0 � RearYard �Z.S'�
em�_. ..,.._..__. i
Demolish
^„A�PLICATION FOR PERMIT
�;z BUILD�tNC '
�OR OFFICE USE ONLY
IReceipt No. ermit No.
3�07 �l7
Recetved by Date He d. Date I ued
I IJAN 1 0 1955
Buildin9 w
Address �j��FGO��I�
Costa Mesa, California
Nearest
Cross St.
-. /
t,! X 70 — '3 �o
tlU��a��9 no. or /
s�_ze p19/S 3-3 sooms stories
Exterio9Wa11 �.L ( Roor g �'6�no APPROVALS
C in VJ4�Cc o Coverfn
l f New �/ Foundation Location Ina ecta
Bu��din9 ��S�C7i�i✓cr �l%/�i1C�M� Forms,Materials, P
Under-Pinning
Frame: Ffre Stops,
Bracing, Bolts
I hereby acknowledge that I have read this Application Lath. Int.
and sta[e that the above is rnrrect and agree to rnmply Lath. Ext.
with all City Ordinances and Stat Iaws regulating
building construction '
Signatureof� � Plaster, Int.
Permittee /
Valuatfon G� S6 �, Pern
Plan
5 Tota
Fee
FOHM 2a4 0-H 2M 9-9a
�UO�F
Date
O
�
�l
Show locatlon and distances from
property.line and�tietween buildings,� 1� f
�r
�� ..
` � . .
�
. . , .,.I �:. � . . .
. �
_• C�sta Mesa Bnilding Department
- ' 111 EAST 20th STREET
� COSTA MESA� CALIFORNIA
FOR APPLICANT TO FILL IN
e�imio9 � �- , (�
Address � / r � �/G' /;iGy �1 '�
Costa Mesa, California
■ Owner
or
■ Size of Lot
G
APPLICATION FOR PERMIT
d�d,� BUILD�LNG �
FOR O�'FICE USE ONLY
_ RecefptNo. I PermltN
�O O �
I by Date Rec'd. D�
J /r-�--9-�b /r-
,
Costa Mesa, California
LiC. I P�ans I
No. Approved
by
_.. _ , _ CORREC'�IONS
Z 2.�! :�,c.vTif /��'.f /9v.a
ILot I I
No. Block I Tract
sand Bounda) ��%��/ 3� Z T
.,c �2 No. of Bldga �
`(� /� l Z+�+ Now on Lot
./�1 I No.of No.o} �
�/ X �7/�r�77,�amllles� Rooms�
f�m � � Rear YaM �
Additio�
��9 6 �l /6 � Rooms � s+
ior Wall .� I Roof �
�ing .f: a•t-c0 Covering `—`
FNew
ing � TO " co �a2
APPROVALS
-7 ir Forms, Materials,
�L�t���,rrt�[�1��h4k�,� '�n B"�rc+_�JM1 Under-Pinning
Frame: Fire Stops,
Bracing, Bolts
I hereby acknowledge that I have read this Application
and state that the above is correct and agree to comply Lath. Int.
with all City Ordinances and State Iaws regulating
building construction. �ath. ext.
Signatureof
Permfttee Plaster, Ini
�
Authorize Plaster, Ext
Val ation e v PermitFee $ �� MasonryReinforoed
7v G7 r• Pian Check $ � gond Beam
$ Total
Fee � FINAL
FORM 204 S-HP 2M fi-SS
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