HomeMy WebLinkAbout436 FLOWER ST - Building Permits�Y OF cOSTn MEsa CONSTRUCTION PERMIT
�aProjectAddress 436 F].OWOY St.
qpplicanYsMailingAddress 126 Commercial, C.M.
pwner's Name TOfil R.l.kei Phone 548-3561
qddreu 936 Plower St., C.M.
Arch/Eng, License No.
Address
�nvactor'sNama Crank Bros. Roofinq phone 548-556
Addresslmailing) 126 Commercial, C.M.
City License No. 5993
LICENSED CONTRqCTOR DECLARATION
1 hereby aflirm that 1 aT Ilcensetl U�tle� 0/ovi57on5 ot Charte� 9(contmencing
with section ]000) of O���slon 3 ot tno Business antl Professions Coae, antl
my Iicense is in full force antl etfect.
License Class — License io. 867
Da�e �— Signature
WORKERS' COMPENSATION L RATION
'�ereby affirm that I nave a c '¢ate ot consent to selt-insure or a certlficate
Workers' ComOensa[Ion n rance, o� a ce�tifietl coPY [hereo( (Sectlon
J0, Lab. C.
Po��cv No. 85/224-86 comPa State F1lR
❑ Certifietl copy is hereny furnishea. A�
IS Certitietl cop is �yv ith the city Bu' ��Q
oate 7—� �/ Applicant T'OS. ROOf1Rq CO.
EXEMPTION FROM WORKERS' CO ENSATION pECLARATION
(Tni55ection need not be completetl if the permit is for one huntlr¢tl ($100) or
les5).
I Certify thal �n the per/Ormante of the wo�k fo� whiCh tbls pe�m�t i5 i55uetl, 1
shall mt em0loy any pe�son in any mdnne� So as lo become subject [O the
Workers' Compensation Laws ot Calitornia.
Oa�e Signature
NOTICE: If, af[er makin9 this tleclaration, you sM1oultl become subject to the �
IWo�kers' CortiPensa[ion Provi5ion5 of the Labo� Cotla, you must forthwltb
cornP�Y with Such p�ovisions or thi5 pe�mit shall be tleemeC revoketl.
CONSTRUCTION LEND�NG AGENCV
I I nereby aifirm that there is a construction lentlin9 agency for the performance
I� pf t�e work for whith this permlt is issuetl (SecUon 309� Civ. CJ
�pptler'S Name
. LePtler's Atltlress
OWNER BUILDER �ECLARATION
� I nereby aiflrm that I am exempt from the Contractor's License Law tor the
I� fol�owing reason (Section 7031.5 8u5ine55 antl Professional Cotle: Any dty or
I couniy whicn �equires a Pe/mlt to COnstruct, alt¢r, improve, tlemolisb o� re0ai�
�. anY ztruCtura, prior to Rs issuance, also requires the applicant (or such permit
' to f��e a signCtl Stafement thdt heJShe is licens¢C purzuan[ to Ihe provislOns of
I[h¢ Contracror's License Law (Chapter 9(mmmencing with Section 7000) of
�ivision 3 of tne Business antl Professions Cotle) or that he/she is exempt
<refrom antl the basis �or tM1e alle9etl exemOtion. Any violation of Sectlon
:31.5 by any applicant for a permil subjects tlte applicant [o a civil
tpalty of no[ more than five huntlretl tlollars (E500).
b 1, as owne� ot the prope�ty o� my em0�oye¢s with wa9e5 as [heir sole
compensation, wi11 Oo the work, antl the sVucture Is not intenaetl or oiferetl
}Q� sale (Seclion ]044, BuSiness antl ProtezSional Cotle� The Cont�acto�'s
Li�ense Law tloes not app�Y to an Owner of a property who CUIICs o� imprOves
thereon, antl who tloes such work himselt/herseH or Ihrough his or ner own
¢Mployees, provltletl that sucn improvements are not intentletl or oReretl (or
��e. It, howeveq tne bulltling or irhp/ovement i5 Soltl within one year ol com-
p18�1on, the owner will have the burtlen Of proving hCjShe tliG nol bWitl o� im-
��P�e tor tne Purpose o1 sale).
I, as own¢/ of the property, am excluslvely Con(ractir,� witn IlceOsetl Con-
Va«ors td conitruct tne project (SetUon ]044, Business antl Professions Cotle:
The Con[ractor's. license l.aw does not apply [o an c�v0er of Property who
bu��ds o� Improves Nereon, antl who contracts for sutn project5 witM1 a con-
tractor(z) iiceme'pmsuant to the Co�Vactor's License taw). 1 am aware that
prOof o( tbeir Worker's Compensatlon insurance should be provltletl to me.
❑ I am exempt untler Sectlon B. & P. C. for this reason
Da1e Owner _
� pereby cpppccc��� rty tha[ 1 have read 1
��{ormatiop I� mrrect. I agree ro co
an0 state Idwt �elating to buildm9 �
sentatives bflthis citv to enlsi u
Sig�ature
Dt��ers'
CMF O86 4
nt to ���� �� all ipaces exeeD< <hose witnin heavy boreer lines ana sign all approoriate tleclaratio�s.
TYPE OF CONSTRUCTION L1 NEW LJ ADD XXI A�TERATION IJ REPAI R
❑ CONVERSION ❑ DEMOLISH ❑ O�jHER - A,p, �6
DESCRIPTION OF WORK/USE OF BLDG. "emove eX1StlCiq�, lClStd
�O S Main Buildi
TVPE OF PERMIT ❑ GRADING ❑ FOUNDATION STRUCTURAI. T FrOnt
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICP.L B Rear -
❑ OTHER A
PROJECT DESCRIPTION 54. F7. � oCCUPANCV sing e C Right
CONSTRUCTIONTVPE residential VALUATION$ 5�6��,0� S Left
ZONE GRAOING CU. VDS. ACRES Ping. Ref, #
Remarks: Planning Notes:
Sink
Preventer
Irrigation
king Fountains
�r Drains
�r Sinks
Service Outlets
Kitchen Sink
Lavatories
P—Trep
RooS Drains
Reinspac[ion Fee � $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/FacL Blt. ICBO �h
Heating System & Ducting
❑0-100,000 BTU � 100 000 BT
' — _ _ --'--�—`� � I Reinspectian Fee I $15
nse or 55 �
rev. ]0/84 White - Builtling; CanarY - Applicani; Pink - Accountin9; Goltlenrotl - Asseszor
Showers
Service Sink
Sewer Cap
Sewer Connectian
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Aum-Wash
laue Fee $ 3
Automatic Washer '
Construction Pole Sub.
Cooking Unit
Dishwasher
Fan
F,A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generator �0.5 KW
1709 2%04/87
Zone
Accessory Buildi�y�.
Parking Req./Providetl
ELECTRICAL -
Transformer ❑ 15-50 KW
❑ SO+KW
Meter Dup ro 100 amps
Meter ❑oveit00amps .
Suh Panel
Motors �0.1 HP O 1 h- 8
Inc.Solar �9-15 HP [�16-15+
Microwave
Pole Light
Range
Standing Sections
5 KW Trash Compactor
Reinspection Fee $15 Issue Fee
IANICAL FEES
Hoodor T DEVELOPMENTSERVICESREQUIREMENTS:
YPeI ❑
CanoPY TVPe I I ❑ Zoning APProved By
Building Approvad 9y ,A�
Refrigeration System
❑0.100,OOOBTU ❑100,000
System RepaidAltereNon
Fire Dampers
Registers
Iswe Fee � $ 3
40050 , TL I
Z
O
N
1
N
G
F
E
Q
M
T
S
FEES
$ 3
SUM� p/�p Y�� FEES � SD
BUIlO1NG PERMIT. $ _14$1(L SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL S GFADWG 5
PLANCHECK 50% $ MICROFILM $
MECHANICAL $ TOTALFEE� $ D�SO
PI.AN CHECK 25% $
CONSTRUCTION ANDpLANNING POOL&SPA
APPROVALS 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-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. . 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Tesi
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation � 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final �
16. Rough Electric Wiring 67. Fencing & Access Approval
17. �Rough Wiring Sign 68. APPROVED FOR PLASTERING �
78. Rough Electrical-T Bar �eiling 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 �Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ 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:
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 o
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 ti
51. CERTIFICATEOFOCCUPANCY
No. Date • ,
nooiica�� eo
�CITY OF COSTA MESA ae
CONSTRUCTION PERMIT G
Addrea
Address
al1 spaees witnin heavy Dortler Iines antl sign a11 appropriate aeclaration
NO. _ i TRACT NO. LOT NO. BLDG. NO.
l�:8 3�L � TYPE Of CONSTRUCTION
Phone ' ❑ NEW I�{ ADO ❑ ALTERATION
� - ❑ REPAIR ❑ CONVERSION ❑DEMOLISH
LiCense Na: ❑ OTHE0.
DESCRIPTION OF WORK
Phone �/ TVPE OF PERMIT '
:� A/ ❑ GRADING ❑ FOUNDATION �STRVCTURAL
GCENSCo wn�nwcion-uc�.�wnni��N � � ' ❑TENANT �ELECTRICAL �PLUMBING (e�MECHAI
1 h¢reby aftirm th;.t� 1 am Iicensetl untl¢r provi51on5 O( Chdrter 9�(COm- � . , '
mancing wltlt sectlon ]000) 'of ;Divlsion 3 of tha Buslness antl � 0 OTHER
Profezslons Cotle ntl my license Is In full torce antl itect �� pROJECT DESC �IPIION -. . ..
License ss ' e �o ay
Date���� Z� c'onature ��✓#+�. ' -- SQ. FT. "p, , � r
WORKERS'-COMPENSATION OECLARAT� N � - . OCCUPANCV.6�yCONSTRUCTION TVPE �r
I hereby aifirm tha[ 1 have a certificate o} consen[ to selhlnsure or a� VALUATION � 6to ZONE
certi(ic2tebf"WO/k¢�s' COmpenSatlon Insy�ant¢, O/'a cerUfietl copy - � �
thereot (Secllon 3800, LaO. C.). , ' GRADING CV. VDS. ACRES
� v No. Company � - � - � -
rtifiecl COpy IS hereby turnishetl. REMARKS: • - -
}� .,ertlti¢tl Copy IS tiletl with th¢ City 8uiltlin9 DivlSion. .
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION �
(Thiz soctlan n0etl not be complet¢tl if [ne pe�mit is fo� one.�untlretl . ., . '
1§1��� OI IC55). •
cerU(y tnat dn lhe performance of the wo�k for whlch tnis permit Is
Issuetl, I shall not employ any Oe�son in any mannet So d5 to become � PLUMBING PLAN CHECK
subjett to the Workers' Compensation laws ot Cali(ornia. .. _. .
Date Si9nature � BATHTUBS SHOWERS •
NOTICE: If aHer making this tle<laration, you shoultl bacome subjec[ TOILETS URINALS ��
to the Work¢rs' Compensdtion provlsions Ot th¢ Wbor Cotle, you must LAVATORIES DOVBLE LAVS
}orthwith comply wlth such provi5ions o� this perrtllt shall be tleEmetl
revoketl. _ ' ` s_ ". _�'.' _ _ _ . .
GONSTRUCTION LENDING AGENGV K�T. SINKS �DISFIWASHERS
I hereby a(firm Ihat there i5 a construction I¢ntling agency tor [he perv $ERVICE $INKS ' $UMPS
formance of the work for which this permit fs Issuetl (Section 3097
Civ. C.). -� � FLOOR SINKS - FLOOR DRAINS
LentleYs Name - -
Leneer'S Atltlress DRINKING FOUNTAINS '
OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS .
1 herebY affirm tM1at I am eaempt from tne Qontrac[or's Licenie Law lor
the following reason (Sec[ion ]03L5 Busihes5' antl Protesslons Cotle: SWIMMING POOL P TRAP
Any ci[y or county whlch reQuires a permit to con5truct, alter,
Improve, Cemolish or repair any s[ructure, prior to its issuance, alm re- yyqTER SERVICE ALTERATION�
quire5 th¢ ap� litant tor sucn permit to 1il¢ d Signetl statem¢nt [hat ne
is Iicensetl'pursuanCtd the provisions of [he ConVactor's Licanse Law GAS SERV ICE OUTLETS -
(Chap[er 9(commencing with Section 7tl00) o/ Division 3 of'the
Business antl Proiessions Cotle) or that ne 16 exempt therefrom antl ihe 'yyqTER HEATERS �- � BTV OUTPOT �
N�:t,�-,,,(or the allegetl exemption. Any violation of Seclion 7031.5 by
. ;,.�ppllWnt'"/or a permit su��e<[s the dpplicdnl l0 a tivll pendlty -SEWERCONNECTIOIV$
�� y� more tban live huntlretl tlollars (5500). '
Li�`i, as� owner ol the property, or my employees witn wages as their SOLAR TANK � COILECTORS -
or offered for sale. (Sec[ion ]044, Buziness antl Professions Cotle: The SOLAR PIPING SVS. �•
Con[ractor'S�Licanse Law tloe5 not apply to an ownGr of a p�operty . _ _ . _
who builtls or improve5 thereon, antl who Does such work himself or ISSUE FEE ��
throu9h his own employees, provitletl Ihat Su<h Improveme0[5 are not '
Intentletl or offcred for sale. If, however, tho builtling or Improvement MECHANICAL PLAN CHECK
ii�Soltl wilhin onp year of_completion, [he owner will have tne burtlen
of Provin9 ne tlitl not builtl or improve tor the purpose ot sale). HEATING SVSTEM 0-300,000 BTU _
❑ I, as owner ot' [ne prop¢rty; am ekclusively con[racting with qND �UCTING
IicenS¢tl conVactorz to wnstru[[ the prol@Cf (Section 7044, Business 100,000+gTU_
dntl Profez5iOn5'Gotle: Tn¢ Coniracror's LlCense I�w OoeS not apply ro' -
an owner ol p�operly wh0 builtls o� imprOv¢5 thereon, antl who COn- REFRIGERATION 0-300,000 BTU_
tracts-lrom`su<n pro�ects wiN a convactor(s) Ilcesnetl pursuant to SVSTEM' " `
the Contraclor's license Law). , 100,000�+ BTV _
❑ I am exempt untler Sec[ion� � � �� B.�L P. C. for this ' BOILERS, BTU �
reason ' " '
Date - - Owner �-- . SVSTEM REPAIR, ALTERATION
I.hereby cerliry Ihat I have reatl this application antl s[at¢ thdt the above EXHAUST SVSTEM MULTIPLE
info�mation is WrrecL I a9ree to comply yyiSh a❑ clty ana county . .
OtGinanCes antl state Idws reldiing [o constr4CtlOn, dntl�hereGy authorize
representatives���qqq f thls city to enter upon tlte abOvo en[ionetl
prop¢rty _to��� pyrppse��
Signaluro ���� Date
Drivers' License or 55 � ISSUE FEE' ' "'
CMFOBfi5-46 White-Bulltling:Canary-Abpliwnt:Pink-Accounting;Goltlenrotl-Assessor ,
t- �_F
A.P. �
ZONE
�831 I/18/82
ZONING REGULATION:
C// / .
. PLNG. REF. �
REAR YARD (TO P/L) ��.
PKG.SPACEREp. _ Pf1BVIBE61 ,
STREET WIDTH „ ,. PARK tE�f._.,.__.
SPECIqL CONDITIO
ELECTRICAL PLAN CRECK
, OQ " _ '
Q GENERATOR ' Od KW_1-lO�KW 1
TRANSFORMER -
Q �APPLIANCE �10-SOKW_50+'KW
'MOTORS 0-1 HP_I-30 HP'
� (INC. SOLAR) �0-SO HP SO�+ HP
i FIXTVRES� OUTLETS SWITCHES
� ' GAS TUBE S�GNS — - ' -
� , POLELIGHTS -` � ' -� �
�
�
71'.24 TL
PANELS �. MAIN SUB-- �
SERVIGE ' '- " " "' AMP�' � _
ISSUE FEE - ' S OV �
Oa APPLICATION APPROVED BV " DATE�
SUMMARV OF FEES " � �
;BUILDING si. Oa�i _
' �PERMIT S v � SMIP �` � S D•SD
.PLANCHEGK S��/J�,� .PERMIT. ... _
PLUMBING g_[��5� �SSUANCE S .
.� - - GRADING E -
' ��� PLANCHECK ¢•"� �� _
ELECTRICAL $� S �
MICROFIL,M §
. 'PLAN CHECK $ .
MECHANICAL $ •OO TOTAL FEE $ � '
PLAN CHECK g " LE55 AO- .•
VANCEPC $_
� J � t �7��
� �_ FINALFEE $�/.4T
CONSTRUCTION AND PLANNING
APPROVALS Permit # �
1. Temporary Electrical Service or Pole
2. Soil ipe-Undrgrn
3. Electrical Conduit Utility-Undrgrn'_:
... ..................,......... - .. ........_.,.
6. Electrical UFER Grn
7. Footings ' '"
8. Foundation -
_ 9. Water �Pipe-Undrgrn - •
10. Structural Floor System
11. _ Property Sewer Line & House Connection
12. Street Sewer. Connection �
13. Rough Plumbing� .
14. Rough Electric-Conduit
15. Rough Electric-Wiring �
16. Rough Heating & Air Conditioning �
.17. _Ducts in Structure
18:� � Ducts, Ventilating
19. Gas Pipe-Rough & Test •
20. Roof Framing '
21. Roof Sheathin
22. Frame and Flashin -
23. Insulation �
24. lathing & Siding .
25. Drywall Nailing
26.�Plaster 8rown Coat -
'27. Electrical Power Meter-Final
28. Final Electric
! 29. Final �Heating & Air Conditioning
� 30. Final Gas Pipe-Test
31.. .Final Plumbing
.32.. Water Service-Final.
' 33. �.GasService-Fi�al. -
34. Solar pomesticFinal �
35. Landsca e S rinklin S stem
- 36. Sound Attenuation � • �
37. Handicap Regulations � �
• 38. FINAL STRUCTURE & BUILDING
' 39. Special Requirements Completed
' 40. Electric Release to Edison �� •
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
� Nu� Date
rn� /
, '�00 L & SPA " � � �
Date Inspector AppROVALS Permit �{kJ ' .,Date. Inspector
' � 43. Pool 8i Equipment Location - �
L„o -Z„Z�-3„ 44. Steel Reinforcement - - ' -
�- �� � � 45. Forms
46. Electrical Bonding ;
47. Rough Plumbin & Pressure Test � •` �
' ` 48. APPROVALTO COVER-GUNITE -" " - - � -
> l.� �� Z;' 49. Electiical Conduit-Undr rn - � �
50. Gas Pipe, ❑ Undr rn, Test �'-
51. Ba kwash Lines P-Tra �' ndr m� -
69 APPRnVAI Tll f)FCK - - --• • � .- .
- 56: Electrical-Final-
> 57. Solar SVstem-Final -
. encing & Access Approval
. APPROVED FOR PLASTERI
60. POOL/SPA SYSTEMS FINAL
. t. . _. ._ .. `
�;,� NOTES: • �
�
<
County of Orange
'BuildiPg Department
APPLICATION FOR p&RMIT NO.—� .3O
, Room 322 PERMIT
Cour# House Annex
Sanfa Ana, California ''
Phone: KI 2-6211 — � , 19�—/
1. OWNER'S NAME= � �ED (3 �EG�Y __ pHONE: /'�ONE
MAILING ADDRESS �y� h'A.�/ �� TO.v C7;'Ty LOSTA MESA
(Stceee or P. O. Sos Na.) �...O
NAIvIE__��� NAME 7` XFD Q���f'
(Architmt or Engineer) (Conmaor or Build<c)
ADDRESS_ ADDRESS 'yy'7' yA.�1//iTO,t/
CITY CITY �OS TA M�`SA !: A.G/�
Stace Lic. No. Phone State Lic. No. /���C Phone �/�N�
2. JOBLOCATION 'i�36 f�iOCUE/� JT. (�oSTA /`1�`'s�
(Houeo NoJ (Name oE Saee�) (Town or School Disaice)
3. LEGAL D6SCRIPTION: Lot '� � Block Trac� # 30 `�
" 4. Meets and Bounds Description — Use Reverse Side of This Form.
5. CORNER I.OT () INTERIOR LOT (� THROUGH LOT () SLOPE OF LOT �iEGl�G
THIS AFPLICATION CANNOT BE PROCESSED UNLESS LEGAL DESCRIPTION
IS ACCURATE AND COMPLETE.
6. PROPOSED WORK: New Building (!� New Structure ( ) Addicion ( ) Repaic ( )
Alteiations ( ) Move ( ) Demolish ( ) Conversion ( )
7. PROPOSED USE: LILI/ELl. /.VG- Y 7YTTA!'HErD (�`A/cA�,.E
Cw�ecC �i�os d a
8. SIZE OF BUILDING—�c.,,o�! AREA �(��a_�ESIZE OF LOT�� x�3S� AREA__�T��20 �F
9. CEILING HEIGHT l�� TOTAL BUILDING HEIGHT �2 � NO. OF STORIES �
10. NO. LIVING UNITS � SIZE OF SMALLEST BEDROOM /D 9 x ii SIZE OF KITCHEN l� /3 S� ��
11. EXTERIOR WALL CONSTRUCTION: Brick O Concrete Tile O Monolithic Concrete O
Wood Frame (!�' Steel Frame ( ) Concrete Frame O .
12. WALL COVERING: Wood O Lvletal .( ) Smcco (� Other_
13. FRONT YARD SETBACK FROM CENTERLINE OF STREET � t' T
i
14. DISTANCE TO PROPERTY LINE: Side Yard '��� Rear Yard 3G _
15. SHOW ON PLOT PLAN EXISTING BUILDINGS NOW ON LOT, STATE USE OF EACH.
16. DISTANCE I[V FEET FROM PROPOSED BUILDING TO NEAREST EXISTING BLDG.:
17. VALUATION OF PROPOSED WORK: Induding AII Labor, Plumbing, Electrical Wiring, Heating, Fire Sprink-
lers, Painting, Sewage Disposal $ %00 U .
18. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION
IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM
TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE
THERETO. „ _ „ „ _ i
Plan Filed.
Owner oc Au<harieed Agent
FOR DEPARTMENTAL USE ONLY >
19. GROUP �,� TYpE�—DISTRICT MAP — NO. `��!
PERMIT FEE � „�� RECEIPT NO. 3 D�pAID TO DATE -� i' '��
CHECKING FEE y5 ��C IPT NO.� PATD-TO �_ DATE �r r/
PERMIT GRANTED � 19 -�"`-�'
PLANS CHECKED BY ,- � CHECK SHEET ATTACHED
APPROVED BY:
HEALTH DEPT.
STATE FIkE MARSHAL
STATE DIV. OF HOUSIIVG
SM—R-A9 p��
V
Ti`1E .$'odrf��.SrERG % 3�: S�^> OF .�aT '��i o T,9cr �`SD y
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f�/L �.97� 7'�HETc'EOrt' _ `�6Co.?DE Zi /.�/ �OOiY .fij'i �/''Gc� .`�/ pr2' •
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