HomeMy WebLinkAbout1537 PONDEROSA ST - Building PermitsI)
4 '� CITY OF COSTA MESA •
/___ BUILDING DIVISION PERMIT.NUMBER
t• ' •""^' ' DEVELOPMENT SERVICES DEPARTMENT
vcit PERMIT
I
99-00488
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1537 PONDEROSA ST Status: ISSUED
Suite: Applied: 04/13/1999
Vicinity: Issued: 04/13/1999
Parcel Nunmber: 13930106 Zoning: R3 R3 Pp
Applicant: CHRISTIANSON, CHARLES ISSUED BY: �l
Address:
Phone:
Zip:
Owner: JACQUES, DONALD F
Address 2913 PEPPER TREE LN
Phone:
COSTA MESA,CA Zip: 92626
Contractor CHRISTIANSON ROOF CO., INC.
Address: 1939 MONROE ST
CA Phone: 909.351.8556
RIVERSIDE
Zip: 92504-5223 License: 599505
Arch : Eng:
Address: Address:
Phone: Phone:
•
Zip License: Zip: License:
SCOPE OF PERMIT
REROOF-T/O,INSTALL 2 LAYERS 15#FELT, REPLACE 3/8"SHEEETING AS REQUIRED,AND INSTALL NEW 20 YR
FIBERGLASS SHINGLE ROOF.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3,000.00
Permit: $74.75 Claim Valuation: $3,000.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other $0.00
Inspection: $0.00
Total: $75.25
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existinq: 0 Required: 0 Proposed: 0
NOTES:
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
DECLARATIONS d
•
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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/s valued at one hundred dollars($100)or less.)
❑ I certify that In the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Car 'mia,and agree •-I if I sh• d become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with the o I-•n9 /A L/ p a
Applicant Signature: •�� /ice J�� Date: / 17'/ /
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL ANO SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100.000)•IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am IlcensedAnsr prgyjsio&iX Chapter 9(commencing with Section 7000)of Division 3 of the Business and_e ofessions Code,and my license is in full
force and effect.Lic.# 7'f r �// Class# Cay .
Contractors Signature: e,-24/ �///6v Date: —Z-n$
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: Lenders 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 Gvll 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 WM1 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 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 then 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 apermit 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 LI 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? 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.
2a: gnatu . l3� ate
•ndf• •• •nze Applicant yni Date
600E 1 INSPECTION TYPE DAIF• EMU CODE INSPECTION TYPE QAU MALS
1616 Fixed System Final Fire Prevention 208 Final Mechanical
1266 Pool Spa Final � 208 Final Plumbing
�
200 Final Re-Roof o•ziRD M 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
2446-46
PROJECT ADDRESS: 1537 PONDEROSA ST UNIT: A CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 05583'
OWNER'S NAME: DONALD JACQUES
ADDRESS: 2913 PEPPER TREE LN PERMIT NO: M 055837 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA
CA 92626 CONSTRUCTION TYPE: 5—N PERMIT TYPE: MEC PURPOSE: OTH
(714 ) 540-5599
ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : FORCED AIR UNIT CHANGE OUT SQ FT: •
ADDRESS: UNIT:
• CLAIM VALUE; CALC—VALUE: GROUP OCC: R-3 /
PERMITTEE: GRAHAM BROTHERS ( 714 ) 546-1653
ADDRESS: 2952 CENTURY COMMENTS : NO 'BLDG. ' PERMIT INVOLVED
COSTA MESA CA 92626 ******************4**** *************+Fx******+E******************7E****** *>E* ***
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and NecL SETBACKS
CITY UC.: 005963 STATE LID.: 2486 CLASS: C-20
1 'n ,,may A MAIN BUILDING ACCESSORY BUILDING
Dale: Signature: FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers'
Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY ND.: WC 71610 3 0 216 MEWL 08/01 /92
IMPANY: LIBERTY MUTUAL PARKING REQ: PROV: PARCEL : 13930106 ZNE: REF NO:
Cenired copy
yyFreZ
is hereby� furnished. Gi Certified(c Ith the city Building Divi n. PLANNING NOTES>
Date: ` `t ' \ APPlicadl �
Lh.. --� ***********************************3FIE******iP********************************IE**
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred 151W)or less). DEVELOPMENT S E R", V I C E S REQUIREMENTS
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. ZONING APPROVED BY •t1., DATE:
Date: Signature:
NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : 7 DATE;
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. ,4)
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y•1E - `` DATE• 4*�x���
which this permit is issued(Section 3091.Civ.C). ********************* ** * *SF* * * s ** **************** *{(.
LENDER: ***********************************3f**** *** 0*********************************
*********************************
ADDRESS: LEGALIZATION:N F E E S U M M • R Y STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 9 00
repair any structure,prior to its issuance,also requires the applicant for such permit to fife a signed statement that he/she is licensed 5$ SMIP/NON—RES
pursuant to the provisions of the Contractors'Stale License Law(Chapter 9(commencing with Section 7O00)of Division 3 of the Business
and Professions Code)of that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S5OO). ISSUE FEE 15 .00
I. as owner of the property or my employees with wages as their sole compensation, win do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 9 . 00 15 . 00 0 . 00 2 4 . 00 24 . 00 . 00
does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through
N5 or her own employees,prbvlded that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 24 . 00 OVER/SHORT' 00
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve
for the purpose ol sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 24 . 00
❑ and Professions Code: The Contractors'State License law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the ContractorsState License Law).l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.&P.C.
torMIS reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: MEC 1 INST FORC—AIR/GRAV FURN <= 100 K BTU 9 . 00 9 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533.and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions.
Date:' Applicant:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and state laws relating to building constrecti ere ihorize representatives of this city to enter upon the above-mentioned
property for inspection purposes. _ __ _
1 q LOS— -----
�. Dale'. k.• VI 1'Z-- Signator C'rr CE X a 1;1; '92 7 21';C• : I.:;.
Driver's License or Social Security a:
164646 White—Buildino:Green—Code Enforcement:Canary—Aoolicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING PC ' SPA
APPROVALS Permit#- Date Inspector APPROVALS 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 Test
6. Electrical OF ER Grnd, 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & HouseConnection 62. Backwash & Receptor-Final
12, Sewer Cap 63. Heater & Vent-Final
13. Roof Drains : - 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System•Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit
21. Ducts,in Structure _ 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough &Test 72, Underground Flush
24. Roof Framing 73, Undergrnd.Storage Tank 0 Gas 0 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 (/2/i Z ter).
35. Final Gas Pipe-Test •
36. Hood or Canopy
■ - _
37. Final Facttoryry Fireplace
fireplace '
38. Final Plumbing
39. Water Service-Final '
40. Gas Service-Final
•41. Solar Domestic-Final
42. Backflow Preventer ,
43. Backflow Irrigation -
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
11135 FEE RECEIVL &
COSTA"MESA BUILDING DEPARTMENT I ' _ s `,L`
P.O. BOX 317 FINANCE DEPT.
COSTA MESA. CALIFORNIA
CITY OF COSTA MESA
FOR APPLICANT TO FILL IN 1,V APPLICATION FOR PERMIT
BUIL
15 3 7 10inEQOset 0_'I BUILDING
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
Kenkol Investment Co. RECEIPT NO. PERMIT NO.
_
OWNER /// �i V
MAIL 1555 PlacentiaRECCEIVED B_Y/ DATE RECEIVED DATE ISSUED
io
ADDRESS
GIT. Newport Beach „37I 6-3227 ADDRESSG
/
OR .
ENGINEER C.
NE LIC.
OR COSTA MESA. CALIFORNIA
FIRE
ADDRESS ZONE
W.
ZONE `^ NO.OF TYPE GROUP
CONTRACTOR K. �'• K011 CITY NO.4316 PLANS / ,/
[C TEL. APPROVEDY ro
ADDRESS 1555 Placentia y+ NO. BY
49, DATE lair A�
LEGAL LOT G E Fairview c9a.R.Ecr-+eNS fie
ix,
DESCRIPTION NO. (�B(iLOCK ( RAGE .y/J� ,G
A.P.NO. /l -73 J'.o s 7-. ,,, ,f - ref
I
OSIZE F LOT 5C3 a 143 NO. ON LOTS. 0 CCC Suf-° J/ F I
USOF
EXISTING BLDG. 1 to
SETBACK LINE FROM _ /!
_ /
CENTER OF STREET REAR YARD ` I�f �t 3 S r
r J
SIDE YARD RIGHT ' � LEFT J(j
DESCRIPTION OF WORK
NEW X ALTERATION ADDITION
REPAIR �f MOVING DEMOLISH I
SIZEI
BUILDING1. ,to /� ROOMS it NO.OF f 5 STORIES 2-
EXTERIOR WALL v 0 ROOF {J /, e,
COVERING ST�GCA COVERING ¢+ DLY 1
BUI OF NEWre J PL ' " / °)/ p"
BUILDING / �" !'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND /
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC-
TION. VALUATION ��
PERMIT FEE S .,.r
PERSIGN ITT RE E OF
S tg G J/^ 21 -
- PLAN CHECK S a 3
'V
AUT 1 E AG N V L j I/ TOTAL FEE $ 6 y .....
lir
11205 �:,
S. '
•
L •�-ter:— . „ ..,��
COSTA MESA BUILDING-SAFETY DEPARTMENT cliJ i-� _(, 0
, P.O.BOX 317 COSTA MESA. CALIFORNIA
•7Pv.nCE OPE.'
TOR APPLICANT TO F/LL /N COMPLETELY APPCICATIONrFOR-PERMIT
TYPE OR'PRINT BUILDING
BUILDING 1537 Ponderosa
ADDRESS rc//��
COSTA MESA, CALIFORNIA fOR OFFICE USE ONLY
RECEIPT NO. PERM! NO...�
• OWNER Kenkol Investment Co.,' • 1114.1 a
MAIL 1555 Placentia , ED BY DATE 5gECEIVED p_�DAATEE ISSUED
ADDRESS' /� f"-///C'AOD I 47/11 6 Mill
TEL. Midway BUILDING
Cr Newport Beach NO. ._ • ADDRESS 5-3 / is. /r
AR. :ECT LIC COSTA MESA. CALIFORNIA
' OR ENGINEER NO.
FIRE
ADDRESS �f . /41° ZONE TYPE Y GROUP // .
K.14.. Koll STATE APPROVED iJ //�/(�j//J
CONTRACTOR LIC. TE ' BY DATE ///
ADDRESS 1555 P1 anent! a T ;LNG
LEGAL LOT y� Fairvie! ZONE ").„..1NO.OF •�' USE OF NEW/,-�y� 44/Let
DESCRIPTION NO. BLOCK G TRACT PLANS
/� I BUILDING 1W.) %9X/
BY
PRO I i(I 11
Y j ; „ DATE /✓1�// Cl/ C
SIZENO.OF BLDGS. L'rEVES
-
OF LOT 50 r 143 I NOW ON LOT 1 REQUIRED • ALLOWED
USE OF FRO(CENNT LINE ST.)/T ,.L ...t/
EXISTING BLDG. Triplex FRONT .i;M�� C FT. �{- IN.
• SETBACK LINE FROM existing REAR YARD r {X' '
CENTER OF STREET [[lY b �T 15 R.SIDE J FT.•' IN.
SIDE YARD I LEFT16 I RIGHT 81 L.SIDE /7/% FT. . IN.
DESCRIPTION OF WORK �
,_ p REAR / SFT. (/47(7& 1/% IN.
. NEW II ALTERATION III ADDITION I_x
REPAIR I II MOVING I II DEMOLISH I
BUILDING 520 sq l t ROOMS 1 STORIES 1
SIZE 4
EXTERIOR W L • IROOF
COVERING OtucCQ COVERING Rn k ,
USAQtached Agarag®ND WORK O.BE PERFORMED
Add to Permit No. 11135
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
' PLY WITH ALL CITY ORDINANCES AND STATE LAWS R GULATING
BUILDING RUCTION.
(, VALUATION
SIGNATUR= - /• 590.00 PERMIT FEE $ 4. no
' PERMITTEE / 7 J�
• $ PLAN CHECK $
AUTHORIZE• 'GENT TOTAL FEE $ k.Do