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Home My WebLink About302 ALTA LN - Building PermitsAOP�icant to fill in all spaces exteDt those within heavY bortler lines antl si9n all apprapriate tleclarations. CITY��JF COSTA MESA CONSTRUCTIOI� PERMIT ' Project Address z�� :� Applicant's.M�ilingAddress S�1a7G Owner's Name Phone Address �� 7. �f %'�'� �f� Arch/Eng. License No. Address Contractor's Name �-� G' J�L�[ .�+1�. .a.. Phone�'1l ^/�i3 Address (mailing) 'f'� ��/�� % � L/57f Citv License No. ��L/' LICENSED CONTRACTOR DECIARATION I hereby affirm that I am licensetl untler provi5ion5 of Charter 9(commencin9 with section ]000) of Division 3 of the Business antl Professions Gotle, antl my license is in full orce antl itect. / License Class icens o.1 ��' Date Signature WOR RS' OM ENSATION DECLARATION ' hereby affirm that I have a certificate of mnsent to self-insure or a certificate f Workers' Compensation Insu�ance, o� a certiFletl copy thereof (Section 1800, Lab. CJ Policy No. company eCer[ifietl wpy is hereby tu�nishetl. Ceriifietl copy is filetl with the city Builtlinq Division. Date Applicant EXEMGTION FROM WORKERS' COMPENSATION DECLARATION (Thissection neetl not be mmpletetl if the permit is tor On¢ huntlretl ($100) or less). I certify that in the pertormance ot the work tor which///ttthis perm�t is is5uetl, I shall no[ employ any person in any manner so a� 1��9ubje t o t� Wotkets' Co pg spt� ws ot Cali m � // �ate T � Signature �� NOTIGE: , afte mak' g this tleclaration, u Shoultl be ome Subject to the Workers' ompensation provlsions of the Labor Cotle, y0u must forthwith comply witM1 such p�ovisions o� ihis pe�mit shall be tleemetl �evoketl. CONSTRUCTION LENDING AGENCV I hereby affirm tha[ there is a mnstruction lentling agency to� the perto�mance oi the work for whith this permit is issuetl (SeCtion 309� Civ. C.) Lentler's Name �entler's Atltlress OWNER BUILDER pECLARATION I hereby affirm thal I am exempt from the ConVactor'S License Law fo� the following reason (Section ]�31.5 Business antl Professional Cotle: Any city or county whith requires a pe�mit to construct, alter, improve, tlemolish or repair any structure, prior to its issuance, also requires Ihe applicant for such permit to fiie a signetl statement ihat he/she is licensetl pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000) o( '�ivi5ion 3 ot [he Business antl Professions Cotle) o� that he/She is exempt erefrOm antl the basis tor the allegetl exemption. Any viOlation of Section )31.5 by any applicant tor a permit Subjects the applicant to a civil enalty of not more than five huntlretl tlollars ($500). . b 1, as owner of the property or my employee5 with wages as their sole compensation, will tlo the work, antl the struc[ure is not intentletl or offeretl for sale (Section 7044, Business antl �rofessional Cotle: The Contractor'S License Law tloes not apply to an owner oi a property who builtls or improves thereon, antl who tloes such work himself/herself or throu9h his or her own employees, provitletl ihat wcM1 improvements are not intentletl or offeretl for sale. If, howeveq the builtlinq or imp�ovement is soltl wlthin one year of com- pletioq the owner will have tne burtlen of proving he/she tlitl no[ builtl or im- �rovG for the pu�pose of sale). U I, as owner of the property, am exclusively cont�actinq wi[h Ilcensetl con- t�actors to cans[ruct the project (Section 7044, Bu5ine55 antl Protessions Cotle: The ConVactor's License Ww aoez not apply to an owner o( property who . builtls or improves thereon, antl who contracts tor such pro�ects with a com tractor(s) license pursuant to the Contractor's License Law). I am aware that proof o( tM1eir Worker's Compensation insurance shoultl be provltletl to me. ❑ I am exemp[ untler Section B. & P. C. for IhiS reason Date I hereby certify 1 Information is wr antl state laws reL sentatives ot tnis inspecti Signature Drivers' Licens oi — Owner I have reatl [his application dntl state Ihat (he above I agree to comply with all city antl county ortlinances to builtlinq construction, and hereby authorize rep�e- ' t�entey�upon_thp� above-mentionetl property for 55 � TVPE OF CONSTRUCTION LJ NEW IJ ADD LJ ALTERATION LXI REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. „Zdtt%dLG �,( A TVPEOFPERMIT��y LIGRADING I.J FOUNDATION LISTRUCTURAL ❑ TENANT �W ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ.FT. OCCUPANCV— CONSTRUCTION TYPE VALVATION $ ZONE GRADINGCU.YOS. ACRES_ Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Orinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptois Kitchen Sink L3VdLOfICS P—Trap Roof Drains` Reinspection Fee � $15 Boiler Duc[-UnderGround Duct - Structural Duct - Ventilating Exhaust System � Multiple � Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ 0-100,000 BTU � 100,000 BT Reinspection Fee � $15 CMF 0865-46, �ev, 10/84 White - Builtling; Canary - ApPllcanh Pink - Accountin9; Goltlenrotl - Assessor Showers Service Sink Sewef Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank $wimming Pool w/Spa Urindl Water Cbset Water Heater Warer Service Auro-Wash Issue Fee FEES $ 3 A.P. # S Main Building: E T Front e Rear A C Right SLeft Ping. Ref. # Planning Notes: Automatic Washer Constructian Pole Sub. Coaking Unit Dishwasher Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator DO-5 KW � IB3� 12/21/87 Zane Accessory Building: ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW 15 KW Meter �Lp to 100 amps Meter ❑over 100 amps Sub Panel Motors DO-1 HP 01 Yz - 8 Inc. Solar �9-15 HP �16-15+ Microwave Pole Light Standing Sections Trash Compactor Reinspection Fee ' $15 Issue Fee IANICAL FEES Hoodor Typel ❑ DEVELOPMENTSERVICESREQUIREMENTS: Canopy Type I I ❑ Zoning Approved By Building Approved By _ Refrigeration System ❑0-100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee � $ 3 ��o;n �i_ Z O N I N G R E Q M T S FEES SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $� ENERGV P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ � MECHANICAL $ TOTALFEE $ PLAN CHECK 25% $ ;CONSTRUCTION AND.PLANNINrG ,; � POOL & SPA APPROVALS Permit # Oate Inspector qppROVA�.S Permit # Date Inspector i.� Temporary Electrical,'$ervice or Pole 52. Pool & Equipment Location 2' Soil Pipe-Undrgrnd." 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. _: 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. FoOndation � 59. Gas Pipe, O Undrgrnd., Test i �. 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 67. 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 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # _ , 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil s 23. Gas Pipe-Rough & Test 72. Underground Flush � 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑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 2 80. FOOD CERTIFICATE ISSUED � 33. Final Electric Notes: �. 34. Final Heating & Air Conditioning : �: 35. Final Gas Pipe-Test 36.�Hood or Canopy 37�. Final Factory Fireplace � , � 38. Final Plumbing ' � . 39. Water Service-Final � ' 40. Gas Service-Final ' � 41. Solar pomestic-Final ! � �• "� �> 42. Backflow Preventer � R3. Backflow Irrigation � . . . . � � '44, � Landscape Irrigation System %�. - - ' ' f 45. Sound Attenuation � "' � ' , ,�'46. Handicap Regulations � , , , , �� 47. FINALSTRUCTURE&BUILDING � � � � �,,� 48. Special Requirements Completed �� ' . ' 49: Electric Release to Edison � ' , �, � 50. Gas Release to Southern California Gas Co � � . � 51. CERTIFICATE OF OCCUPANCY No. Date r � � PflOJECTP00flES5: 3O2 ALTA LN owxrasrvnme: HANANO, KAZUMI �;• noosess: 1716 S NUTWOOD ANAHEIM,CA � RHCHIENGINEEfl: AUOflESS: UNIT: 92804 flEG.NO.: UNIT: PEflMITTEE: aoonEss: SANTA ANA ROOFZNG ( 714 ) 558-3707 Gn1j0�j0�`7n En. nWASHINGTON ('n q9'7n G UCENSED CONTBACTOA OELCAAFTIOlf "��re�y alfirm Ihal I am licensed untlel'p164i5ioM15'0� Cllap�r 9(commencing wiih Section 7000� oi Orvision 3 ul i�e Business and Pmlessions Cotle, ana my license is in lull lorce an� effec�. CITY LIC.: STATE LIC.: CIAS 0353�°�z 463596 � �9 oa�e:10 5ignawre:��l.t�'�� l��t-,�._G _ L WOFHEBS' COMPENSNTION OECLPPATION: I �ereby a�hrm tha� I have a ceni�ica�e ot con5eni lo selbinsure ar a ce�ificaie o� Workers' Campensalion Insurance. or a ceni�ied copy Ihereof (Seclian 3800. Lab. C). roucvNo.: zg5-93UNIT00461 EXP.�A7E: OIIOlI94 comrnNr: STATE FUNA—, ❑ Cetlifietl copY is �ereby �umished. i_3C Cenitietl coDY i ie wi�h cily BuilOing �ivision. �ale:�/1 "� �� J ,� Applican��Q�/"t_°L� � E%EMPTION FNOM WOHNENS' COMPENSRTION UECLABATION: (This sec�ion nee0 nol be completea il �he Oermi� is lar one huntlred ($100) or less�. I ce�ify ��ai in �he peAormance o� �ne work for whic� Nis permii is i55ue0. I shall no� employ any person in any manner sa as lo become Subleci lo Ine Workers' Compensalion Laws of Calitomia. Da�e'. SignaNre: NOTICE: If. after making Ihis Oeclaration. you shoultl Aecome su6lec� to Ihe Workers' Compensation pmvisions o� the Labor Code. you must Iorihwilh camply with such pmvisions or t�is permii shall �e tleemetl revokea. CONSTBUCTION LENOING IIGENLY: I hereby aifirm ihat ihere is a constmction lending agency for tne pertormance af the work 1or which ��is oermit is issuetl (Seciion 3097, Civ. C). LENOEfl: ADDflE55: OWNEH 6WLOEfl DECLl�NATION: I hereby aifirm that I am exemp� Imm �he Contractors' S�ate License Law �or �he �ollowinp reason (Sec�ion 7031.5 Business and Pm1e55ionai Coae: Pny ci�y ai counry whic� requires a De�mi� lo consimct, atler, improve, tlemolish, or reDair any s�mc�ure. prior Io i�s issuance. also requlres ihe applicant lor such permi� to lile a 5igne0 s�a�emen� �hai he/she is licensed pursuanl Io Ihe provisions a� the Conlracmrs' Sta�e License law (C�apter 9(commencing wi�h Section 7000� o� Oivision 3 0� the Business antl Prolessions Cotle) or Ihai he/s�e is exempl Iheretmm and lhe basis br �he alleged exemption. Nny uiolation o� Sec�ion 7031.5 by any applicant for a D¢rmil su�iec�s ihe aOPlicanl to a civil penalty of not mnre ihan five hundred tlollars (35001. I, as awner of Ihe pmpertY or my employees with wages as �heir sole compensa�ion, will tlo I�e work, antl Ihe ❑ slmcmre is noi in�en0etl or o�fered lor sale (Sec�ion 7044, Business antl Pm�essional Code: The ConVac�ors' S�a�e License Law does nat appty �o an owner o� a pmperty who bui105 or impmves �hereon, antl who tloes such work himself/hersel� or Ihmugh �is Or her own employees. provitleG I�at sut� impwvemen�s are nol inlenae0 ar o��eretl �or Sale. If, however th¢ �uiltling or impmvement is sald wi��in one year ol comDle�ion, Ihe owner vnli have Ihe burUen ol pmving he/s�e Oitl noi builtl or improve for �he purpose o� sale�. 1, as ownerot ihe pmpeny, am exclusively coniracting wit� licensed contracmrs m consimcu�e prolect (Section 70ad. Business ❑ antl Professions CaOe: The ConVaclors' S�ate License Law tloes not appty Io an owner of DropehY w�o builtls or impmve5 ihereon antl who conlrac�s lor suc� pmlects with a conVactm�s) license pursuantlo the ConlracloK Slaie Llcense Law),I am aware I�ai proaf ol Iheir Worker'S Campensaiion insurance shoul0 be provitletl b me. � I am exempt untler Section: B. 8 P. C. IOf �hi5 f2d5011: oaie: owner: I tlo here�y cemty Ihai I am aware ol an0 unders�and Ihe requiremenls o� Calilomia Heallh and Sa�ery Cotle Sec�ions 25505. 25533, antl 25534 ana that I ar any tulure Ouiltlmg accupant willlwill no� �circle one) nee0 b comply wi�h said 5�aie cotles antl lhe requiremenls for a permll for consimetion or motllllea�ion trom ihe Air Duably Managemen� Dlsl�icl. Resi�en�ial cons�me�ion applications are exemp� �mm �il¢5¢ pfOVi510f15. Date: ApPlicani: I here�Y �erlity �hai I have reatl ��is apPbcalian antl siate ihai the qve inlormation is correcL I agree ta compty wi� II city antl county ordmancesantlstatelawsrelatinglo�uilemgcons�mcuonantl�er y blhorizerE entaiiveso��hisciry�oenterupo eabove-menlioned pmperry �o� inspeciion purposes. Da�e: �� ' � `C7 ? Signamre� 'L�t^' s�-- �river's License oi Social Secunly a: �� .� � � 164v46 W�ite—Bmltling: Green—Cotle Eniorcemen��, Canary—Applicanl: Pink—Revenue; Goldenrotl—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 064332 PERMIT NO: B 064332 PLAN CHECK NO: N GOVT: N S[JPP; N CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: OTH JOH DESCRIPTION : T/OOF & REROOF W/BUR 3 PLY SYSTEM SQ FT: 1,677 CLAIM VALUE; 2,975,00 CALC—VALUE: 1,677,00 GROUP OCC; R-3 / COMMENTS: SMOKE DETECTOR(S) RE�UIRED REROOF 1300SF W/BUILT UP �r�r�rx�tx��r�rir�r�r*�r***+t�txr�t�tx�*x�r*�t*+t +r+r+��tftit�r**�r�r�r*�e�tit*x��tx�*�r�x�*x��r�rir*�rx+r+�*****i�***x**i�* Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGAT; FT IN LEFT: FT IN RGHT: FT IN PARKING REQ• PROV: PARCEL: 93420017 ZNE: REF NO; PLANNING NC3TE5> > +rx�*+r**�t*�r**�r*�r****x�*******�r*ir�r+r�e****�r**�**x-i�**�r+r+t+t*+�+�*��r***�**�t*****i�*+t*x�***�** D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S 20NING APPROVED HY DATE: BUILDING APPROVED HY : DATE: APPLICATION ISSUED BY: DATE; � i4ititiEififififiE�EififiEiFiFiEiEiEMiE�EiE iE1FiE3tifif3Eif�EiF jFiF 7f iE 1f it if iE iE 1Flf ff 1f !f 1f it 1E if fk i6 it iE iF ik iE iE fE f! iE if 1k if iE if 1f ik 1f iF 1E iE �E �E 1F M 1f f! if tE iE if iE k 1E if 1f M if 1F iE 1f iE iE iE ik iE if iE 3t %if �f if iF if K K iE if ik 1E iE LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT;Y� BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 39.00 ' .50 � SMIP/NON—RRS PLAN ZSSUE FEE BUILDING—DIV—> TOTALS----> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE 39.50 0.00 0.00 39.50 39.50 .00 REVENUE DIVISION TOTALS--> COLLECTED: 39.50 OVER/SHORT: .00 HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 39.00 .'S0 iE iE iklf iE if iE iE 7f %iE if �F �E �Elk if iE i! 1E 1E 1E jE 4 iE iE if k if if iE k if iE if it iE iE i! i! 1! 1! if iE if iE it if iE if 1E it 1F 1E iF iE it 1E %!E k iE iE 3E 3E 1F iF iE iE * iF if iE if if if iE if if I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N ONIT COST TOTAL COST SFR 1677 REROOF BY VALUE RESIDENTIAL NOZONE � 1.00 1,677.00 END OF FEES ��.,.u.::�.�, �v�� c,�OKE DETECTOR`c� }_=._: aol��.�� s -��Qu�RFp� �.� T:,��. .�_:: . � _b�ONSTRUCTION A(�D PLANNtNG � qpPROVALS ?ermit ir �� 1. Temporary Electncal S?��ce or Pole 2. Sod Pipe-Undrgrnd. 3. ELctrical Conduit Ut�liry�Undrg�nd. I 4. E�octrical Condult-Und�gr�id. . � 5. Siael Reinforcement - I � �� E!�ctr,ccl UFER Gmd I). Footings , B. Foundation � I9. Water Pipe-Undrgrnd. I 10. Structurai Fioor System . i - 11. Pr�perty Sewer Line & House CqnnecLon � 72. Sewer Cap 13. Hoof Dra�ns � I 14. Rough Pfumbing 15. flough Electrical-Contlu�t r , 16. Rough ElectriCl?�iring 17. Rough 4Vinng $ign 18. Rough Electrical-T Bar Ce�;�ng i9. Ruugh Heating & Air Conditioning 20. Rough Factory Fireplac- 21. Duc+s, in Structure 22. Ducts, Ventilating 23. Gas Pipe�ftough € Test 24. (;oof Framing 25. Roof Sheathing 26. ?•Bar Ceihng IStr�ctura�l & NSonacoat 27. Frame and Piashing ?.8. L.�thing & Sid��ng 29. Insuiation , 30. Drywail Naihng 31. Plaster Brown Coat 32. Electncal Po�.•er Meter-F�nal 33. Finai Electric 34. Final Heat�ng &e Air Cond.t�oning 35. Final Gas Pipe�Test ' 36. Hood or Canopy � 37. Final FactorY Fireplace 38. Final Plumbing 39. tYater Service-Finai 40. Gas Service�Final - , . 41. Solar pomesticFinal 42. Backflow Preventer 43. Backfiow irrigatio� 44. Lar.dscape Irriqation Systzm 45. Sound Attenuation 46. Handicap Regulations 47, fINAL STRUCTURE & BUILDWG 48 FINAL PLANNING �i9. Eiectric Release to Edison 50. Gas Release to Southem Californie Gas Cn 51. CERTIFICATE OF OCCUPANCY Date Date i Inspectw -6-g3� � 0 POOL .PA APPROVALS Permit ;k 52. Pool & Eqwprr*ent Locat.on 53. Steei Reinforcement 54. Forms 55. Electrical Bonding 56. Rou9h Plumbing & Pressure Test 57. APPROVAL TO COVER�GUN'TE 58. Electrical Conduit�Undrgmd. 59. Gas P�.pc, O Undrgrnd., Test 60. Baekwash Lines, PTrap, -�: Undrg•rd 61. APPROVAL TO DECK 62. BaCk�?ash �i RccxpTor�Firal 63. Heater & Vent-Final 64. Plum6ing System - Final G5. E;ectrical�Finai 66. Solar System-Final 67. Fencing $: Access ApP�oval 68. APPROVED FOR PLASTERIRG 69. POOL7SPA SYSTEMS FINAL FIREDEPT.REQUIREMENT 4 APPR6VALS Permit# Date I Intpecmr � 70. Undmgrau^,d HyCro 71. Product Piping � Gas '� Oil ?2. Unde�ground Flush 73. Undergrnd. Storage Tank � Gas ,� �.: 74. Qverhead Hyaro 75. Dry Chem�cal 76. Dry Standpipe 77. FIXED SYSTEM FINAL � 78. FIRE PREV. FINAL �_ h1EA�TH DEPT. REQUIREUIENT 79. FINAL I�\SPECTION 80. FOOD CENTiFICATE ISSUED Notes: Z �/9-9�i-- � e DYNA MFG. G NC. Subsitliary of Familian corp 2540 INDUSTRY WAY LYNWOOD, CALIF. 90262 TEL: (213) 564-6011 August 3, 1976 Mr. Ed Shafer Department of Building Safety 77 Eair Drive Costa Mesa, California 92626 Dear Mr. Shafer: Referring to your telephone conversation with Mr. Burt Williams today, this letter will confirm that Mr. Ed Tobin is installing a Dyna metal fireplace, DFCA-36. Please be instructed that this unit is properly listed with ICBO under report number 2578, dated September, 1974. I am personnally taking a TCBO label to Mr. Tobins, which I will apply to his unit on Wednesday, August 4th. I trust this information is what you required, however, if there is anything further you need, please let me know. Yours very truly, DYNA MFG. CO3 INC. l ' • A. , Dominicis Director hj 39845 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 ,.4Y 15-75Nr_io�� 644', v:�;A c�{5• 215.85 APPLICATION FOR BUILDING PERMIT EIVED BV DATE RECEIVED DATE ISSUED MAY 1 5 1975 OWNER � � �a.r, rvo.n -.7 / -V U � "r n BUILDING c ' AD�RESS ), ' �% '� �- �T�/ �+DORESS �O� NV w W TEL. �qCT CO��y BLOCK a U CITY ' � NO�jr �� Z Q CANSTRUCT�ON W D P O N IENDER am J � BRANCN � J � OWNER m J ADORESS /V UE �7JCw.�.� m ARCHITECT TEL S � CI}�ZATT �'7PrP $ •'i�u J a OR ENGINEER O T 1 O� �7- w � ADORESS , �� , , /' G%/Y'/ . ��Y y ZONE PE " GROUP � � a w APPqOVED r W Z CONTRACTOR /J, Z : �� B�' DATE � � mJ � // � ADOFESS �� S/{ r/!�/S L//�G�IPi //�/ // • w W NE NO.OF USE OF NEW �= TEL� /' p/�L // PLANS BUILDING Z F CITV r/�%e NO.��/-QCj /� —C. W O STATE CITV VARPS APPROVED VARDS APPROVED y� LIC. NO. i Q �� LIC. NO. MAIN BUILDING ACCESSORV BUILDING � O / / (FROM C/L STREET OF LOT D/ X ��OO / NOW ON LO S 7 ROfYT T. EXI5TINGBLDG. /�G�r//i�� FT {� 512EOF / / NO.OF_�J�/��jJ/S Z NEW84DG. ��O Si / ROOMs^ STORIES L.SIDE FT. a EMERIOR WA� Y�O ROOF /� �% COVERING .UO COVERING G4 REAR T. FT. J USE OF BUIIDING AND WORK TO BE PERFOFMED DISTANCE BET. BEf. MAIN & a S ^ r vC ,'�P_� _ MAIN BLOGS. ACCESS. BLDGS. Q VAq. � DATE O j��/j�/� ' / , ' C.U.P. # APPROV . - r �8 APPROVE r N J O yOLD FOR SPECI L EQ � '1 s UI heraby aeknowletlBe that I have read this applicati and s e �� j. � thet the abova information is corract and aprae to comply with _ � all laws regulatinB buil0ing conztruetion, antl I ahall not employ F any pe�son in violatlon of tha workman's compensation laws of y tha Stete oi Californla. �(� � ��O d_ �C� � � tli1 Z I hereby cartify [hat I em prope�ly licensetl as a contracior untlar SQ. FT. O the State of Californla Business entl Profeaions Cotle, Dlv(sicn 3, THE AMOVNT SHOWN UNDER VALUATION IS FOF � Chaptar 9, antl that such licanses are in tull force antl etfect, or I THE PURPp$E OF ESTABLISHING A PERMIT FEE ONLV: m am axempt from Me provislons ot t�e State ot Cetltornie Business Q VALUATION and Professions Cotle, Dlvicion 3, Chapter 9. H � PERMIT FEE $ � SiB�ature of � �/ � 7 CJ'�" m Permittee �Vl � T ��F-'�-C. � �'µ� $ 335oa PLAN CHECK $ / � � E 0 Authorizatl AgenT LL TOTAL FEE $ � D