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Home My WebLink About1984 RAYMOND AVE - Building Permits CITY OF COSTA MESA _r� BUILDING DIVISION f I an.NI; 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.da.us .b, FOR INSPECTIONS CALL: (714)754-5626 4t. le PERMIT NUMBER: B09-00010 r PERMIT TYPE B_ROOF2 STATUS: ISSUED APN: 42630401DATE ISSUED: 01/22/2009 '"ISSUED BY: BJK JOB ADDRESS: 1984 RAYMOND AV CM r Suite/Unit'::- Vicinity: REROOF RESIDENCE ONLY . - .'f. '' 'y - • Squares: 800 ` -Valuation. =-. • -$3,577.00 SCOPE OF WORK: REROOFRESIDENCE ONLY T/O 3 LAYERS OF COMP SHINGLES, REPAIR/REPLACE'SHTG AS NEEDED, 1 LAYER 30#FELT,APPLY"30-YEAR COMPSHINGLES."800 SO FT PITCH 4:12. OWNER: LANGDALE, HARRY J TR :- Address: . 1980 RAYMOND AVE.'. - Unit: PHONE: �{ ` :City/State/Zip: COSTA MESA,.CA APPLICANT: NIELSEN;JACKI Address: 29222 RANCHO:VIEJO RDC'. Unit: " :SUITE 127 PHONE: 949.542-7265 ' City/State/Zip: SAN JUAN CAPISTRANO CA .' CONTRACTOR: CRANK BROTHERS CONSTRUCTION INC -• - . . .`j--License No, 458773 Address: 29222 RANCHO VIEJO RDUnit- ", "SUITE 127 -. _ ; PHONE: 949154227265 ! r City/State/Zip: SAN JUAN CAPISTRANO, CA -. 92675. • CELL:. . ARCHITECT: - - License No. PHONE: '' ENGINEER: m License No,:__ - FEE SUMMARY • Reroof Plan Check: , $000 ' . - - Reroof Permit Fee: $97.25 . Reinspection Fee: $0 00 :_. - . Bldg Std Admin Fund $1.00 - TOTAL FEES $98.25 ` 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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. CODE I. INSPECTION TYPE DATE INTITIALS CODE INSPECTION TYPE DATE INTTALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final2-.4-0 /�-- it--- 208 Final Plumbing 200 Final Re-Roof (L� 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 • w W€RKERS'COMPENSATION DECLARATION. Owner ID verified by drive. _ ..cense. ❑Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. ... ... - Expires: • O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the - performance of the work for which this permit is issued. C0.1/ 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized -�u r by this permit,and that no building structure,scaffdding,falsework,or demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This sedon need not be com eted tl the p pee frmit is valued^eda(one hundred dollars($100)or less) 2,Art Sec.341,Title 6,California Administrative Code). Polic umber: " '3 ,' . 1808 ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Date the Labor ode,I sh II forth h comply with these Prov ions. ' 2•2-10q 'L e- Division of Industrial Safety Permit Number: `N(/�10/4fl¢2J` •••111��"`Applicanf5 Signature �ti -.) HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: NTNG: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No ($100,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND exceptions, that a Business Plan be fled with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effec a registration form for acutely hazardous materials? ❑Yes ❑No I Vol:a4 r ! Class# i 4 f C-3 9 (Section 25533 of the Califomia Health and Safety Code, with some r r exceptions, requires registration with the Costa Mesa Fire Department by !. .! I—22-"O/ _ each business which at any one time has on hand a quantity of acutely Contractor's Signature } Date_../ 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 CO' TRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work fa which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Dale 4. If an RMPP is presently required, has Section 25534 of the Califomia OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No 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 infor on 65850.2 of the California Government Code requires that the requested License Law(Chapter 9(commencing with Section 7000)of Division 3 of the nformation be furnished on applications for non-residential building permits). Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the Califomia Health and Safety Code). ❑ I. as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by Califomia License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No 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 8. (If"yes", attach certificate of compliance from the appropriate air pollution sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she ' CERTIFICATE OF COMPLIANCE: ('certify that iunder penalty of perjury-the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws.and ' ❑ I, as owner of the property, ani EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. • - •' LICENSED CONTRACTORS to construct the project(Sec. 7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature .Date property who builds or improves thereon,and who contracts for such project with a contractor(s)license pursuant to the Contractors License Laws.). CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penally of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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. Si ature of L Owner(s Date Signature Date 1I' )—7 Z ' 3057-a8(3/07) L nelw Aulbonzed Applicant. `Date__J ' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. • PERMIT NO. TRACT NO. ' LOT NO: t UNIT NO'. _ CITY OF COSTA MESA CO TR UCTION�PERMIT . fp �� SP , , I '� , Project Address ./7 g 'y t/9- M 0 (A/ cl &U�Q 1 z r I /- • ..� i I � ' TYPE OF CONSTRUCTION LJ NEW LJ•ADD U ALTERATION L I REPAIR r Applicant's Mail--)lf;Address ❑ CONVERSION ❑ DEMOLISH ❑ OTHER 1 A P # ' •-• I Zone ' Owner's Name' 8"i NCl QA.�.D Phone ' DESCRIPTION OF WORK/USE OF BLDG. &13 • Address ,) 4 p 4 ��y, 11,-ft w D 4.--1/..k rr II S Main Building: • Accessory Building: I Z , Arch/Eng. License No. • TYPE OF PERMIT ❑ GRADING(�H FOUNDATION ❑ STRUCTURAL • T Front :. 0 Address - • ❑ TENANT. ❑ ELECTRICAL pN PLUMBING ❑ MECHANICAL B Rear N Contractor's Name . F'Gs I P113 .)-/ ' phone".46-4144 ❑ OTHER ' A - - • I Address(mailing) O S1 W„ cu-', .' . �. PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right. ' G CONSTRUCTION TYPE VALUATION$ S Left City License Ng. f1 3 I A f-1 I ZONE GRADING CU.YDS. • ACRES - Ping. Ref.# Parking Req./Provided E , LICENSED CONTRACTOR DECLARATION ' - Q I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: Ni • with section 7000) of Division 3 of the Business and Professions Code, and - -` • ' my license is in full force and effect. f T License Class ' C- 3 L mense yyo, S Date '1^20 Signature 3 R.c_z fW CC If + ! PLUMBING FEES' s WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL I FEES 1.' I hereby affirm that I have a certificate of consent to self-in re or a certificate . . _ • ' Workers' Compensation Insurance, or a certified copy.thereof (Section Backflow Preventer Service Sink • 00, Lab. C.) � g p1 _ `- Automatic Washer , Transformer-❑ 15.50 KW:' ., - licy No. W �--7 k 77�CDmpany P h .s'' , 5 0-1-s S • Backflow Irrigation $ewer Ca - -• 1 ' ;❑ 50+KW ,.9 P , _ Construction Pole Sub.. L: Certified copy is:hereby fuinished. • . ' ' - ,'� certified copy is filed with the city iltling Ivisipn. 1 Bathtubs' • • Sewer Connection - Cooking Unit I Meter ❑upio 100 amps • Date? —2'0 '$'W Applicant • SATI \OECL1v,, 1 - • - EXEMPTION FROM WORKERS'RS'COMPENSATION OECLA Clarifiers Solar Collectors Dishwasher - ! • Meter Diver 100 . ps - (This section need not be completed if the permit is for one hundrendrettltltlltltl ($100) or less). Dishwasher- - Solar Piping •- -: Dryers ❑Gas '❑Electric - • Sub Panel 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 Drinking Fountains Solar Tank - P Fan Moto - d0-1 HP ❑1'h-8 Workers' Compensation Laws of California, -• - �_ - ' Date Signature • Floor Drains . Swimming Pool w/Spa F.A.U. NOTICE: If,after making this declaration, you should become subject,to the - - c.Soler 09-15 HP 016-15+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks • Urinal Fixtures ° ' comply with such provisions or. this permit shall be deemed revoked. Microwav¢ CONSTRUCTION LENDING AGENCY • ) Gas Service , Outlets Water Closet O. Device Boxes - Pole Light I hereby affirm that there is a construction lending agency for the performance . _- - - _ -- of the work for which this permit is issued (Section 3097 Civ, C.) • Interceptors Water Heater , Lender's Name .&\ i O1t // . Range Lender's AddressKitchen Sink Water ServiceOWNER BUILDER DECLARATION - - - - SitchesSignI hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Grbo following reason (Section 7031.5 Business and Professional Code: Any city or 9 $Landing$edtidnacounty which requires a permit to construct,alter,improve,.demolish or repair P—Trap Laundry Trays Gnera -5 KW El 5-15 KW Trash Com actor any structure, prior to its issuance, also requires the applicant for such permit P ' to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains ' - the Contractor's License Law(Chapter 9(commencing with Section 7000) of ' Division 3 of the-Business and Professions Code) or that he/she is exempt __ _ . _ .. 'herefrom and the'basis for the alleged exemption. Any violation of Section ii - 31.5'by any applicant for a permit subjects the applicant to a civil • � ' • ialtyof not more than five hundred dollars($500). ' . J I, a& owner of the property or my employees with wages as their sole Reinspection Fee I $15 I Issue Fee $ 3 - compensation, will do the work,and the structure is not intended or offered •- - Reinspection Fee $15 Issue Fee . l $ 3 ' for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL -FEES • License Law does not apply to an owner of a property who builds or improves _ ___ thereon, and who does such work himself/herself or through his or her own - DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0 - sale..If;however, the building or improvement is sold within one year of com- Canopy Type II ,❑ Zoning Approved By Date pleti0n, the'owner will have the burden of proving he/she did not build or im- Duct- Under Ground _ Building Approved By M Date 1�!y7 grove for the purpose of sale). - } - 71-7I4.--- (� ` ilQ LI I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural • Refrigeration System Application Issued By • Date • tractors.td construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who ! Duct-Ventilating 00-100,000 BTU 100,000 BTU SUMMARY OF FEES - builds or Improves thereon,and who contracts for such projects with a con- _ tractor(s) license pursuant to the Contractor's License Law). am aware thatBUILDING PERMIT �S- SMIP $. _ // Exhaust System 0 Multiple ❑ System air/Alteration proof o their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $' PERMIT ❑ •I am exempt under Section • B. & P.C.for this reason Firepl/Fact.Bit. ICBG# re'Dampers • PLUMBING $ .5. QO ISSUANCE $ - • _ PLAN CHECK 25% $ ENERGY P.C. $ _ Date - owner Heating System&Ducting Registers - I hereby certify that I have read this application and state that the above - ❑D-100,000 BTU 0100 BTL • ELECTRICAL GRADING $ _ information is correct. I agree to comply with all city and county ordinances - $ and state laws relating • building construction,and h:reby authorize repro-. - PLAN CHECK 50% $ . MICROFILM $ _ sentatives of this - o enter -.n the a•ove- , tioned property for • - - _ _ _ Inspection purpo �/ i Date MECHANICAL $ • TOTAL FEE $ _ O0 ' Signature , Drivers' License or SS#' - Rein ion Fee $15' Issue Fee $ 3 PLAN CHECK 25% $_ CMF 0865-46,rev,10/84 White - Building; Canary -Applicant: Pink -Accounting; Goldenrod -Assessor - - - CONSTRUCTION AND-PLANNING . .- - POOL &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. FormsI t . 4. Electrical Conduit-Undrgrnd. • 55. Electrical-Bonding • 5. Steel Reinforcement q. 56. Rough Plumbing & Pressure Test- 6. Electrical UFERGrnd. '• 57..APPROVALT000VER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. , 8. Foundation . • - 59. Gas Pipe, ❑ Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash-Lines, P-Trap, El 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 • 18. Rough Electrical-T Bar Ceiling y _ 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 El Gas El Oil 23. Gas Pipe-Rough & Test 72. Underground Flush . 24. Roof Framing . 73. Undergrnd.Storage Tank ❑Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro - .- 26.-.T-Bar Ceiling (Structural) & Monocoat , 75. Dry Chemical ' ,k ' 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 ----1 • 37: Final Factory Fireplace . • - - • 4 38.'Final Plumbing - • 39. Water Service-Final . . . _ ' 40. Gas Service-Final ' . .- .41.:Solar Domestic-Final _ : 42. Backflow Preventer '. - - - '43. Backflow•lrrigation - , • - 44! Landscape Irrigation System - . 45. .Sound Attenuation - - - - , 46. Handicap Regulations n• • - . ' 47. F,INALSTRUCTURE & BUILDING - - • ' � _ _ •� 48. Special Requirements Completed ' - ' 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co - • • r 51. CERTIFICATE OF OCCUPANCY . No. Date 1 OWNER COMETS", E. W. ' r1ATE 5-28-57 _ JOB ADDRESS 198Lt mond Aye. JILDING PERMIT NO. 6451)44 AGENERA13CQDSTRACTOR Owner Bldr, VALUE $ 2,880.00 AP. No. 1,, LOTP0r 6 TRACT 278 FIRE ZONE DESCRIPTION OF WORK Cony. Gar, to Res, & Bath GROUP I TYPE V ZONE Rij PLAN NO. Q36 INSPECTIONS Y DATE SUBCONTRACTOR PERMITS ISSUED ✓/ DATE NUMBER / v Trenches orms Steel 6 /47 Floor Syst Steel Reinforce Chimney Re-Rod Bond Beam ' �q��'�'�� Frame and Flashing — e V ?4/f\ Lathing, In (J/ .Out (:)44U %/WS7 ' Plaster, brown/coat V 6,---'&-'45- W--...4--..C7 . Underground soil/WH S W/G Pipe Tes M.$6-97-y-] Top Out 6-/D-37 /„ _ Furnace /4/1 Mil•J 7-l(,-S7 Gas Vents /H// /O-/-S 7 _ Rough Plumbing MFS 7/6-5 j die."} - G -f/-J 7 /n ofd, Cesspool Septic Tank Prop. Swr. LineOfHouse Con.41//(St. Swr. /O/-3-7 ,Lc,en-Le.n -]?J2,,,, • Q-Ali S7 _ /0 9 C[-, Sprinkling System Heating Final /H/{�' /0-/-57 ' Plumbing Fixtures, Final AilK /O-/-S7 , • Final Gas Test /5 /Gtf�$.fp/ A-7 tCt-..-e- ,r--djrs---, Jr •r'-- '7 )/[� . Construction Pole Underground' Power • /// � �.- ^AI Rough Wiring ; ( _nM— . Y/ c�-.C7 r�0 V Fixtures, Final L�}— /o—i ri f! y, ./t-. . , /C I . L .I 7 .2:0-- -OCCUPANCY 2J-OCCUPANCY 2 'y -In--y l — I Form 210—SM—I-57 ' - - 5144 V i5236 EE RECEIVED COSTA MESA BUILDING BUILDING D • i s7 -� a . P.O. BOX 317 E0v3? COSTA MESA, CALIFORNIA FINAPT. FOR APPLICANT TO FILL IN /�IF�P�I IACM{iSIIFOR PERMIT ADDRESS /9.7&/ Ra/,�,,, Ai D q4%` B U I LD I N G COSTA MESA. CALIFORNIA j FOR OFFICE USE ONLY _ //` RECEIPT NO. PERMIT /NOO OWNER E. kg f AA" P'7-0 /\/ • s � /%T 1 // �q//�)y1, n RECEIVED BY DATED/ RECEIVED DATE ISS E(D' ADDRESS `9/f1L� / 4ky/ V foitI '/ 'I ' t� V 'iiv^ St�6y-S] CITY lC�' 2`'� / rn BUILDING NO�, .vV �dr ADDRESS ARCHITECT LIO, OR TTER NO. •.� COSTA MESA. CALIFORNIA FIRE ' a ADDRESS . ZONE ��nn NO. OF TYPE GPO CONTRACTOR U6 /ff -xst1,(�r CITY NOO, O3 PLANS )/ 66 TEL, APPROVED Y// �/ F ADDRESS NO, BY DATE . LEGAL Lor ' ,,,,jjjj / ; CORRECTIONS • DESCRIPTION NO. [.'2 BLOCK --' TRACT Z7,g I /if-- A.P.NO. L,'3 - 2_ SIZE LSv� X // 6 NONO.W BIDGS.LOT //�/ I APPR Okyp OF ` OFON USE OF CITY OFF )5T t:t •� EXISTING BLOC. - /� • � : ��r I , •• tl _ I) SETBACK LINE FROM / ( I SUBJECT TO ; OG. OLIPT. wia: CENTER OF STREET ['� REAR YARD N SIDE YARD RIGHT ,,..S‘!--' LEFT 6 / , -.___23-3--7 DESCRIPTION OF WORK 7 I DATF ' NEW 1 ALTERATION ADDITION I REPAIR MOVING DEMOLISH I BUILDING 7 vv�� '/ HOOF SIZE /CC IC' 4 T ROOMS j STORIES / EXTERIOR WALLC ROOF ' n2.„ �• I COVERING ((�/;;JcIl��nnV COVERING//T [_ lam• /�' , BUILDINGUSE OF EW \I fi�/9 L'TC -- �o /\I U G— (2T • / i 41, Air , /, (/ 6-c x f-- d _ 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. p VALUATION SIGNATURE OF S, 76• {{..JJ.. PERMIT FEE $ /0 - PERMITTEE (� ` �/� $ ��V I/// ici, PLAN CHECK $ S AUTHORIZED AGENT - TOTAL FEE $ /1•S ,— `BMF 1 .Baa