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Home My WebLink About1958 BALEARIC DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1958 BALEARIC DR Suite: Vicinity: ROOF Parcel Number: 13943113 Zoning: R1 R1 Applicant: BLANKS, JERRY Address: Arch Eng: Address: _ Address: Status: ISSUED Applied: 01/21/2003 Issued: 01/21/2003 Phone:Phone: Phone: - License: License: Zip: Owner: CUNNINGHAM, THOMAS AND JULIEANN Address , 1958 BALEARIC DR Phone: 714-740-2016. Plan Check: COSTA MESA, CA'. Zip: 92626-3513 Contractor: PREMIER ROOFING AND BUILDING CO INC Address: 17501 NORWOOD PARK PL Other: $0.00 -Phone: (714) 573-0155 TUSTIN, CA Zip: 92780 License: 634404 Arch Eng: Address: _ Address: Status: ISSUED Applied: 01/21/2003 Issued: 01/21/2003 Total: $252.68 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existing: 0 PLANNING & ZONING Rear 0-0 Left 0-0 Right 0-0 Rear 0-0 Left 0-0 Right 0-0 Required: 0 Proposed: 0 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: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. 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. FOR INSPECTIONS CALL: (714) 7545626 2646-06 IBM) Phone:Phone: Zip: - License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 7/16 OSB, 1 LAYER OF 30# FELT, HANSON_STANDA_RD WEIGHT FLAT TILE. 3,800 S.F. INCLUDES ATTACHED GARAGE AND 400 S.F. FOR WALKING DECK. ICBO #3748. FEE SUMMARY Plan Check: $0.00 — - Calc Valuation: 814,300.00 , Permit: $251.25 Claim Valuation: 814,300.00 SMTP Res: $1.43 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $252.68 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existing: 0 PLANNING & ZONING Rear 0-0 Left 0-0 Right 0-0 Rear 0-0 Left 0-0 Right 0-0 Required: 0 Proposed: 0 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: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. 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. FOR INSPECTIONS CALL: (714) 7545626 2646-06 IBM) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm 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 of the Labor Code, for the performance of the work for which this permit is issued. ,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 permit Is Issued. My workers' compensation Insurance carder anddpolicy number ere: r5 T%% %G /=64_ rv7 cy Z/�o2/5—i Carrier: ! Poli Number: �._ i This section need not be complmif the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the perfor nce of the work for whit s permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of ttornia, and a reg t t i oultl be subject to the workers' compensation provisions of Section 3700 of 1e Labor Code, I shall forthwith comply with these pr to ---- !� /�a � 0�3 Applicant Signature: Date: -WARNING.-FAILURE TO SEC RKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PENAL ES AND CIVIL MINES UP TO ONE HUNDRED THOUSAND DO__ARE($100, ),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed tinder provisi Cha r 9 (commencing with Section 7000) of Division 3 of the Business nd Plyf ions Code, and my license is in full force and affect. Lic. A 3 C� — Class k ` .7 Contractor's Signature: - "'Date: 7Z02,Z 1.7,3 CONSTRUCTION LENDING GENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its 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 License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her awn employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden ot.proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does 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 License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Calitomia Health and Safety Cade requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire 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 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely 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 temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the 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. ............................................................................................................................................................................................................................................................................................................................................................................................ a II an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ..................................................................................................................................................1....................... .......... ........................................ .... ...................................... ............. -............. .................. .................................. 5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisa plication aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? E5 Yes 6 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ........................................................................................................................................................................................................................................................................................................................ 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................................................................................................................................................................................................................................................................................................................................................................................ 7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ B (If "yes", attach certificate of compliance from the appropriate air pollution control officer). 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 regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection pure ses. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Su gahOwner(s) D t And/or Authorized Applicant Date CODE r. INSPECTION TYPE 11aT1: INITIAL DODEE, INSPECTION TYPE DATE INITIAL� 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Finales 208 Final Plumbing 200 Final Re -Root 2 �'+-+� 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 GARRETT ENGINEERING ASSOd ES CLIENT: 11 M1 Consulting Structural Engineers REVISEDBY: CUNNIN,(H,4m G.E.A. JOB NO-: BY: - DATE: SHEET NO. / OF� �E3/6N Lomas C �i'I1Dl/E C7t11T/^d6 /moi/N6) ROFESS/ 71;ow5,w7/ONE W 5-,k/AX-t- 9.9 Psl <'IZAO 37Y.V) �Qv °we / L/lY3or�E27 3 �� F 17Aa i/01 -Y 614 af/5) � 5- x� � q� 3 1 a2z C� SdAtE0 SH TG /.� * E g <a.- FOL /,Z, k Psf le jel r6/«� 'tT�T�'UCT ti g., Lc AAv- 9TFOFCAUF�� z ¢ y Fie/Ji7/�6 Cf CCG �i�/Hf YtE QCLa�¢s) / /G� 1 OM y gmw z4eZ9"! /,o'051- Yx6ey�"�<w//XiH76 3,yAV ]AU UQo J W O am0 U Q f � W y W r0 4UOu0 1 U<z y a - J,l, tQL[,ESS 0. w yx G N�3o '-Spas W �o Ir z m a /x S%1,4 r-1 Co 7pltYe F14� /Owt2 CRJ. /v�ACL ESS X'C,�F' /4f A N/q - , I <3= t2fnA/n/N6) 43� � 1 I I 2 /z N Ilk WW 12 a rr N 14. 3 J I 9/Z- I - E-Yd•er )2•. ..8 x MEWWiz' — g' g';'-�-- g.`, q't. (f) : xo CrBv" azoI -- -(E)-SXHLTiyr C�3Y "" Sni L /x - ------ spAH-- Si f –1 T iI� I� Ll �3W -off 60_ e d== EN '=o gag e� Sao �:Fg G, ARETT ENGINEERING ASSOCIATES p n CLIENT: _ Consulting Snnenural Engineers ! /`G'✓%�E'%L ^ REVISED BY: l // UN N/lyd, /I nM CES A",-6 e 7-y'4 t90 G.E.A.JOBBNO.: G3,0/,pd BY: 1// -4:"- DATE: SHEET NO. -2 OF� A,6 -//,5L /! 985, 3h JL /Lf = Y6S',3~ i4, 7.SG z/S6Y i'S//YSvy/,zS= (fisPJ/ 07� : a, � `-/ p� -a.v- Okk )O, 7 ,Ip 6 )/zo,BJ Le 5XYL-1 ,3/7 L 8'6" iof 3,Yt/6,Yy�`/37.8.°cf 33 L o� r N-I-��.P i1 5e � 0 L=a IN= �zt Zk29.b�f/z)/-8)=365,6/'U- z 36S,Gy/6Z-// Z E3�` ll�p9•�'Z�t37iPsl �/s<sPSI -o•'� /o>. Y/ LS)CJ7ss�Dsy).//�zE) ,oma QTS 9m 0/1Sf71�97/dri- CES 7)6 P ZY "r% IN 59.6 loo -/i- Ty z _ < lis, /✓- /Zd -'- -- i -,— . .-m; 4_. m -;icy iA-.,-_a_. �k?_d,12 �A At77fW91 71.111 97 ZtFF140:SPCit�3-�1tiET?i ��Glv.Os ASO A7.E EERYTJ��f!97E. IpN.VfZ7doN I/�7Qa�Y:P1T��=/6:C Ng%4i� ADo /�a �nnrN 7a de9f704L 0IM",71,P11 i� �Eg G*RETT ENGINEERING ASSOCIATES Consulting Structural Engineers CLIEIR: P/LL r /E%Z REVISED BY: ` UNNININ/riI &7E % Vf "O -Z/ 0/2 7z"-52 f}QE /1Y5791 -1 -ED Ir -1,47" 4G4/N57 12Af7t-,72-S, G.E.A. JOBB NO.: G3D7O� BY: LD DATE: SHEET NO._3 OF%A AM 2x,Y I'vEn7" ac- /'111-7 Z-9 w/ /6Il P 8"O,' /JL10 4771Hh (Al),41,? 70' �X/17iN6 62f<E�, R_Z (N) 16'( e $ w/3 -16d 70 0) 435- E) &�,lt 24 n Vc ( ( E) f[y7 r,q PUACI y IQArr ..i._ L ._.�.. Y CITY OF COSTA I•9,1SA PLANNING DEPARTMCNT A, P. No.Patn 139-431-13 OCi 20 70cnsa00 879 0****70.00 Bldg. Permit No. joi� PARK AND RECREATIONAL FEES - Apartment Developments Fee Payment Receipt Project Address 1Q5g Ralaarir priva_ r. M Owner's Name John F. Heying Bachelor or 1 - Bedroom Units @ $25.00 = 2 - Bedroom Units @ $40.00 = 3 - Bedroom Units @ $55.00 = 4 -Bedroom Units 1 @ $70.00 = $70.00 5 - or more Units @ $75.00 = Total. Fee Total number of Dwelling Units 1 Planning Department Approval Date 10-20-70 Park Area No. 12 Ey RLB Applicant's Signature CITY OF COSTA 1,T]SA PLANNING DEPARTMENT A, P. No. 133-431-13ocr z0-70P A00 870R�V --*70.00 Bldg. Permit No. 3-o? a(C)L PARK AND RECREATIONAL FEES - Apartment Developments Fee Payment Receipt Project Address 195£1 Baldric Drfvo. C 'S. Owner's Name John F. Bachelor or 1 - Bedroom Units 2 - Bedroom Units 3 - Bedroom Units C $25.00 = G $40.00 = $55.00 = 4 - Bedroom Units 1 C $70.00 = t�'''•'� 5 - or more Units C $75.00 = Total Fee Total number of Dwelling Units 1 Planning Department Approval Date 10-20"70 Park Area No. lc By �� Applicant's Signature OWNER Dr.Cnt•MXr i iin. r. DATE ' a U,' J JOB ADDRESS 23T1c BUILDING PERMIT NO. 23925 GENERAL CONTRACTOR Modern Const. Co. DESCRIPTION OF WORK Pvt. Blockw&11 AP No. 139-431-13 LOT TRACT FIRE ZONE VALUE 296. om- INSPECTIONS Signature Date GROUP J TYPE III ZONE R1 Soil SUBCONTRACTOR PERMITS ISSUED Gas I Date Number Signate__ Water Plumbing Rough Plumbing Prop. Swr. Line ❑ House Con. ❑ Sprinkling System Miscellaneous Rough Heating and Air Conditioning Temporary Service or Pole Underground ❑ Power ❑ Rough Wiring Trenches Forms 0 Steel Reinf. 1 7 C77 Heating and Vent. Floor System Bond Beam ❑ Steel Reinforce ❑ Sheathing Frame and Flashing Lathing — In ❑ Out ❑ Plaster, Brown Coat Structural, Final Electric Heating, Vent., Refrig. and A.C., Final Plumbing, Final and Gas Test ❑ Electric, Final _ Building, Final c—inl Ra„,,;rements 23925. .. COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 317 COSTA MESA; CALIFORNIA For Applicant to. Fill In Completely TYPE OR PRINT BUILDING ' ADDRESS COSTA MESA, CALIFORNIA ®MAIL ADDRESS 111f Di.v/e:a le. 1� LC. NO. ZO 6 f 7JATE� NO. ��.3/ ZR'�/ SIZE _ --- • NO. OF SLOGS. ■ USE SETBACK LINE FROM F CENTER 'PSTREET REAR YARD SIDEYARDI LEFT `- I^RIGHT R DESCRIPTION OF WORK NCY.IN 1 11M YIPIU "1 11 1 BUILDINGNO. OF SIZE ARMs " STORIES EXTERIOR WALL ROOF COVERING ICOVERING USE OF BUILDING AND WO K TO SE PERFORMED CITY OF COSTA MESA APR 27 1965 APPLIV) F ®MIT For Office Use Only RECEIPT NO. P USE OF Ng PLANSI BUILDING W ��[L✓( W".. tey- 7 No. / 3`f' q3 13 NO SAVE OVERHANG SHALL BE LESS THAN TO SIDE B REAR P. L. iS )WED (U. S. C. REQUIREMENT) 'ARDS APPROVED YARDS APPROVED MAIN BUILDING I ACCESSORY BUILDING REAR - FT./ DISTANCE BET. BET. MAIN d MAIN BLDGS. ACCESS. BLD S. VAR. # DATE 7.c C 4 L. TE9/ "OJ/l CITY I NO. ARCHITECT EL. OR ENGINEER NO. 1 HEREBY ACKNOWLEDO THAT 1� LC. NO. ZO 6 f 7JATE� NO. ��.3/ ZR'�/ SIZE _ --- • NO. OF SLOGS. ■ USE SETBACK LINE FROM F CENTER 'PSTREET REAR YARD SIDEYARDI LEFT `- I^RIGHT R DESCRIPTION OF WORK NCY.IN 1 11M YIPIU "1 11 1 BUILDINGNO. OF SIZE ARMs " STORIES EXTERIOR WALL ROOF COVERING ICOVERING USE OF BUILDING AND WO K TO SE PERFORMED CITY OF COSTA MESA APR 27 1965 APPLIV) F ®MIT For Office Use Only RECEIPT NO. P USE OF Ng PLANSI BUILDING W ��[L✓( W".. tey- 7 No. / 3`f' q3 13 NO SAVE OVERHANG SHALL BE LESS THAN TO SIDE B REAR P. L. iS )WED (U. S. C. REQUIREMENT) 'ARDS APPROVED YARDS APPROVED MAIN BUILDING I ACCESSORY BUILDING REAR - FT./ DISTANCE BET. BET. MAIN d MAIN BLDGS. ACCESS. BLD S. VAR. # DATE 7.c C 4 60. FT. 1 HEREBY ACKNOWLEDO THAT 1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE ANO STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCT N. VALUATION PERMIT FEE $ J SIGNATURE OP p` PERMITTE ( v � 1/P $.. CHECKPLAN AUTHORIZED AGENT. - - d J TOTAL FEE $ OWNER HEYING. JOHN F. DATE ve 132,111 "%AP No. 1iQ-4-A1-1-4 LOT 74 TRACT 4941 FIRE ZONE VALUE $ 44,982.00 INSPECTIONS Si nature Date GROUP I & J TYPE V ZONE H-1 SOIL SUBCONTRACTOR PERMITS ISSUED Date Number I Si not. 'GAS WATER-qWATERaq Plumbin _ ROUGH PLUMBING / / / �� /';L PROP. SWR. LINE OUSE CON. _�,/ _ _Zr — - SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR COND17IONING TEMPORARY SERVICE OR POLE UNOERG RO UNO POWER ROUGH WIRING . eati nd Yent. TRENCHES M FORMS 0 STEEL REINF. FLOOR SYSTEM .1G-- BONO BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING — IN OUT PLASTER, BROWN COATL STRUCTURAL, FINAL i I HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST /S_-7( ELECTRIC, FINAL L. - (S-' BUILDING, FINAL ......... .... ..,......... w S— 7 n ..-n Z . a CWj Z Z Q Ov~ tl Co J W J N in J J m Q UN Za W 2 aw W J Q M Z J lY W W O Z F w0 N m r Z a U_ J CL a a O H U3 Z 0 L) U cc I— N Z 32361 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 Pr,ia *,** OU ?0-70-,—',,,',00 sso * • 708.50 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RECE VED BV DATE RECEIVED DATE ISSUED ^"7 47? -, ,IR BUILDING `�. � ADDRESS / f' ' _ '1 9 I P RMI O, '_ OWNER h - `]—O, A.P. NO. r�. BUILDING 3y' MAIL ADDRESS ADDRESS �' TEL _ CITY C NO. TRACT LOT BLOCK CONSTRUCTION W AD A Plqw LENDER BRANCH OWNER ADDRESS VA E SE �/ $ ARCHITECT TEL. _ OR ENGINEER t- NO. _ FIRE ADDRESSa ZONE TYPE GROUP APPROVED CONTRACTOR BY ATFL ADDRESS TEL. Z E NO, OF USE OF NEW CITY n NO. PLANS BUILDING, STATE CITY YARDS APPROVED YARDS APPRO ED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE J 0. OF BLDGS. (FROM C/L STREET) ^�4 0/1 OF LOT OW ON LOT (� FRONT FT. Ur FT. �� USE OF 0is EXISTING BLDG. R. SIDE FT. rf FT. SIZE OF NO. OF rr NEW BLDG. ROOMS STORIES L. SIDE FT. f, FT. EXTERIOR WALL ROOF COVERING COVERING REAR FT. FT. yY1 USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. VAR -AL DATE C.U.P.* APPROVED S I APPROVED a a I hereby acknowledge that I have read this application and state „OLD FOR SPECIAL REQUIREMENTS that the above information is correct and agree to comply with InF� all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of �1' rilT rGl .J� SO. FT. 1304 the State of California. I hereby certify that I am properly licensed as a contractor under THE AMOUNT SHOWN UNDER VALUATION IS FOR the Stateof California Business and Professions Code, Divisicn 3, Chapter 9, and that such licenses are in full force and effect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION and Professions Code, Division 3, Chapter 9. PERMIT FEE 5 Com/ PLAN CHECK $ Signature of Permittee % C �Cll $�Ot1: / Authorized Agent TOTAL FEE