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HomeMy WebLinkAbout1947 PELICAN PL - Building Permits ' CITY OF COSTA MESA• 4 BUILDING DIVISION >• • , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �. PIC PERMIT ega0de IL/PO4-00635 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1947 PELICAN PL Status: ISSUED Suite No Applied: 09/17/2004 Issued: 09/17/2004 Vicinity: ISSUED BY: Parcel Nunmber: 13947301 Applicant: DEGROODT, CHARLES Address: 17931 BEACH BLVD STE 218 Phone: 714-375-1325 HUNTINGTON BEACH,CA Zip: 92647 Owner: PRIJATEL,KIMBERLY J Address 1947 PELICAN PL Phone: COSTA MESA,CA Zip: 92626 Contractor: DEGROODT CONSTRUCTION Address: 17931 BEACH BLVD - STE 218 Phone: 714-375-1325 HUNTINGTON BEACH,CA Zip: 92647 License: 554204 • Arch / Eng: - - , - - -Address: - - - - - -- - • • Phone: Zip: _ License: SCOPE OF PERMIT REF: B04-01122;ADD 360 S.F.TO SFD.WORK TO INCLUDE:EXTEND KITCHEN,LIVING ROOM AND MASTER BATH AND REPLACE FIREPLACE IN LIVING ROOM: PLUMBING PERMIT IS FOR DISHWASER, 1 GAS'SYSTEM(1-4 OUTLETS), 1 SHOWER, 1 KITCHEN SINK,.2 WASH BASINS,& 1 WATER CLOSET. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 - Sump Pump $0.00 0 Backflow irrigation. $0.00 . 0 . Landscape Irrigation $0.00 0 - Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System 10.00 0 Process Piping(per 10 ft) $0.00 .0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 . 0, Septic Tank $0.00 0.. Wash Basin $19.60 2 Dishwasher $9.80 1-, - Sewer Cap for Demo' $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $9.80 1 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)7545626 2446-46(6/00) . WORKERS'COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and this ea is uete of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. /❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which his permit Is issued. My-workers'compens to Insuranc riser an policy number are: j j 1 L/�V c Carrier: a.Q Policy Number: Szp • q ,.(This section need not be mpleted if the p mrd is valued at one hundred dollars($100)or less.) �---) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation lawsf Califom'a,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith Nil with these I I s. / / � ,Applicant Signature: 1 YY/ rDate:1 g 1 1 {� ik WARNING:FAILURE TO SECURE ORKE 'COMbENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P NALTI AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),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 DECLARATION: I hereby affirm that I am licensed under provisions of Chap, •Ae0 ' e•cin.wi Section 7000)of Division 3 of the Bushes Professions Code,and my license is in full force and.effect.Lic.# r _ _ _ Class# ly/CCantrectSignature: Irl ate:-- ` ✓� CONSTRUCTION LENDING AGENCY: . 9 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 9 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes lJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 9 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: I CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. �`-1�'nV'''''�.!'.1�IS\��I ure Of L s) Date c'—An r'Authodzedappllcant- Date--i CODE I INSPECTION TYPE PATE • INTRIALS CODE! INSPECBON TYPE DAIS PI7AI4 1616 Fixed System Final Fire Prevention 206 Final Mechanical �2 1266 Pool Spa Final 208 Final Plumbing �- Iti•U f l 4,N 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall • . 212' Final Fire Prevention 202 Final Factory Fire Place ' • 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA • o " BUILDING DIVISION > • ; DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER . y.1 • PERMIT %,•oso,so*. B04-01122 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1947 PELICAN PL Status: ISSUED Suite: Applied: 06/18/2004 Vicinity: Issued: 08/19/2004 Parcel Number: 13947301 Zoning: R1 R1 • C=� Applicant: CHARLES DEGROODT ISSUED BY: Address: Phone: 714-375-1325 Zip: Owner: PRIJATEL,KIMBERLY J & KEVIN Address 1947 PELICAN PL Phone: COSTA MESA,CA Zip: 92626 Contractor: DEGROODT CONSTRUCTION Address: 17931 BEACH BLVD STE 218 Phone: 714-375-1325 HUNTINGTON BEACH,CA Zip: 92647 License: 554204 Arch : STEVE BRADLEY ARCHITECTS Eng: Address: 814 MORENA BLVD,.#209 Address: Phone: 619 2954102 Phone: SAN DIEGO,CA - Zip: 92110 License: License: SCOPE OF PERMIT • ADD 360 S.F.TO SFD.WORK TO INCLUDE:EXTEND KITCHEN,LIVING ROOM AND MASTER BATH AND REPLACE FIREPLACE IN LIVING ROOM. FEE SUMMARY Plan Check: $418.76 Calc Valuation: $50,000.00 Permit: $644.25 Claim Valuation: $50,000.00 SMIP Res: $5.00 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,068.01 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 23-8 Rear 46-0 - Left 0-0 Right 6-2 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 4 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work Is suspended or abandoned. for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable c end all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration s permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/ ) DECLARATIONS ( j ) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the /�`'ork for which this permit Is issued. �V I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My wo ers'compensation Insurance carrier and policy number are: Cautery E ¶Mum Porcy Number I`{ nee"I '" 2 an y Q(TAis-Ttection need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of -Mamie,and a roe that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr. • ) p- nt,Slgna ut re: - v Clann jLS ARNINO.'FAILURE TO SECURE WORKE'•'COMP ATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES LOD'{GVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37030F THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 ..Business Professions Code,and my license Is in full :force andeffect:Lia k`-'� '120 .Classg 1 I onC irectolsSlgneture � {a y • CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,end who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec, 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division, Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the Calif omia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes S No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. g at,Legal Legal wn 8 L I D 4: �Oi;A: »�rfied Applicant?.7.'-_ LIN LOPE E INSPECTION TYPE PALE INU LODE( INSPECTIONTYPE PALE HUM 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory.Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site JAL 204 Final Demolition 250 Final Building/Occupancy .S CITY OF COSTA MESA • t, -@ BUILDING DIVISION >:t; ,,;,, 4r 8 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. 1, fr�sffd ia• 1 PERMIT J . ��-""+++��rorororororo ������ MOA 0Ord7 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1947 PELICAN PL Status: ISSUED Suite No Applied: 10/19/2004 Issued: 10/19/2004 Vicinity: Parcel Number: 13947301 ISSUED BY: Applicant: LAMONT BRYANT Address: Phone: 714-309-3405 • . Zip: . Owner: PRIJATEL,KIMBERLY J Address: 1947 PELICAN PL ' Phone: , COSTA MESA,CA Zip: 92626 Contractor DEGROODT CONSTRUCTION ' Address: 17931 BEACH BLVD • STE 218 Phone: 714-375-1325 HUNTINGTON BEACH,CA Zip: 92647 ' License:554204 , • SCOPE OF PERMIT ALTER HEATING/COOLING DUCTS, 1 FACTORY FIREPLACE, 1KITCHEN/MECH EXHAUST,2 VENT FANS FOR RESIDENTIAL ADDITION,RE:B04-01122. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 , Repair/Alt Absorbtion Unit - $0.00 0 Inst FAU<100 k BTU $0.00'_ 0 _ - - - Repair/Alt Refrigeration Unit $0.00 '0 Inst FAU>100 k BTU $0.00 . 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $13.70 ' 1 Evaporative Cooler • $0.00 0 Inst/Rep. Recess Wall"Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00_ 0 r Refrig Sys>100 k BTU , $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace - , , $10.65 1 _ 3 To 15 hp/500 k BTU " ' ' $0.00 0, Hood w/Mech Exhaust $10.65 1 15 To 30 hp/1,000 k BTU $0.00 . 0 " VAV Box $0.00 0 30 To 50110/1,750 k BTU $0.00 0 Vent Fan/Single Duet ' ' $14.50 - 2 Over 50 hp/Over 1,750 BTU , $0.00 0 Appliance . - - $0.00 0 - Boilers Fire Dampers . $0.00 0 Up to 3 hp' - . , $0.00 0 Smoke Dampers ' ' ' $0.00` 0 3 To 15 hp " $0.00 0 Inst or Relocate Appl Vent f.$0.00 0 . - - , .15 to 30 hp- Air Handlers< 10000cfm : $0.00 0 30 to 50'110 $0.00 0 Air Handlers> 10000cfm . $0.00 0 ' Over 50 hp $0.00 0 Floor Furnace $0.00 0 - Other Mechanical Fee Floor or Suspend Heater $0.00 0 , Investigation Fee - $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $73.00 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448-46(MO) . DECLARATIONS , WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: . . . .. ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued, My workers'compensation Insurance carrier and policy number are: Carrier: , ' Policy Number: �- (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) • XI certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California d agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the provlsil / / Applicant Signator✓ / Date: 70-( [T- d �/ WARNING:FAILURE TO S CURE WORKER COTPENSATION EIS UNLAWFUL AND SHALL SUBJECT I AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES TUPO N ONE HUNDRED THOUSAND DOLLARS 1000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions f Chapter 9(commencing with Section 7 0)of Division 3 of the Busin and Professions Code,and my license is in full 7 force and effect.Lic.if - ES Class N ✓ •-----1 Contractor's Signature: -./- -- Date: /1) i 9 -0 51 / CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant tor a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? jIy yes jJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ge Ig lure Ot Le Owners) z, _/9 _cDate nd/Or uthorized Applicant / Date CODE# INSPECTIONTYPE PAL INRTIAL@ CODE! INSPECTION TYPE �Y r1PATE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 9\ ' 5 -.06 _M • 1266 Pool Spa Final 208 Final Plumbing _ 200 Final Re-Roof 210 Final Electrical _ 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place ' .• 220 Final Planning Approval • 203 Final Sign 222 Final Site 204 Final Demolition • _ ' 250 Final Building/Occupancy ' ' CITY OF COSTA MESA BUILDING DIVISION >N ____ ,i, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F1 - I , In PERMIT seE04-01020 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1947 PELICAN PL Status: ISSUED Suite No Applied: 09/17/2004 Vicinity: Issued: 09/17/2004 Parcel Nunmber: 13947301 Applicant: DEGROODT, CHARLES ISSUED BY: (ft:2\1A_ Address: Phone: Zip: Owner: PRIJATEL,KIMBERLY J Address 1947 PELICAN PL Phone: COSTA MESA,CA Zip: 92626 Contractor: DEGROODT CONSTRUCTION Address: 17931 BEACH BLVD STE 218 Phone: 714-375-1325 HUNTINGTON BEACH,CA Zip: 92647 License: 554204 SCOPE OF PERMIT ' REF:B04-01122;ADD 360 S.F.TO SFD.WORK TO INCLUDE:EXTEND KITCHEN,LIVING ROOM AND MASTER BATH AND REPLACE FIREPLACE IN LIVING ROOM. ELECT. PERMIT IS FOR 22 FIXTURES,46 OUTLETS,25 SWITCHES,8 UPGRADE ELECT.SERVICE TO 200 AMP. FEE SUMMARY Quantity • Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0' , Temp service test. - $0.00 Busway/100 ft $0.00 0 - Res.a/c package $0.00 - Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 - ' ' Transformers up to 1 kva/kw $0.00 0 ' Pool/Spa $0.00 _ 0 -• up to 10 kva/kw $0.00 0 Lighting Fixts $23.46 22 up to 50 kva/kw $0.00 0 Recept Outlets .'$40.98 46 - - up to 100 kva/kw $0.00 0 Switches $25.65 25 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0. Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt - $0.00 0 Service to 200a - $30.50 . 1 Misc.Conduit $0.00 0 Service to 1000a $0.00 - 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 / Circus(gen or ride) $0.00 0 Motors to lhp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 ' - 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 . 0 Fireworks Stand - $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-44346/00) WORKERS'COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. O I have and will maintain orkers'co ensation in urance,as required by section 3700 of the Labor Code,for the performance of the work or Io thiszper it Is issued. /My workers' nsat n nsuran mer an policy number are: \ � -Carrier: PolicyNumber:��' �1-� ( (This section need no a corn coed if the permit is valued et one hundred dollars(5700)or less.) \ O I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that it I should become subject to the workers'compensation provisions of Section 37 0 of the Labor Code,I shall forthwith comply with th rovisions. ,Applicant Signature: /x � {Date.- N1 WARNING �R FAILURE TO SECURE KEVRS' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO/CRIMINAL P NALTIE AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),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 DECLARATION: I hereby affirm that I am licensed under• . cion' •t •.. :r 9 commencing with Section 7000)of Division 3 of the Business Professions Code,and my license Is in lull force and effect.Lic.M a 0._ .�A._ Class N cContactors Signature:�i man (Date:- t CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ 1,as owner of the properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,1.0.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or wit the applicant or present or future building occupant require for the work which is the subject of this application aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Y reOf Lea 1, • (s) Date nWOkrtro .Aoplicant Date ;ODE t INSPECTIONTYPE PAIL BIM& . CODEI INSPECRON TYPE PATE IIRlDd1$ 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical • 1266 Pool Spa Final • 208 . Final Plumbing • �..{ �� 200 Final Re-Roof 210 Final Electrical 1—frac f 7W 201 Final Block/Retaining Wall _ 212 Final Fire Prevention 202 Final Factory Fire Place - 220 Final Planning Approval 203 Final Sign _ 222 Final Site 204 Final Demolition ' _ - •. 250 'Final Bullding/Occupancy I OFFICIAL PUBLIC NOTICE OF ZONING APPROVAL July 6, 2004 RE: ZONING APPROVAL (B04-01122) 1947 PELICAN PLACE The Planning Division has completed its review of the above-referenced project. The application has been approved based on the following project description. PROJECT DESCRIPTION: Single-story remodel and a 360 sq.ft. addition (expanded front entry, master bath, kitchen, and living room areas), including a vaulted ceiling/dormer over entry area measured 20 ft. from finished grade to ridge. The zoning approval will become final at 5 p.m. on July 13, 2004, unless appealed by an affected party (including filing of the necessary application and payment of the appropriate fee) or by a member of the Planning Commission or City Council. If you have any questions regarding this notice, please feel free to contact the project planner, Wendy Shih, at 714-754-5136, between 1p.m. and 5 p.m., Monday through Friday. Distribution: Kimberly J. Prijatel 1947 Pelican Place Costa Mesa, CA 92626 Gregory Tuppan 1953 Pelican Place Costa Mesa, CA 92626 Gerald Watton 1943 Pelican Place Costa Mesa, CA 92626 Brad and Valerie Edwards 1950 Killdeer Circle Costa Mesa, CA 92626 File A PLANNING ZONING REVIEW SUMMARY Location: 1947 Pelican Place Plan Check Number: B04-01122 Request: Single-story expansion to single-family residence. SUBJECT PROPERTY: SURROUNDING PROPERTY: Zone: R1 (Single-Family Residential) North: All surrounding General Plan: Low Density Residential South: properties are Lot Dimensions: irregular East: single-family residentially Lot Area: 8,165 sq.ft. West: zoned and developed. Existing Development: Single-story, single-family residence. DEVELOPMENT STANDARD COMPARISON Development Standard City Requirement Proposed/Provided Lot Size: 6,000 sq.ft. 8,165 sq.ft. Building Coverage: Buildings NA 33% (2,663 sq.ft.) Paving NA 5% (420 sq.ft.) Open Space 40% 62%15,082 sq.ft.) TOTAL 100 % 100% Building Height- sloped —roof design: 2-stories/27 ft. 1-story/20 ft. Ratio of 2ntl floor to 1st floor* 80% 3% (81 sq.ft./2,663 sq.ft.) Setbacks** Front 20 ft. 21 ft. Side (left/right) 5 ft./5 ft. 5 ft./6 ft. Rear 10 ft. 43 ft. Parking: Covered 2 2 Open 2 2 Guest NA NA TOTAL 4 4 CEQA Status Exempt- Class 3 Final Action Planning Division * Vaulted ceiling area exceeding 15 ft. high is counted as 2nd floor area. Lot 30' I 49 rtt KtCLIVED MAR '. 1964 COSTA MESA BUILDING-SAFE, I DEPARTMENT FINANCE DEPT. P.O.BOX 917 COSTA MESA,CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMR TYPE OR PRINT BUILDING For Office Use Only BUILDING ADDRESS 1947 Pelican Place yRp lJp� RECEIPT NO. 2758'45'7584V COSTA MESA, CALIFORNIA C/_ UY SSSIL-,/ RECEIyEDpV D TE RHCgIVEO DATE ISSUED OWNER Pemba Subdividers, Inc. /`/ / E`y APR 1 4 'yb4 MAIL BUILDING ADDRESS 2850 Mesa Verde Drive ADDRESS FIRE .TEL. ZONE TYPE GROUP CITY Costa Mesa NO. 5490395 V n ', L� APPROVED �" OR ENGINEER G. Kaltenbach NOL5478046 BY DATE ADDRESS 1833 E. 17th St. Santa Ana ZONING - ZONENO.OF USE OPNErtngl tam. R-1 I PLANS I BUILDINW/ att gar. CONTRACTOR'-6WIit Su m t 2 LEGAL T ADDRESS DESCRIPTION Lot 30, Tract 5289 A.P.NO. none CITY NOSTATE 187318 TEL. 90TE: NO EAVE TO SIDE @ REAR PH LNG SHALL BE LESS THAN LIC.NO. NCI. -P}�I�R���T..�� ��y^'7�F��� EAVES SIZE .I..L d 2O/Lp fib.%BLIT.0 ALLOWED (U.B.C.REQUIREMENT) OF LOT `J I NOW ON LOT USE OF /� I I3)� �� kI� YARDS APPROVED • YARDS APPROVED EXISTING BLDG. '�--�_ MAIN BUILDING ACCESSORY BUILDING (FROM C/L STREET) SETBACK LINE FROM COI 45n FRONT SOFT. FT. CENTER OF STREET J REAR YARD /p SIDE YARD LEFT 61 I RIGHT 6' R.SIDE (SFT,. FT. DESCRIPTION OF WORK L.SIDE ,/(4FT. FT. NEW X ALTERATION _ ADDITION REAR L(''FT. FT. DISTANCE BET. BET.MAIN& REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDG'S. BUILDING NO.OF VAR.* DATE SIZE 2, 1`39 pp'' ROOMS 6 �¢I�T OR ES 1 C.U.P.# APPROVED EXTERIOR W�L.SZU1n8 I ROOF Sha ce APPROVEy,A� -.30 - (l COVERING uCC COVERING L mg e QY I6( , DATE , 1- 1, USE OF BUILDING AND WOR O B ER OR ED Single family with attached garage. House 1, 714 sq.ft. Garage 425 sq.ft. Plan 41 BR /�yG 90.FT. �,� 4.:2S I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATI IS FOR THE F' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION - ///I m BUILDING CONSTRUCTION. / '%/'/'� m PERMIT FEE $ (O(p A ca SIGNATURE OF • PERMITTEE ���CCC / $ 9e, 3 O� PLAN CHECK $ 33 p P / 0 iL AUTHORIZED AGFA /TOTAL FEE $ %9"----