HomeMy WebLinkAbout933 ARBOR ST - Building PermitsApplicant [o fill in all spaces exce0t those wit�in heavy Oortler lines antl sign a11 avProo�iate aeclarations.
– PE MIT NO. TRACT NO. LOT NO. UNIT NO.
�iTY OF cOS7A MESA CO.N�1STRUCTION RERMIT 2 D � A.P. # �'Z � rj 2, c9 . zo�e
Project Address ✓��� �`�'� �- _ S Main Building: � Accessory Building:
Applicant'SMailingAddre55 ���N� : - TYPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR E Front � Z
�'� � �'> 2 ❑ CONVERSION ❑'DEMOLISH ❑ OTHER � T O
Owner's Name � � `�� �Q –" Phone � 2� � ' . - � �
•),��,,�/� t DESCRIPTION OF RK/�/SE OF B DG. � ' G f'N B Rear N
Address �QY_YI_C Wq`�/ � �fy/i ,�'�� 3��g�(�.Lf/L�� . A 1
Arch(Eng. License No. S TVPE OF PE� ADING FOUNDATION STRUCTURAL i K Right G
A d dre55 � ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ' g Lef[ . R
Conirecmr's Nam Phone ��OTHER � � , Ping. Ref. # � Parking Req./Provided E
Address (mailingl s/t'VLl � PROJECT DESCRIPTION 5(1. FT. OCGUPANCV ' n
CONSTRUCTIONTVPE�_ VALUATION$ 4y��] w PlanningNOteS: � Wap u� lG�� M
CityLicenSeNo. - ZONE � GRADINGCU.VDS. ACL3E5 b h F�CY� ^tiLtL) �
LICENSED CONTRACTOR DECLARATION . . S�
1 hereby affirm tha[ I am licensetl untler provisions of Charter 9�(commencing Remarks U d O � �'
with section ]000) ot Division 3 of the Bu5ine55 antl Professions Cotle, antl
my Iicense is in full force ntl effect. . � ELECTRICAL FEES
License ass License o.��� �' -
oate� Siqnature PLUMBING FEES P.utomatic Washer Transformer ❑ 15-50 KW �
WORKERS'COMPENSATIONDECL TiON � ConstructionPoleSub. � 50+KW
�eby atfirm that I have a certificate of consent lo selLinsure o a certi(icate Bar Sink Showe�s �
lorkers' compensation Insurance, or a certifietl copy thereot (Section Backflow Preventer Service Sink Cooking Unit Meter ❑up ro 100 amps
J. Lab. C.) ' ..' - �. .
Policy No. Company Backtlow Irrigation Sewer Cap Dishwasher Meter ❑over 100 amps
eCerti/ietl copy i5 hereby fUmishetl." • Dry¢f5 ❑Gas ❑Electric Sub Panel
Certifietl copy is (iletl with the city Building Division. Bathtubs Sewer COnnection �
Date Applicant ' . Fan Motors �0-i HP �1 h- 8
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers SOId� COII¢ct0l5
(Thissection neetl not be complet¢tl if the.permit is for on¢ huntlretl ($300) or F.A.U. Inc. Sol3� 09-15 HP,�Oi6-15+
less). Dishwasher Solar Piping
I certlty that in the pertormance ot the'work tor which this perm�t is issuetl, I Fixtures �� '
shall no[ employ any pe�son in any m r 50 a5 to beC Subj¢ct to the Drinking Fountains $oldl T3�k Mic�OwOv¢ �� •�
Workers' C pe �iQ�n Laws of Califor 'a.
r, Device Boxes Pole Li ht
Date t7a—Signature Floor Drains Swimming Pool w/Spa 9
NOTICE: If, after mabhg this tleclaration, u 5 oultl become subjet, t he .
Workers' Compensa[ion provisions of th bor Cotle, you must t th ith FIoo�Sinks Urinal Outle[5 Range
tompry witM1 such p�ovisions or thi5 ermit Shall be tleemetl ¢voketl. SWitCh¢5
CONSTRUCTION LENOING AGENCV GasServiCe OUtletS WaterCloset $ign
I hereby affi�m that there is a construCtion lentling agency fo� the per(ormance
ot tne work for wnich this permit is issuea (Section 309� Civ. CJ Intercepmrs Water Heater Garbage Disposal Standing Sections
LentlEr's Name
Lentler'S Atldress Kitchen Sink Water Service Generator �0-5 KW �5-15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby affirm lhal I am exempt trom the ConVactor's License Law for the Lavatories Auto�Wash
followin9 reason (Section ]031.5 Business antl Protessional Cotle: Any city or
munty which requires a permit to construct, alter, improve, tlemolish or repair P–Trap LaundryTrays
any sttucture, prior to its issuance, also �equires Ihe applican[ fo� such permit
to file a signetl slatement that he/she is IicenS¢tl pursuant to the provi5ions oi ROOf Drdins -
the Contractor's License Law (ChaO�er 9(commencing with Section ]000) of
,, �r�,�ision 3 of [he Business antl Professions Code) or tnat he/she is exempt Reins ection Fee
-�=x,�':efrom antl the basis for the allegetl exemption. Any violation of Section P 15 luue Fee 3
"Je=�1.5 by any applican[ for a permit SubjeCtS the applicant to a civil -
''"'alty ot not more chan tive huntlretl tlouars (5500). DEVELOPMENT SERVICES REQUIREMENTS: --
I, as owner of the property or my employees with wages as their sole ReinspBGtion Fee $15 ISSue Fee $ 3
compensation, will do the wo�k, antl the struc[ure is not intentled o� otferetl ZOning ApproV¢d By DdtO
for sale (Section �044, Business antl Protessionai Cotle: The Contractor's - . MECHANICAL FEES Buildin8 APP/ovad By Date
LicenSe Law tloes not apply [o an owne� of a property who builtls or improve5
thereOn, antl, who Coes such wo�k himself/herself o� through his o� he� own gOilCf HOOd O� T ¢ I ❑ APP���tion Issued By `� D3t
employees, p�ovitletl that su[h improvements a�e not intentletl o� offeretl for YP '
Sale. It, however, tne bullding or improvement is soltl within one year oi com- C2no�Y Type 11 ❑ SUMMARV OF EE .
pletion, tne owner will nave the burtlen o( proving he/slte tlitl not builtl or im- DuC[ - UOdE� GroUnd
prove tor the purpose ot saie). _ BUILDING PERMIT $ �2• d0 SMIP $ •�
� ❑ I, as owner oi the property, am exclusively contracting with licensetl con- Duct = Structural Refrigeratlon System PLAN CHECK $�,� PERMIT
t�actorsto wns[ruct tM1e project ($ection ]044, Busine55 antl Protesslons Cotle: '
The Contractor's License Ww tloes not apob to an owner of property who Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU PLUMBING $ ISSUANCE $
builas or improves thereon. antl who contracts for such oroiects with a mn-
tractor(s) hcense uursuan� ro cne Contractors License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteretion PL.P.N CHECK 25% $ ENERGV P.C. $
roof oi their Worker's Compensation Insurance should be provitletl ta me. ELECTRICAL $, GRADING $
� �I am exempt untler Section e. & P. C. for this reason Firepl/Fact. Bit. ICBO # Fire Dampers � PLAN CHECK 50% $ MICROFILM $
Date Z c[� � o Heating System & Ducting � Registers MECHANICAL $ ♦.
I nereb ce tity that I have reatl this applicatlon antl state that the above ❑0.100,000 BTU �100,OOOBT TOTAL FEE $ ��q 30
� information is correct. I agree to compty wrth all city antl county ortlinances PLAN CHECK 25% $
antl�s[ate laws relatin9 to builtling construction, antl hereby authorize repre- .
sentatives o is ciry to ente upon the above-mentionetl property tor
inspettion p rp Se5
�Sygriature � Date 4 �'+ . ReinspectionFee $15 IaueFee $ 3 �1 (!�Q*J,.�7�Q�ti'F �i 1- �i'
Drivers' �ice or 55 ���4 e
33,,5 'i' "E� � _'...
OBfiS-46, re . 5/88 White - Builtling; Canary - Applicanp Pink - A<countin9: Goltlenrotl - Assessor GNTE� i�4t25�fi� j.�i'([: 5�.�: g�
,.
CONSTRUCTION AND PLANNING POC SPlA � �„� .
APPROVALS Permit # Date Inspector p�ppROVALS Permit # Date-�' Inspector
M
i. Temporary Electrical Service or Pole �_ 52. �Pool & Equipment Location _ -'
e1
2. Sail-Pipe-Undrgrnd. ,e. i�.Y 53. Steel Reinforcement `� �.�. �
3� Electrical Conduit Utility-Undrgrnd. 54. Forms �
�• -
4.LfElectiical Conduit-Undrgrnd. � i 55.' Electrical Bonding
1I � A
5. SteelSReinforcement; 56. Rough Plumbing & Pressure Test '+;
��
6.`.,ElectricalUFER�Grnd. , 57. APPROVALTOCOVER-GUNITE ,
7:�F.00ting5 �' � t" 58. Electrical Conduit-Undrgmd. •r -i
8:� Foundation C.i. �-. .'�� 59. Gas Pipe, O Undrgrnd., Test i.: �_�
.r
9. Watei Pipe-Undrgrnd. �� 60. Backwash Lines, P-Trap, O Undrgrnd. ��'
�
10.StructuralFloorSystem '.,� 61�.APPROVALTODECK �� '
��
11. Property Sewer Line & HouseConnection ^.�i 62. Backwash & Receptor-Final �
12. Sewer Cap,... .. -- ' 63. Heater & Vent-Final .,
�,
13. Roof Drains � � -' 64. Plumbing System - Final � • �
14.� Rough Plumtiing 65. Electrical-Final � '"�
15. Rough Electrical-Conduit 66. Solar System-Final �
�]6? Rough Electric Wiring 67. Fencing & Access Approval
yZ. Rough Wiring Sign 68. APPROVED FOR PLASTERING �-
- 18� Rough E�Iectrical-T Bzr Ceiling 69. POOL/SPA SYSTEMS FINAL
79: Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
.20~ Rough,Factory Fireplace '�, APPROVALS Permit#
� .n
`21. Ducts, in Structure �L � 70. Underground Hydro
22. Ducts, Ventilatin i': �' � �
9 � „� 71. Product Piping O Gas ❑ Oil
23" Gas Pfpe.Rough & Test - � 72. Underground Flush �
24: Roof F amin T: '
9 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing '�;� � 74. Overhead Hydro ' �
26. T-Ba� Ceiiing (Structural) &TMonocoat - , 75. Dry Chemical
27. Framel� d Flashing �� ` 76. Dry Standpipe �
28:� Lathing�^&'Siding _ . 77. FIXED SYSTEM FINAL
�y
�29. Insulation • � 78. FIRE PREV. FINAL
30. Drywall�Nailing ` HEALTH DEPT. REQUIREMENT �
�31. Plaste? Brown Coat �:� - - 79. FINAL INSPECTION '�
32. Elect%ical Power MeterFinal � 80. FOOD CERTIFICATE ISSUED
L�/. 1
33. Final Eiectric � � �i 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 , ��� � �j
40. Gas Service-Final " �
��
.41. Solar, DomesticFinal . �'�' �
.' :,i' ; v.,-
_42. Backflow Preventer /�i/�� � i' �
43. Backflow Irrigation '� � -'•
�44. Landscape IrrigatiomSYstem �
/.i /
�45. Sound Attenuation ' ��'r
yr, ,,
46. Handicap Regulations � �
!
47.FINALSTRUCTUR�&BUILDING O� C � �, � -
48. Special Requirements Completed _ '
� ,, .
49. Electric Release to Edison ' � f�u' �..
�.
��50. Gas Release to Southerri California Gas Co .. .� ��, i�� �
51.�CERTIFICATE OF OCCUPANCY ;� t> ��� W
No.� ' Date � .�.�,y' �
Aop�i�ant to fi11 in all spaces exeeo� t�ose within heavY�eortler lines antl sign all apo/oD��ate Eeclarations.
cifiYOF�OS7nmpESA CONSTRUCTIONPERMIT
Project Address t �� �� � _ �
ApplicanYs Mailing Address -
r
Owrier's Name � Phone ' �
Address sM��
Arch/Eng. Ucense No.
Address'.
Contractor's Name Phone
Address (mailingl
City License No.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensetl untler provi5lon5 ot CM1arte� 9(commencing
with section ]000) of �ivislon 3 of the Business antl Professlons Cotle, antl
my license is in full for p antl effecL �u� �I
Licens C ss License �
Date� Signature
WORK RS' COMVENSFTION DEC ATION
' hereby aifirm that 1 have a certific ot consent to self-insure r a � rtifi<ate
Workers' Compensation Insurance, or a certifietl copy tnereof (Section
Oq Lab. CJ
Policy No. Company
eCertifietl cooY is hereby fumishetl.
Cettifietl [opy i5 filetl with the city Builtlin9 Division.
Date AOP�icant
EXEMPTION FROM WOHKERS' COMPENSATION DECLHRATION
(Thissection need not be completetl it the permit i5 fo/ one huntlretl ($300) o�
Iess).
I certify.thal in the perfo�mance ot tne wo�k for which this permk i5 issuetl, I
shall not employ any per on in any man er so as to be e subject to the
Workers' C ensa w5 of Califor �a.
Date _ rr Signature
NOTICE: If, after akin9 Nis tleclaratio , ou shoultl bewme s e to the
Workers' Compensation provisions ot Labor Cotle, you f thwith
comply with such p�ovisions or thi permit shall be tlee etl voketl.
CONST0.UCTION LENDING AGENCV
I hereby afflrm that there is a conztructian lentlinq a9ency for the pertormance
of the work tor which this permit is issuetl (Section 3097 Civ. CJ
lsntler's� Name
Lentler's AtltlreSs
OWNER BUILDER DECLARATION
I M1ereby aftirm lhat I am exempt from the ConVactor'S Lirense Law for tM1e
. following reason (Section 7031.5 Business antl Professional Cotle: Any city or
county wM1ich requires a pe�mit to const�uct, alter, improve, tlemolish or �epai�
any structure, prior to its is5uance, also �equire5 the applicant for SUCh pe�mit
to file a si9netl 5[atement that he/she is licens¢tl pu�suant to the prOvisions o/
the Contractor's License Law (Chaoter 9(commencing with Section 7000) of
7ivision 3 of the Business antl Professions Cotle) or that he/she is exempt
eret�om antl the basis for the allegetl exemption. Any violation of Section
��5 by any applicant for a permit subjects the applicant to a civil
alty of not more than five huntlretl tlollars ($500).
1, as owner ot the property or my employees with wa9es as Iheir sole
tompensatiOn, will tlo the work, antl the structure i5'not intentleA or offeretl
for sale (Section 7044, BuSiness antl Professional Cotle: The Gontractor'S
License Law tloes not apply to an owner of a propercy who builtls or improves
thereon, antl wlto tloes such work himselt/her5elf or through hls or h¢r own
employees, p�ovitletl that such improvements are not intentletl or offeretl fo�
sale. If, however, the builtling or improvement Is sold within one year ot com-
pletion, tne owne� will have the burtlen Ot prOving he/she tlitl not builtl o� im- �
prove �or Ihe�purpose oi sale).
❑ 1, as owner of the property, am exclusively contracting with Ilcensetl <on-
fractorsta`.Onst�uct the projec[ ($ection 7044, Business antl Professions Cotle:
The. Coniracto('s License Law �loes not apply [O an owne� ot property who
builtls or improves thereon. antl who contracts fo� such oroiect5 with a con-
tractor(sl hcense pursuanc io [ne ConVactor•s License Law). 1 am aware thax
praof of Ihei� Worke�'S Compensation insurance shoultl be provitletl to me.
❑ I' am exeiRipt untler Section B. & P. C. for this reason
Date Owner
I hereby ertif that I have reatl IK application antl state t at t e above
intormation is correct. I agree to co ly with all city antl countY tlinances
antl state laws relating to builtling mnstruction, antl hereby autho�iie repr¢-
sentatives of lM1is city [o e r upon the above-mentionetl Pro erty for
inspection pu ses.
Signature �ate � � g�
��-i v l� l i- i i-__ ._.
TVPE OF CONSTRUCTION NEW 'ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER �
DESCRIPTION OF WORK/USE OF BLDG.
TYPE OF PEHMIT LJ GRADING LJ FOUNDATION LI STRUCTURAL
❑ TENANT �LEGTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 5�. FT. ocCUPANCv
CONSTRUCTION TVPE VALUATION $
ZONE GRADINGCV.VDS. �ACRES
Remarks: ,
Bar Sink
Backflow Preventet
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks ' - -
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—T�ap
Roof Drains
Reinspection Fee
$15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blc iCBO #
Heating System & Ducting
❑o-i oo,000 aru � i oo,000
R' F
Drivers' Lice or 55 � I emspect�on ee
0865-4Q rev. 5/88 White - guiltling; Canary - Applicanq Pink - ACCounting; GOltlenrotl - ASSe55or
$15
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heatei " �
Water Service
Auto-Wash
Laundry Trays
Issue Fee
Hood or Typel ❑
CanOpy Typell ❑
Refrigeration System
❑0-700,000 BTU ❑100,000 BTU
System Repair/Alteration .
Fire Dampers
Registers - �
Issue Fee
A.P. #
S Main Building:
E
T FrOnt
6 Rear
A
C Right
K Left
S
Ping. Ref. # �
Planning Notes:
FEES Automatic Washer
Consvuction Pole Sub.
Cooking Unit
D ishwasher
Dryers ❑Gas ❑Electric
Zona
Bui
Parking Req./Provided
ELECTRICAL FEES
Transformer ❑ 15-50 KW '
❑ 50+KW
Fan
F.A.U.
Fixtures
Device Boxes
Outle[5
Switches
Garbage Disposal
Generator 00.5 KW �5-15 KW
Meter ❑uptd1L00amps
Me[er ❑over 100 amps
Sub Panel
Motors OO-1 HP O1'/: - B
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light
Range
Standing Sections
Trash Compactor
I Heinspection Fee '$15 I � Issue Fee
$ 3 DEVELOPMENTSERVICESREQUIREMENTS:
2oning Approved By
fEES Building Appraved By
Application luued By-
$ 3
SUMMARY 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% $
$
t�.'J�.���OSi'G�J����ii '-1&T,'
9r;7F. 04/14!$° iI�tc% 1i:i�6
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{ CONSTRUCTION AND PLANNING
APPFIO�%A'�S Permit #
: 1. Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
�,
3. Electrical Conduit Utility-Undrgrnd,
,
4.. Electrical Conduit-Undrgrnd.
5.'Steel Reinforcement
6�-Electrical UFER Grnd._ ,
7. 'Footings '
. �!
8.�Foundation
9. Water-Pipe-Undrgrnd.
10. Structural Floor System ,
11. Property Sewer Line & HOuse Connection
12. Sewer?Cap ` _
13. Roof Drains `
�
14. Rough Plumbing "
15. Rough Electrical-Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign
18. Rough Electrical-T Bar�Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
��3. Gas Pipe-Rough & Test
24. Roof Framing � ,
25. Roof Sheathing � . � . .
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing �
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31 . Plaster Brown Coat
32. Electrical Power Meter-Final
33. Final Electric
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 '-
43. Backflow Irrigation
44. .Landscape Irrigation System
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 Cc
51. CERTIFICATE OF OCCUPANCY '
No. Date
Date
POOI .P.A
Inspector AppROVALS Permit#
52. Pool & Equipment Location
. 53. Steel Reinforcement �
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
� � 5S. Electrical Conduit-Undrgrnd.
.� 59. Gas Pipe, O Undrgrnd., Test
� c 60. Backwash Lines, P-Trap, C] Undrgrnd.
� 61. APPROVAL TO DECK
�� , 62. Backwash & Receptor-Final .
, 63. Heater & Vent-Final,
. 64. Plumbing System - Final
� 65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIREDEPT.REQUIREMENT
. APPROVALS Permit#
70. Underground Hydro �
71. Product Piping � Gas ❑ Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78.'FIREPREV.'FINAL ��
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
. Notes:
9
Date �In'spector
�t
� ,�i
_.
� . .
�
ORANGE COUNTY BUILDING DEPARTME�NT APPLICATION FOR PERMIT .
636 North Broadway � ' � , B
'� SANTA ANA. CALIFORNIA _..- _B M• ��D- •� G— - � -
FOR APPLICANT TO FILL IN FOR_OFF.ICE.USE_ONLY___ :,
' RECEIPT NO. PERMIT NO.
ADD E'S5 933 Arbor St. q",3 .!'j ,. ��� IJ'� S,� �
SCHOOL DIST. COBtH MB$H RECEIVED BY- �ATE OF APPL. DATE ISSbED
OR TOWN ((� J/ [M� 2
NEAREST 7-�y--/-, ' �1J ��✓� I��G ��J J
�Ross ST. Monrovia Ave. u�:�f" C —
OWNER COMANCHE NOMES INC. BUILDING /'�� /�-��e
) ADDRE55 `�J �� l�/1 L��1_/ .�� � �
MAIL 9363W,�sH�Re B�V�• SCHOOLDIST. .i
ADDRE55 OR TOWN '
cirr BEVERLY HILLS NOLCR• 5436t NEAREST �/;fC�l/ULIIW� �
ARCHITEC Og v^L
rrariuccr�Alf�l R MCKERRACHER SY. 61i 9�
ADORE55 6 WILSHIRE BLVD.� BEV.HIllS
�ESCRIPTION I LOT NO. �5 e�ocK 1%12
(ATTACH METES @ BOUND51
TRACT
SIZE OF LOT p7 X����0 I NOW ON LOT �O
USE OF NO. OF NO. OF
EXISTING BLDG. Fnmiti[s ROOMS
DESCRIPTION OF WORK
BUILOIN�o�1. S�.FT NO OF
SIZE Y ROOMS
COV RING STUCCO I O
��SE OF NEW
'LDING RESIDENCE
CRO55 ST. V-
20J�N�}E/ NO.OF TYPE I GROUP �y
/r` 1 I PLANS _�` JIT'._{ I �.�I
Jt/
SETBACKLIN F 9M.CENTER OF ST. ��!,[l � -
REAR'VARD /�'�� g p�' �SIOE YARD 11'� �1.Q � .
APPROVED \j yy,( � JA _Ci� 3
FOUNOATIi
I HEREBY ACKNOWLE'JGE THAT I HAVE READ TMIS FORM:
APPLICATION AND STATE THAT THE ABOVE IS CORRECT UNOEI
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FRAME: FI
AND STATE LAWS REGULATING BUIL�ING CONSTRUCTION. BRACI
LATM. I NT.
SIGNATURE OF �E RT VI STA
LATH,EXT.
PERMITTE
PLASTER.I
AUTHOHIZED A . -�,�G .
s 4830.0o P. �. _ �
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