HomeMy WebLinkAbout3106 BARBADOS PL - Building Permits.
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CITY OF COSTA MESA
5�""'F BYILDING DIVISION
i . � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
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� FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: BC08-00586
PERMIT TYPE: B COMBO
Sub Type:
STATUS: ISSUED
DATE ISSUED: 07/15/2009
ISSUED BY: RMD
JOs a��ReSS: 3706 BARBADOS PL CM Suite/Unit:
APN: 13s15211 Zoning:R1, ,
Vicinity: LIVING ROOM Primary Occ: R-3
Const Type: V-B SQ. FT: 360 Valuation: $60,000.00
SCOPE OF WORK: 360 SF LIVING ROOM EXPANSION IN AN EXISTING SINGLE-STORY SFD WITH 1 REPAIR/ALTER
COOLING/HEAT, 1 MECH GAS PIPING, 2 FACTORY FIREPLACES, 12 LIGHT FIXTS, 6 OUTLETS, 4 SWITCHES, AND RELOCATE
(E) SERVICE PANEL.
OWNER: CALDERON JOEL; FLINT MICHELLE.M Address: 3106 BARBADOS PL
Phone: 949-500-2347 City/State/Zip: COSTA MESA, CA
APPLICANT: CALDERON, JOEL � Address:
Phone: 949-500-2341 City/State/zZip:
coN7RnC70R: OWNER-BUILDER
Phone:
Cell:
ARCHITECT: ARHTUR KENT
ENGINEER:
Address: Unit:
Ciry/State:
License No.C15748
License No.
COMBINATION PERMIT FEE SUMMARY
Building Plan Check: $463.94
Building Fees: $713.75
Electrical Fees: , $78.20
Mechanical Fees: $64.65
Plumbing Fees: $0.00
SMIP Residential: $6.00
SMIP Commercial: $0.00
Bldg Std Admin Fund ??
TOTAL FEES: $1,329.54
^Re�er to (ee recelpts br all fees paitl for project
License No. 000000
Unit:
Unit: :
ZipCode
PHONE:714-969-6306
PHONE:
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 160 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
WSPECTIONS: 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 fnal approval will result in the expiration of this permit.
COOE/. INSPECTIONTVPE DATE IN1111pL5 COOEp INSPEL110NTYPE OTE INTITIRLS
1616 Fized System Final Fire Prevention ' 206 Final Mechaniral �
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electncal („�'�
201 Final Bbck/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 �� �
WORKERS' COMPENSATION DECLARATION:
I hereby aHirm under penalty of perjury one of Ihe following declarations:
❑ I have and will maintain a certifcate of consent to self-Insure for vrorkers'
compensation, as provided for by section 3700 of the Labor Code, (or me
pertormance of the work for which [his permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by
sec[ion 3700 0( �he Labor Code, tor ihe performance of Ihe v.ork for which this
pertnit is issued. My vrorkers' compensation Insurance carrier and policy
number are:
Carrier
(Th�s SeIXun need nol6e mmpleted �/the peimR is valuetl a( one huntlietl dollars (5100) or less )
Polic �Number:
( �'-I�certify Ihat in Ihe performance o( the work (or which this permit is
is ued, I shall not employ any person in any manner so as lo become subject
� to [he workers' comp sa[ion laws of Calitomia, and agree that i( I should
become s ct to e wor�fers�' ��ation provisions of Section 3700 of
the La� � de, I all f rih 'Ifi co �ly witJ� these provisio . �,
i � �
qppli nfs5i � Wre a�Ev '
RNIN : FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE Hl1NDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTERESi�, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm thal l am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in (ull force and effect.
Lia # Class #
Comrac�or's Signawre Daie
CONSTRUCTION LENDING AGENCY:
❑ I hereby aftirm that there is a construction lending agency tor the
perfortnance of the work for which �his permil is issued. (Sec. 3097, Civil COde�.
Lender's Name:
lender's Address:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that untler penalty o( perjury thal I am EXEMP7 FROM 7HE
CON7RAC70RS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Pmfessions Code: Any city or county which requires a permit to
conslruct, al[er, improve, demolish, or repair any stmcWre, pnor to its
issuance, also requires the applicaN for such permit to file a signed stalemenl
that he or she is licensed pursuant to the provisions of the Contractors
LiGenSe Law (Chapter 9(commencing with Sec�ion 7000) of Division 3 of the
Business and Professions Code) or thal he or she is exempt there(rom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicaM for a permi[ subjecls the applicant to a civil penalty of nol more than
fve undred dollars ($500).):
i;;as owner of ihe property, or my employees with wages as their sole
c�pensation, WILL DO THE WORK, and the structure is not intended or
' offered for sate (Sec. 7044, Business and Professions Code: The Contracrors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such vrork himself or herself or through his or her own
employees, pmvided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
complelion, Ihe owner-builtler will have the burtlen of proving [hat he or she
did not build or improve for purpose of sale.).
❑ I, as owner o( the property, am EXCWSIVELY CONTRACTWG WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Pro(essbns Code: The contractors License Law dces 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 Ucense Laws.).
❑ I am exempt under sec.
Business and Pro(essions e �� this,r �on:
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CSig��dNfG' �y�'i L.D9t2�----I
]-4fi(3I01)
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Owner ID verifed by driver's license.
exP� ire5_�r� v �2
Verifcation of Ownership by (type of document, i.e. - property t x bil or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation fve (5) or more feet in depth into which a
person is required !o tlescend, will be made in conneclion with work authorizetl
by ihis pertnit, and that no builtling slrucNre, scaffdding, falsework, or demolition
or dismantling thereof, will be more ihan ihirty-six (36) feet high (Chap. 32, Gry
2, Art 2, Sea 341, Title 8, Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to do vrork which vrould
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit �o do such work (rom the division.
Applicanl's Signature Dale
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applican[ or present or (uWre builtling occupant need [o file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Seclion 25505 of [he Cali(omia Health antl Safety Code requires, with some
exceptions, that a Business Plan be liled with the Costa Mesa Fire
Department by every business which has at any one time tluring a reportetl
year a quantity of hazardous materials equal to or greater Ihan a weight of
500 pounds, or a volume o( 55 gallons, or 200 cubic feet of compressed gas
at standard temperature antl pressure).
2. Does or will Ihe applicant or present or future building occupant need to fle
a registration form for acutely hazardous materials? ❑ Ves ❑ No
(Section 25533 of the Califomia Health and Safety Cotle, with some
excep�ions, requires registration with the Cosla Mesa Fire Departmenl by
each business which at any one time has on hantl a quantiry of acutely
hazardous materials equal to or greater than a weight of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
[emperature and pressure).
3. Does or will ihe applicant or present or fuWre building occupant need to
prepare an RMPP (Risk Management antl Prevention Pmgram for acutely
hazardous materials)? ❑ Ves ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, cerlifcation antl
fling with the Fire Depariment 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 ❑ No
5. Does or will the applicant or presenl or fu[ure builtling occupant require �or
Ihe vrork which is Ihe subject ot this application a permit Ior such construction
or modifcation from the South Coast Air Quality Management Dislrict or from
any other air pollution control distnct or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requestetl
information be fumishetl on applications Fa non-residential builtling pertnits).
6. Will any part of the facilily to be consiructed untler this permit be within
1000 feet from Ihe outer bountlaries ot a school? ❑ Yes ❑ No
Qf "yes", the facility must meet the requirement of Sections 25534 and 42303
of the California Heallh and Safety Code).
7. If a permit from Ihe South Coast Air Quality Management DisMct or other
air pollution control dislrict or agency is required for the work which is the
subject of this applicatioq have all of the disclosures prescribed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach certifcate of compliance (rom Ihe appropriate air pollution
control oKcer�.
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 regartling Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury that I have read this application and state Ihat
the information given is correcL I agree to c pty with all state laws and city
ordinances relating to �in onst o antl authorize representatives of
yWf
the Ciry of Co�6sa t� en �up the above-described property for
in ection pur s I agr e �to o� py or allow occupanc JJJany ilding
auth ized��pcm» � i�f�JI'rfsp ction. /� ,)
(/ � (/
5enatu�orLTeBalOvmerfs)_�a -...�^,— /
.
�— � � y of Costa �l�lesa �13uiC, zg 1�ivisioia
77 Fair Drive, Costa Mesa, CA 92626
oSta 1YA��7C� 714-754-5273 / Fax 714-754-4856
��/VNER �I�I�D�� V��aFI��`����J
Permit # �'�y) ��571 �J
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in yo� r na� listin yourself as ihe builder of the
property improvements specified at .�14` /�/ ./.s //L ./iJ'� il� � 4Z6Z.6
VVe are providing you with an Owner-Builder Ackno�vledgment and n�ormaticn Veri ication Form to mz4e you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute lhis notice unless you, lhe property owner, obtain the prior approval of the permitting
authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
qI�ZECTIONS: Read and initial each sta ement belo�v to signi(y you understand or verl(y tliis in(ormation.
1 I II 0� �
\''�� 1._I�understand a frequent practice of unlicensed persons is to have lhe property owner ob(ain an "O�a�ner-
Builder" building permit that erroneously implies ihat the property o�vner is providing his or her own labor and
material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. h1y
homeowner's insurance may not provide coverage for those injuries. I am will(ully acting as an Ovmer-Builder
and am aware of lhe limits of my insurance coverage (or ir,juries to workers on my preperty.
�'1'�I�understand building permits are not required to be signed by property owners unless !hey are
�res onsible for the construction and are not hiring a licensed Contractor to assume this responsibilily.
;I�understand as an "Owner-Builder" I am fhe responsible party of record on lhe permit. I understand lhat
I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
or ��,r name instead of my own.
laundersland Contractors are required by law to be licensed and bonded in California znd to list their
numbers on permits and contracts.
\L'Y I_understand if i employ or otherwise engage any persons, other than Califomia licensed Contractors,
and the total value of my construction is at least five hundred dollars (5500), including labor and materials, I may
t�apnsidered an "employer" under state and federal law.
i� ru,_,
c=-6_ I,.understand if I am considered an "employer" under state and federal law, I must regi=_ter with the stzte
and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my faiiure to abide by these
�ay subject me to serious financial risk.
7. I-understand under Califomia Centractors' State License La�v, an Owner-Builder who builds single-famil/
residential structures cannet legally build them with the intent to offer them for sale, unless all v:ork is performed
by licensed subconlractors and the number of structures does not exceed four within any calendar year, or all of
t ork is performed under contract with a licensed general building Contractor.
I understand as an Owner-Builder if i sell the property for which this permit is issued, I may be held li�ble
tfor-any financial or personal injuries sustained by any subsequent owner(s) that result from any latent
construction defecls in the workmanship or materials.
1 of 2
a
� � . . .. • .
�;g-1 understand I may obtain more informalion regarding my obligations as an "employer" from the Intemal
evenue Service, Ihe United Stales Smail Business Administration, ihe California Deparlment o( Bene(it
Payments, and the California Division of Industrlal Accidents. I also understand I may conlacl the Califomia
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or ww�v.cslb.ca.gov for more informalion
bout licensed contraclors.
, O=Pam aware of and consent to an Owner-Builder building permit applied for in my name, and undersland
that I am lhe party legally and financially responsible for proposed cons!ruc!ion activity at the follotving address:
�11'. I agree thal, as lhe party legally and financially responsible for lhis proposed conslruction acliviry, I��riil
abide by all applicable laws and requirements lhat govern Otivner-Builders as well as employers.
�-'(2.-I_zgree to notify the issuer of this form immediately of any addi;ions, dzletions, or changes to any of the
information I have provided on lhis form. Licensed contraclors are regulated by laws designed lo protect the
public. If you contract wilh someone who does not have a license, the Conlraclors' Slate License Board may be
unable to assist you wilh any financial loss you may sustain as a result of a complaint. Your only remedy againsl
un{icensed Contraclors may be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your properly, you may be held
; : ' , o � �__ � �_ �_
�12b e Of 8fT1^uCJ'Bu. �f y0U C ulfl 8 NEi^lit aS �L'r'fic�- lii CiEf af1G� Vr'iSil t0 ilii2 CvfliiaL�viS� y'GU Wli� uc (c�pcns� ic
for verifying whelher or nol those Contrac[ors are properly licensed and the status of their workers'
compensation insurance coverage. � �
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit. Note: A copy of the p�operiy owner's
driver's license, form notarizatron, or other veri Icat' ptabie to the agency is requi�ed fo be
presented when the permif is issued 6 veri th pr er ner's signature.
Signatu�e of;nro�erty o�ti�n r �ate-_�, � v
�
^Jo,e: T"e fcl;ow,'r,g AuL �crization Fcn-n is reGuired to ba compfeied by iha prupaiiy uwiiar unly ivhen
designating an agent of the property owner to apply for a construction permit for the Owner-Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding lhe Notice to Property Owner, the execution of which I understand is my personal responsibility, I
hereby authorize the foilo�ving person(s) lo act as my agent(s) to apply for, sign, and file lhe documents
necessary to oblain an Owner-Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
I declare under penalty of perjury that I am the properly owner for the address 4isted above and 1 personzlly filled
out the above information and certify its accuracy. fvbte: a copy oltha o�vnar's driver's license. iorm
notari:ation, or other verification acceptable to lhe agency is required to be presented when the permit is issued
to ve�ify the property nwner's signature.
Property Owner's Signature:
Dale:
2 Of 2
TYPE Oi
INSPECTION
HEUUIRED
Job Atltlresy-� � �,
j
JOb Na[[+e,—+�
� G
Type of Siructu�e
AQpferiol Descnpflon
Inspector(s)
D IN3PECTORS'�AILY
[]'Reinforced Co � refe
� Posi Tensioned Concrete
� Reinforced Masonry
�
TVPE OF SAMPLE I SLUMP
:
. �
❑ Siructural Sieel Assembly
❑ Fire Proofing
❑ Asphali
Ciry
Pl�f)Yi - �O.r7 St %
Engineer
SWIT Job No. pate �
r�
❑ Quality Control
� Other � n � C„
1' ..!
n
TESTS PERFORMED
.�UANTITV IN SET ADDITIONAL REMARKS ON SAMPLES
INSPECTION SUMMARY — LOCATIONS OF WORK INSPECTED, TEST SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS, REMARKS, ETC.
� INCLUDES INFORMATION ABOUT- AMOUNTS OF MATERIAL PLACED OR WORK PERFORMED, NUMBER, TVPE & IDENT. NO'S OF.
TEST SAMPLES TAKEN: STRUCT. CONNECTIONS IWELD MADE H.T. BOLTS TORQUEDI CHECKED, ETC.
G(�OL"'i�P � Y1 t� PS D51 �1 �^�ov/1 C� 1"' IIF /'� . iU �P �
' �I , � � --- - - t � - -t r' '-�v _ . !`_ -�-
�
CEqTIFICATION OF COMPLIANCE CONTINUED ON NEXT PAGE U PAGE OF
IHEflEBVCEPTIFYTHATIHAVE0B5EHVpDTOTHEBESTOFMVKNOWLEDGEAILOFTHEABOVEAEPONTEU TIMEIN TIMEOUT REG.HOURS O.T.HOURS CYLINDEflS
WOAK UNLESS OTHEPWISE NOTE�. I HqVE FOUND THIS W� TO COMPLV WITH THE APPROVED PLANS,
SPECIFlCATIONS, AND APP.LICABLE SEQIONS OF TNE qWNG 6UILDING LHWS. � OO �•�O
//�� All inspections based on a mini um of 4 hours and over 4 hours - 8 hour
/ ,�'is� / ��"� minimum. = �
/�J�j/� IGNA' OF EGI EFEDINSPECT �%' � . '�r' � `
' ` �^ �a �i �`� �5� - y � .?- r c" Approved by.! =� � ��—'i
SPECIALTV N0. AGENCY � �
Pmject Superintendent
WHITE - OFFICE COPY, CANARY - ACCOUNTING COPY, PINK - INSPGCTOR'S COPY, GOLDENROD - JOB SITE COPY
CITY OF COSTA MESA, BUILDING DIVISION
SPECIAL INSPECTOR REGISTRATION
� '�b Address P U �O Y � � 'l a nr�,.� Q— � � �� �b � Permit # �—(if/��(D
� . . ,�
,pector's Name �
Residence Address
Laboratory
Address _
� � V 4, ['S_O.!' DC�(T � Phone#
Number & Sireet
r�;s+; �i;� ���
Ciry State Zip
Sireet
Cily
All licenses listed below must be currently valid and legible copy(s) and must be attached to this registretion.
ZiD
DISCIPLINE L.A. COUNTY L.A. CITY ORANGE COUNTY OTHER
Concrete
Ductile Momen� Resis�ing Frame
Reinforcing Steel, Presiressing Steel �-�"�"-
Welding
High Sirengih Bolting
Siructural Masonry
Reinforced Gypsum Concrete
Insula�ing Concrete Fill
ayed on Fire Pmofing
Pilings, Drilled Piers, Caissons
Special Greding, Excavation or Filling
Special Gases Unusual Hazards
I hereby cerlify that I am qualified by training and experience to pertorm the inspections for which I hold ihe above listed Special
Inspectors licenses, and will provide all certifications required by ihe City of Costa Mesa.
Q
I will insped and certity the following procedures and locations:�nr,x�. '$rr� Xi� S�.,r..rr ��
1 will certiiy not only to the job condltions but that they are In conformance with the approved plans. It at any time, progress occurs
on the above meniioned job relating to my area(s) of responsibility, without my knowledge or approval, I will stop the jobs process
immediately with nofification in wri�ing to ihe job superintendent and notify ihe Building Division of ihe situation. A record of my tests and/or
inspections as agreed to above will be available upon request by the Building Division. Upon request I will submit a complete package of
testing and inspedion results. A letter certi(ying satisfactory completion will 6e provided by me upo �mpletion.
This registration is accepted�nd approved by:
� ___�_,_
��a
�6'"
Date
ir
. � ; 49U5
COSTA MESA BUILDING DEPARTMENT
P. O. BO% 31 �
COSTA MESA. CA�IFORNIA
FOR APPLICANT TO FILL IN
OWNER <
MAIL
ADDRE55
CiTY LO:i I
ARCHITECT
OR ENGINEER
ADDRE55
COSTA MESA. CALIFORNIA
TEL.
NO.
LIC.
NO.
Land „ ���� ;�� �
LEGAL ILOT �1 I I
oESCAiriioH ry0. G� BLOGK TRACT
A.P. NO.
SIZE / ^ NO.OF 9LOG5.
OF LOT OOGV rvow Orv LOT j�]
USE OF
EXISTING BLDG.
SETBRCK LINE FPOM
CENTER OF STREET i � REAR YARO i
SIDE VARp RIGHT 'J � LEFT � �
DESCRIPTION OF WORK
NEW � ALTERATION ADDITION
REPAIR MOVING DEMOLISH
5 ZIE DING l�l/D ROOMS 6 STORIES
EXTERIOR WALL�,. ROOF
e
FEE RECEIVED
FI�}u�y5-� J�J
DE�PT.
APPE��fPFI��Pl}Fk�1 PERM IT
BUILDING
FOR OFFICE USE ONLY
BUILDtNG
A�DRE55
COSTA MESA. CALIFORNIA
FIRE
ZONE
ZONE �
APPROVED
CORRECTIONS
NtBY FCtt1JOWl[OGE l MPVE REAO TXIS APPLICTTION tNO
STnTE TNAT THE ABOVE IS CORRECT f�NO PGREE TO COMPLV WITM ALL
CITV OR�INANCE$ RNO STATE LAWS REGIILATING Bl11LDING CONSTRUC�
norv. VALIIATION
SIGNATURE OF � PERMiT FEE $
PERMITTEE
PLAN CHECK �
�J/ s �� ���
AUTHOR�z A EN t I TOTAL FEE $
��
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OWNER SLR�fMi'RLAND LQND CO DATE (1_2f1_S']
JOBADDRESS 3105 Barbados Place BUILDINGPERMITNO. �{I,�S77
GENERALCONTRACTOR OWri2T` Bldr.�.` VALUE $ ZZ.I1Zi1.0O
LOT 2�. BLOCK TRACT 2j53 Res. W�3tt, ear.
GROUP I R[ J TVPE V ZONE RZ FIRE DISTRICT Lt9OS
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR DATE I NUMBER
Foundation Forms and Grade to
to
Pole
-�-ti � i y ;�.�x ✓
` Wirinq.Rou9h „C �}� 17..�'.l71'�. //7r Z`�t _ Ila-i� -.171 �rl'Y'f �/
Heating,Final !,,/ �'vlG�7 /-/ iS'
9ewer, House �/IL Sewer, St. �,/�,'V 5!-7 �'S L Q' 3Ty �
Septic Tank or Cesspool ��
Lathing, In i� Out i �•"): -,�"d(p "�
Plasterinq
Plumbing,Fin�al,FiXturesCompletetvGC1 i�,rq�.i�%
Pium6ing, Final GakTest / S�j LYlGrj .f �/4,y)
Wiring,Final /��, � �.7�'" �f ��f-.;
OccuPancY 'r/ , �.%G! fi l/ /rf2Y%
FORM 210 3M 10-vi