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Home My WebLink About398 BUCKNELL RD - Building Permits, � � CITY OF COSTA MESA � . � BYILDING DIVISION F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa. . s �. � FOR INSPECTIONS CALL: (714) 754-5626 �� PERMIT NUMBER. 607-09020 PERMIT TYPE B_ROOF2 JOB ADDRESS: 398 BUCKNELL RD CM Vicinity: FRONT PORTION OF RESIDENCE AND GARAGE Squares: 1100 STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: Valuation: ISSUED 11/09/2007 BJK 53,500.00 SCOPE OF WORK: REROOF FRONT PORTION OF A RESIDENCE AND ATfACHED GARAGE: TIO EXISTING WOOD SHAKE, SHTG AND UNDERLAYMENT pER MFG'S SPECS, APPLY 40.YEAR COMP SHINGLES. PITCH UNKNOWN BY PROP OWNER. 17 SQUARES OWNER: ALIEN, LEONARD R TR PHONE: APPLICAN7: ALLEN, LEONARO PHONE: 714-751-7228 CONTRACTOR: O W N ER-BU ILDER Address: Unit: CitylState2ip: ARCHITECT: ENGINEER: FEE SUMMARY Reroof Plan CheCk: Reroof Permit Fee: Reinspection Fee: TOTALFEES $0.00 $97.25 $0.00 597.25 Address: 398 BUCKNELL RD CitylState/Zip: COSTA MESA, CA Address: 39B BUCKNELL RD CitylState/Zip: COSTA MESA, CA License No. License No. PHONE: License No. 000000 CELL: PHONE: PHONE: � � Ip 3 UniL• Unit : NOTICE: The work authorized by this permit shall wmply with all applicable handicap access requirements under Calitomia statutes and re�ated regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the vrork authorized under this permil to be wnsidered legal, such work musl comply with all applicable codes, and all required inspecttons and final approval must be obtained. Failure to obtain inspeclions and final approval will result in Ihe expiration o( this permit. L�O,�, INSPECTIONIYPF O�T IN7fIIALS COOEI INSPEC710NTYPE Q�j$ IN7IlUL5 1616 fixed Syste�h Final Fire Preveniion 206 Final Mechanical 7266 Poo15pa final 208 Final Ptumbing � 200 Final Re-Roq( E�1 210 Final Electncal 201 Final Bbck/Retaining Wal! 212 Final Fire Prevencion 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 FinalOemolition ' 250 Final Building/Occupancy � ' WORKERS' COMPENSATION DECLAR�ITION: � I hereby aHirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 ot the Labor Code, for the performance of the work (or whicb this permit is issued. ❑ I have and will maintain v.orkers' compensation insu2nce, as required by sectbn 3700 of I�e Labor Code, for the peAormance of the work fw which this pertnit is issued. My workers' compensation Insurance carcier and policy number are: Cartier: (iM1is sed in neotlnof De cwipeletlllfre pemuf k ruNxl ef ine frwiNMWlars (5100) a�bssJ Policy Number: � I certity Ihat in Ihe pertormance Of lhe work (or which this permit is issued, I shall not employ any person in any manner so as to bewme subject to the wnrkers' compensalion laws of Gatifomia, antl agree thal I( I shoultl become suGjecl to the workers' compensalion provisions of Section 3700 of the La r Cotle, I shall forthwith wmply wIN these provisions. �1r��. 4� //- 9-O% � � Ap0liranfs Signat Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAFtS ($100,000), IN ADDITION TO THE COST OF CAMPENSP.TION, DMMGES AS PROVIDED FOR IN SECTION 3706 OF YHE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrtn Ihat I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business antl Professions Code, and my license is in full force and eflect. Lic. # Class # Contractor's SignaWre Date CONSTRUCTION LENDING AGENCY: ❑ I �ereby affum that [here is a c�stmction lending agency fa the pertortnance of the �wrk fa v.fiich tNs perrnii a asuetl. (Sec. 3097, Civil Cotlej. Lender's Name: Lender's Address: Ddle OW NER-BUILDER DECLARATIONS: I hereby atfvm Nat untler penalty of perjury thal 1 am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for lhe following reason (Sec. 7037.5, Business and Professions Code: Any ciry or counry vmich requires a permit to conslruct, alter, improve, demolish, or repair any structure, prior lo ils issuance, also requires [he applicant for such permit to file a signed statement t�at he or she is licensed pursuant to �he provisions o( lhe Conlractors License Law (Chapter 9(commencing with Section 7000) of Division 3 0l the Business antl Pro/essions Code) Or that he or she is exemp� therefrom antl ihe basis for Ihe alleged exemption. Any violation ot Section 7031.5 by any appliwm for a permit sobjects the applic2N to a civil penalry of nol more than five huntlretl tlollars ($500).): ❑ I, as owner of the pmperty, or my employees vnth wages as their sole compensation, WILL DO THE WORK, ynd the structure is nol iniended or offered lor sale (Sec. 7044, Business and Professions Code: The Contractors License Law tices not apply to an ovmer of property who builds or improves thereon, and who does such work himsel� or hersell or through his or her ovm employees, provided that such improvements are not intended or oftered lor sale. Il, however, the building or impra�ement is sold within ona year of completion, the owner-builtler will �ave t�e burden of proving that he or she did not build or improve for purpose of sale.). I, as ovmer ol ihe property, am E%CLUSIVELY CONTRACTING WITH IC SED CONTRACTORS to wnslrucl the project (Sec. 7044, Business and Professbns Code: The cont2ctps License Law tices not appty to an rnvner of property who builas or improves thereon, antl who coniracts for suc� project with a contracta(s) license pursuant to the Contcaclors License Laws J. � I am exempt under sec. Business and Professions Cotle for this r6ason: !/ - 9-�% Signatum Date 5'!i6 (3/0]) Owner ID venfiea by tlriv e. � Yes ❑ No Driver's License No. Expires' �� Venfication of Ownership by (type of document, i.e. - properry tax �ill or tleed): DIVISION-OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: � ❑ I hereby certify Ihat no ezcavation frve (5) or more leet in depth inlo wfiich a person is requiretl to descend, vnll be made in wnnection with vrork authonzed by this permit, and that no builtling strucwre, scaftdding, falseaork. a demolitbn or dismanlling Ihereo(, will be more Ihan thirty-s& (36) (eet high. (Chap. 3.2, Grp 2. Art 2, Sec. 341, Ttle 8, Califomia Administrative Code�. ❑ As ovmer-builder, I will not employ anyona to d0 wnrk which would require a permit trom the Division of Inaustrial Satety, as noted above, unless such person has a permit to tlo such work from the division. Appliwmb SignaWre Division o( Intlustrial Safaty Permit Number. _ HAZARDOUS MATERIAIS AND EMISSIONS CERTIFICATION: 1. Will Ihe applicant or present or fuNre building occupant need to file and certify a Business Plan for emergency response to releasa or I�reatenetl release of a hazardous matenal? ❑ Yes ❑ No (Section 25505 of the California Health and Safery Code requires. with some exceptions. Ihal a Business Plan be fled with the Costa Mesa Fire Department by every business which has a� any one time tluring a reported year a quantily ol hazarCous malenals equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of wmpressed gas at standartl temperature and pressure). 2. Does or will the applicant or present or tuWre builtling occupant need to file a registration �orm for aculely hazardous materials7 ❑ Ves ❑ No (Section 25533 0( the California Health and Safety Cotle, vrith some excep[ions, requires registratlon with the Costa Mesa Fire Department hy each business which at any one time has on hand a quantity of acutely hazardous matenals equal to or greater than a weight of 500 pountls, or a volume of 55 gallons, or 200 cubic teet of compressed gas at standartl temperawre and pressure). 3. Does or will the appliwM or present or tuNre building occupant need to prepare an RMPP (Risk Management antl Prevention Program !or acutety hazardous materials)7 ❑ Yes ❑ No (Section 25534 ot the Califomia Health antl Safery Cotle proviCes that t�e Costa Mesa Fire Departmenl may require the preparation, certifiwtion and (ling with the Fire Department o! an RMPP by businasses which are requiretl to register acutely hazardous matenals vrith the Fire Deparimen�. 4. If an RMPP is presentty required, has Section 25534 of t�e Califomia Health and Safaty Code been fully complied with? ❑ Ves ❑ No 5. Does or will the applitant or present or fWure builtling occupant require (or the work which is me subject of this application a pertnit for such wnstruction Or mOdifcalion from the South Coast Air Quality Management DiStrict or from any olher air polWtion control district or agenry? ❑ Yes ❑ No (Section 65850.2 of the Califomia Govemment Cotle requires Ihal the requestetl information be fumishetl on applications for rron-re5iden�ial building pertnits). 6. Will any part ol Ihe facility to he constructetl untler thi5 permil be within 1000 feet fmm Ihe outer boundanes of a school7 ❑ Yes ❑ No Qf yes', the faciliry must meel the requirement of Sections 25534 and 42303 o( ihe Califomia Health and Satery Code). 7. I! a permit from the South Coast Air Quality Management District or other air polWtion control district or aqency is requiretl for the work which is the subject of Ihis application, have all of the disclosures prescri�ed by Califomia Heallh and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If yes", attach certificate of compliance from the appropriate air pollution control oKcer). CERTIFICATE OP COMPLIANCE: I certily that untler penalry of perjury the intormation gi'ven above is wrrect. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certi(y under penalty of perjury that I have read lhis application ana state that the information given is conect. I agree to comply with all state laws and ciry ordinances relating to building consWction, and authorize representatives of lhe City of Costa Mesa to enter upon the above-tlescnbed property for inspection purposes. I aqree not to xcupy or allow occupancy of any building authonz��il unlil (� A-� //-�'i-�% SignalureolLegal er(s Date AntllOr AWhariie0 Appli�nt CI1 _ DF COSTA MESA GLIFORNIA 02626 P. p. BOX 1200 FROM THE OFFICE OF THE DIRECTOR OF BUILDINO SAFETV � �/ � �� . •.. _ � � i Project Name � /�%� �� — • L�� >.../. � _� � % � �, • •.. _ � � /. / � i � • -. . - i � � Pernut � `��' 9-l/ �YPe —� e r City Use Q�ly I �_ � as r (strike out all � pt one) do here ttest that er��nt of any person, or persons, is not anticipated at the time of seeking the above-referenced permit. in the event that any person, or persons, are e�loyed under the prwisions of this pezmit, I shall imnediately cause a valid Certificate of Worlanens Carq�ensation to be filed with the Costa Mesa Building Division. I agree to defend at my own oost, and to inde�mify ard hold harmless, the City, its officers, agents and/or m�loyees, from and against, arry arc] all liability, d�nage, costs, l�ses, claims arcl expenses, howscever caused, resulting directly or indirectly fran, or oonnected with the improv�rent under this pernut. I further state that I have rnad and fully imdecstand t sponsibilities of the above stateJnents, and will cc�ly Contractors State License Iaw found under the Business Division 3, Chapter 9, of the State of California. � FPJ ti '4'�" � ,c�. A2-C�"� Print Name I L �-s", -L�� ,/� ��% /Lri� /� GMF 0777-46 he implications and rr with all provisions of the ard Professions Code, � / � I]3te APPLICATION FOR A BUILDING I MIT BUILDING PERMIT NO. Eiettricai ao Tract Blotk Lot Permil No. � Plumbin9 . a B��d��9 7 d S��l � Atltlress Permit No. � CroSs Methanital 6 Area Streat Pormit No. a m Owner � � �-�� TYpe ot Project: ❑ New Alter ❑ Aatlitlon � Atltlress ��nJ�j�� , ❑ Repair ❑ Convert ❑Demo ❑ OccupancyPmt. Clty �' �� ZIP �j�Phone —� A.P. Sn P.Area Architect/ D� . 1 r "� I �� Zon¢ SPI. PmL No. Deslgner �� ""� � License No. ' SetOacks P/L Front C/L SL $treet Witlt� Atltlresi Ya�Gs I,.eit R gh ear ��ty 21p Phone ave ro�. e 9 . . r Engin¢er Ucense No. � rk ng Spates equ re rov e overe a Atltl�Ms m City Zip Phone Struct No. of No. of Height Stories Family Y Park Fees Ves Fee � LICENSED CONTRACTOR'S DECLARATION C.T. Recei m I heraby afflrm thet 1 am licansad untl¢r provis�ons of Chapter g RequlreG No PL t (commencinp witn Section 7000 of Division 3 ot the Business und Zoning Approvetl By: Date Profassions Cotlo, �ntl my licenza is in full force and ef(ectl. � Llcensa Clas License Number T Dale Convactor Misc. E Atltlress ProPoSed Use of Structure jy City antl Zip Phone � CONSTRUCTION LENDING AGENCV � I hareby effirm that t�ere is a conzlruction lentling agency for the a parformance of tho work for which ihis permit is issuatl (Sec. 3097, Occ. Type Cotle ' Civ, CJ. Class Const. Year y Lantler's Nama USE/OCCUPANCV SI2E SQ. FT. C Lendar's Atltlress J OWNER-BUILDER DECLARATION r I hnroby affirm tM1nt I em exempt from the Conhactor's Licensa Law 1� � tor e tallowing raason: � I, as ownar ot t�e property, or my employeas with wages as their 2. C sole comyenmNon, �will Co tha work, antl Ne snvcture is not �t„ intendetl or o/fB�eC for sele. � ❑ I, as owner tl< <�e praperty, am axclusively conhacting with 3' licensetl convaCtors to conshuct tha project. d ❑ I a axam t u�der Sec. P t's reawn 4� - e�=2�� — a ont ner E WORKERS' COMPENSATION DECLARATION Total Valuation � 1 heroby atfirm rhot I heva a carNficate of consenc to self-insure, Encroachment Pe�mit ReqWretl ❑ V¢s ❑ No or a certi.'itato of 4Vorkeri Companaation Insuranca, or a tertitied C copy thareot. Gratlin9 Pmt. Gratlln9 8 Palicy No Campany Requiretl ❑ Ves ❑ No Pmt. No. �a ❑ Certitled copy IA horeby turnishetl. Rough Gratlio9 y G ❑ Certified copy i4 ��od with O�ange County, EMA. �p Q Approvetl by: Da[e Date APo�icant 3 GER7IFICATE OF EXEMPTION — FROM WORKERS'COMPENSATIONINSURANCE Z (This sec[ion nead mt be tompletetl if parmit Is for $100 or less�. � I certlfy that in the Partormancn of tha wo�k tor whic� this permic is � isauetl, I shnll not employ eny person in any mannor so es to become �p sub�oct to rne Workors' Compensacion Laws ot California. PERMIT FEES Det� Applicent NOTICE TO APPLICANT: It, at[or making this Certificate oi Struttural S Plan Chetk E Exemption, you should Oecome sublact to tha Workeri Compensation provisions ot tho babor Cotle, you must torthwith comply with soch 5 SPecial 5 provisions or [hia p0�mit shall be tleemetl revokatl. ElecVical ��ezt. I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFOFMATION IS CORRECT. I AGREE TO Plumbin9 S COMPLV WITH ALL COUNTY OFDINANCES ANO STATE LAWS REIATING TU BU�LDING CONSTRUCTION, AND HEREBV AUTH� Me<hanical E ORIZE i7EPRE5ENTATIVES OF TNIS COUNTV TO ENTER UPON THE ABOVE MENTI NED PROPE TV FOR INSPECTION PUR- p�y_Gratle P S . �� 7�f (A� InSPectlon E O'� /—Q l/ Pre-Gratle Permit ' ure of Applicant or Age Da[e Rec. No. $ Issue s � Print Applicant'slA9ent's Name All spaces within this box must ba completad to process P�a� Issuance CheCk By: Approvetl: �,mr vaao-va �eu-zo� �ev. oioo OWNER ��A� R � DATE R�/80 JOB ADDRESS 39g g�]mell Road BUILDING PERMIT N0. snscai AP No. 141-422-06 LOT 13 TRACT 2750 FIRE ZONE VAWE c �s W�TEa MISCELL�NEOUS IJ V ING UN�ERGROUNO U POWEN ROUGH WIRING TRENCMES � FORMS �r v BOuo 6E�M [� STE � $HERTNING �FRAME RHO FLASMING LRTHING — IN [� ( .�PLASTER. BROWN CO�T IEFRIG. AND A.C., FIN11l RN� GAS TEST rI FI SUBCONTRACTOR � COSTA MESA BUILDING-SAFETV DEPARTMENT !. P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BVILDING ADDRE55 knJFcr OWNER OR N�, �LLEn/ TENANT MAI LI NG ADDRE55 TEL _s GTV NO. CONSTRUCTION LENDER l�I I./ BRANCN APPLICATION RECEI VED�1' A.P. NO. �u/ - y�- ( BUILDING qn� �� HODRESS JT UNIT OR SPACE NO. !��`; � li� ��a*��:. URALPERMIT 50 TL� �° - 50591- � � � -�G E�-C �� BLK. MOVING DEMOLISH OWNER ��NN.FC � '� , e ADORESS VALUE ARCHITECT TEL. � USE �� G LIG� $ DD' OR ENGINEER � � N ADDRESS � 20NE � TYP�^ GROUP /. l APP OVED CONTRACTOR `v �n%� BY DATE '� ADDRESS TEL. CITV NO. F STATE CITV APPROVEDSETBACKS LIC. NO. LIC. NO. � SIZE NO.OF BLDGS. (FROM G/LSTREET) v. OF LOT NOW ON LOT OfYT FT. a USE OF � EXISfING BLDG. H FSeparate permits are required for �, i FT. � electric, plumbing and heating work. Fr. F USE OF BUILDING AND WORK TO BE PERFORMED LANNING ACTION Q � ; � DATE �J Q, C �ROVEC�J � OV } ..l a w � I �ereby acknowletlBe thet I have reatl this eOPlication antl rtete \ � that Me ebova Informatlon is corract and agrea to comply with a all laws regulating builtlinB eonsttuction, antl 1 shall not employ � Z any person In viola[ton of the workman's compensation lews of ? = Ne Staie of Californie. � 0 3 1 �ereby certity thet I am proparly licansetl as a coniracior untler SQ. FT.' � OO � N the Siete of Californle Business antl Proteuionz Cotle, Dlvision 3, THE AMOUNT SH WN UNDER VALUATION IS FOR m Chepter 9, and that cuch licancas ere in full torce entl effect, or I THE PURPOSE OF ESTABLSHING A PERMIT FEE ONLV: e em exempt from Ma provlslons o( tha State of California Business VALUATION PERMIT FEE E entl Profoszions Cotle, Oivision 3, Chapter 9. �-� � � �/ ^n m SIB^ature Of �/',��hv_ �. _ p/Q � //� /% PLAN CHECK S � o Parminea b�/ k�JC.d�'✓� . X 57O (J '� TAx a O/ C7�'l� O U Author(zatl Agent Date �S .L TOTAL PqID S 4�� c� OWNER COSTA MESA ESTATES ' oATE �'12-�6 JOBADDHESS 398��kT�ell Road BUILDINGPERMITNO. 2613 GENERALCONTRACTOR �ven-Spiegel Co VALUE $ 11�ZOO.00 LOT 13 e�ocK TRACT �75� Single Res x/att gar CROLIP I& J 7VPE V ZONE R�-� FIRE DISTRICT 2635 INSPECTIONS Footing Trench Foundation Forms and Grade to G Rough Framing Plumbing, Rough fo 91abs,.Lf 0. Plumbing, Rough Complete ' Temporary Pole Wiring, Rough Heating, Rough y� Heating, Final � ✓sewer� House� L sewer, st. Septic Tank or Cesspool Lathing,ln Out r Plastering Plumbing, Final, Fixtures Comple� Piumbing, Fin.al GasTest /S'�_ Wiring, Final Occupancy - FOPM 110 3M 10�55 PERMITS ISSUED DATE SUBCONTRACTOR DATE I NUMBI r _� ��- +' .l G lo/� �I' '� -� 3a i a— _ _� i z�r - ,,«Costa Mesa Building Department . 117 EAST 20th STREET ' - COSTA MESA, CALIFORNIA • FOR APPLICANT TO FILL IN 3uilding � /�,�J / „a �� 4ddresa �- % �[c( COSie, eS&, CalifO �fl, Nearest Cross SL man /7 i q r.! <- Address J d �7o Cti / /i i � TeLI!/C�� cicy fL0 Gi .tiGz�"G�S nlo. �✓ % Aroh itect or 1� �L�� Lic. Engineer 7�-G� C/� U. No. Address%�U��'"� �L�6. �iP7�'773/Y/,f� Contractor 0U�i4�7%�Ev Cc City LI •�' /6 Z �L No. /� iY� 5� J� ll , �' // ' Address. � /. �� i� �l/Ei Descriptlon I Not �/ I Block j Tract�t N d (Attach Meteaand Bounda) �� / No. of Bldgx SizeofLot �ry'�'�iX�C%�.1� NowonLot Useof � No.of No.of Existing Bldg. I Families I Rooms Set6ack Llne from ` i Rear Vard :77. L�i CenterofStreet .)� � SldeVard c-Y9•a' � I Alteration I I Addition e�uni�g �f 3x � o Ne. o, Bize Rooms 4 Exterfor Wall I Roof Covering iTU�i�,e Coveri G APPLICATION'FOR PERMIT ��3� BUILDiNG � � FOR OFFICE USE ONLY I Receipt No. Permit No. 0�2-(� �� Received by Date Rec'd. Date Ipued � /�"� S� —� L —�� /� — Building �j �7 Address � / O < Costa Mesa, California zone�� Approved Plans APPROVALS �n Location Inspecto Materials, �inntng ire Stops, . Bolts I hemby acknowledge that I have read this ApplicaUon and state that the above is correct and agree to mmply Lath. Int with all Ctty Ordinances and State Iaws regulatlng building ConstnlCtion. Lath. Ext Stgnature of �5r/j'- //�E�j�}�- �i�%� Permittee �Y Plaster, InL AuthoNzed Agt � lC��7 plaster, Ext Valuation Permit Fee $ C, — Mawnry Re � Plan Check $ � T� Bond Beam $ �� Total Fee $ Z- � FINAL uwi NN R_RP .RTrf ILi4 Grou O � � 2 D r PLOT PLAN Show Iocation and dlstancea from property Ifne and between bulldings. .� , �.,-� �a=�' � �;z : �, � ^� . {�p4�;, ,; ,. _ Fc 5 LV 0. Q � y � F ' COSTA MESA BUILDINGSAFETY DEPARTMENT APPLICATION FORJSTRUGT,U�AL PERMII�' I 5005 TL � r•vuV^'LVV Vvu•^1•"V^•V^` V••'••^JLVLV RECEIVE Y PERMIT N� 50Q82 For Applicant to Fill in Completely — Use Ink Only BUILDING � � ' A.P. NO. e ' � ADDRESS G NELL /// BVILD G OWJNn.EROR Q��N��/ /�,�� .� R/1� e� ADDRE55 � \�' T� ,/'aC:l q UNIT OR ADDRE 5 � / � �KNh� �� SPACE NO. p � LOT BLK. CITV �5 �� .5.7- NO�� /.9 NEW ADD ALTER REPAIR MOVING DEMOL�SH CONSTRUCTION LENOER N NL � BRANCH OWNERL�ar' Ie.+ti ADDRESS � -(J , VALUE ARCHITECT 7EL.y��,. /� VSE �DONYL [CRv� S O'3(j ORENGINEER O WNC2 3Tk+ J�+ ADDRESS � ZONE TVPE��N GROUP —3 APPROVED CONTRACTOR /JE BV DATE — C� ADDRESS ~~ TEL. CITV NO. STATE CITV APPROV SETBACKS LIC. NO. LIC. NO. SIZE // � / NO.OF BLDGS. G (FfiOM C/L T T) OF LOT (� �� NOW ON LOT �L— OM EXISTINGBLDG. �f/H��- ~r� / G Separate permits are required for �, sio ' electric, plumbing and hea[ing work. FEAR USE OF BUIIDING AND WORK TO BE PEflFOFMED PLANNIIVG ACTION ��[ DATE /L ��0� / �7:�OVED 1 APPflO I hereby eeknowletlBa thet I have reatl thia epplieetion antl stata � thet tha above Intormation Is corract antl n8ree to eomply wIM ell lews reBulating buildin9 consttuctlon, entl I shall not amploy � eny oerson In vlolation of tha workman's compensation lews of m the Stam of Celifornla. ' /S'o •� m I hereby certify that 1 em proparly Iicansetl as e contractor under � SQ. FT. N the Stete of Cali(Ornlo Business ontl Gfofesaions Cotla, �Ivision 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, antl that such licanses are in full foree antl effect, ar I THE PURP06E OF ESTABLSHING A PERMIT FEE ONLY: � om ezompt from the provisions ot the5tata of Callfornie Businesa VALUAT�ON PERMIT FEE S a antl Professione Cotla, Divlsion 3, Chepter 9. m _ �/� � — - ^ PLAN CHECK E � Sipnat�re of / /� p �/ � •�� o Permlttee r'•�L �(�y�� $�SO �•�� TAX S LL AuthorizedAgeni Date �—��a� TOTALPAID § ,O U .�