HomeMy WebLinkAbout1136 CARSON ST - 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: 1136 CARSON ST
Suite:
Vicinity:
Parcel Number: 14169221 Zoning: R1 R1
Applicant:
WILLIAMS, KELLY
Permit:
$153.25
Address:
613 SHASTA LN
SMTP Com:
$0.00
Other:
$0.00
Phone:
(714)444-1111
COSTA MESA, CA
Zip:
92626
Owner:
LOMELI, JOSE ANTONIO
Address
1136 CARSON ST
Phone:
COSTA MESA, CA
Zip:
92626
Contractor:
ALL COAST ROOFING
Address:
613 SHASTA LN
Phone:
(714)444-1111
COSTA MESA, CA
Zip:
92626
License:
598440
Arch :
Address:
Phone:
Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: 08/16/2004
Issued: 08/16/2004
Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL NEW SHEATHING, COVER WTIH 30 YEAR COMP. INCLUDES GARAGE.
Plan Check:
$0.00
Permit:
$153.25
SMIP Res:
$0.72
SMTP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total: $153.97
SETBACKS
MAIN STRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existing: 0
NOTES:
FEE SUMMARY
PLANNING & ZONING
Rear 0-0 Left 0-0
Rear 0-0 Left 0-0
Required: 0 Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0-0
Right 0-0
$7,155.00
$7,155.00
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) 754.5626
2446-46 (6100)
DECLARATIONS L
WORKERS' COMPENSATION DECLAFLA71ON:
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
w rk 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 carrier and policy number are:
Carrier: 1 Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars ($100) or less.)
❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as t become subject to the workers'
compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 700 of th Labor Code, I shall forthwith
comply with these pro 'sin /
Applicant Signature: Date: V
WARNING: FAILURE TO SECURE WORD S' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL F ES UP TO ONE HUNDRED
THOUSAND DOLLARE ($1(70,000), IN ADDI ION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect. Lic. N Class q
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031 .5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she I$ 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 own 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 of proving that he or she did not build or improve for purpose of sale.).
❑ 1, 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 contractors)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I 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 California Health and Safety Code 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.
..................................................................................................ec.ti'o'n.................................................................................afe-...................................................................h"?,..............................................................................................................
4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Ves 01N0
.......
No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication aEEermi[ for such construction or modification
Air
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ 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 feat 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
.............................................................................................................................................................llut...................................................................................................................................................................................................................
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 purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
SZrJ L al Owners)
And/Of Authorized Applicant F� D110
CODE.. INSPECTION TYPE DATE IWITIAL CODE. INSPECTION TYPE DATE 11FITTIRL
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof-y_I - N 210 Final Electrical
201 Final BlocWRetaining 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
ADDRESS OF BUILDING: 1136 CARSON ST
GAN✓ERS�&WE IF gMYIN: MON TOYA
ADDRESS: 1136 CARSON ST
COSTA MESA,CA
UK. MM1 ADDRESS:
ARCNRECT OR ENGINEER:
ARCH OR ENG.'S ADDRESS:
UNIT:
FLOOD: AHL38
92626
UC. NO.:
UNIT:
coumnT01Ts NAME: NOCK PLUMBING (714)895-1246
coingACTORsiamuNG 11610 SEABOARD C I R
AmwEss: STANTON CA ucNo.: 511971
90680 UNIT:
LICENSED CONTRACTORS DECLARATION: I hereby affirm under Pena , of perjury that I am licensed under pnrisicm Of Cha,4w 9
(oommencirg with Semon 7000) of Division 3 of the Business and Pmfessiau Cade. and my limine is in lug form am effect.
Cm LIC. 11 95038 arc. class: C-36 uC.`NO.: 511971 EXP: 02/97
`IO
NNER BUILDER DECLARATION: I hereby, affirm under penaly diperjury that I am menial from the Cmtrareaa Licem s Lew for Urs
Allowing reason (Se tior 7031.5 B imnsiss and Professore Code: Any city Or oc u ity which requires a permit to construct, after, prospers,
demd'wh, or repair any structure, prior to he lsmence, also imuires the applicant for each permit to NO a signed slmamad that he m ant
is licensed pursuant to the osovisima of the Cmtradors Licenae Lew (Chapter 9 (oomm move, with Session 7000) of Civuion 3 at IM
Business snd Prdeaom Code) or that he ar she a essmq Ihaahom and the beat for the diapers exemption. Mry videtion Of Sedion
7031.5 by any applicant la a perms subjects the applicant to a civil Penalty d not mase than five hundred ddlare [S54)0D.
❑ 1, ars owner of the property or my employees with wages as their sole compensation, will do the work, and the miniature is not intended
adored mels(Becton7004,Bus end Prolessioms Code: TheCmtreclon Loaree Lewdoseintappytombwnsrd properly
who Wide or numbers thereon, and who dose much work himself or herself or through his Or her own empknsess, pmeided that such
improvements are mI intended «dlered la mak. ff. however, IM WiNirq or knpmernret is add within are year of csinddion, the
owmrbuilder will have the Wrdm of pmeirg M or she did not Wild or tiaprove la the pubba r of sok).
❑ I, as ower d the p rpemy. am exclusively contracting with licensed contractors to canmud the protect (Section 700.1. Business and
Professions Coda: The Cmtraoms License Lew does not apply to an owner of property who WiWS or improves thereon and who
connate la such projects with a mnlectods) licensed pursuant to the Conlradae Limine Lew).
❑ 1 am exempt under Sectio: B. 8 P.C., for this reunion:
Date: Owren
I do hereby mrlily Nat 1 an aware of and understand the requirements of California Health ant Safety Code Sedum 26505. 25533. and
25534, and that I Or any future Wilding ocoupamt will / will nm (desk oat) need to comply with mid date bodes and IW equiremmts lor
apermitloreonetructonbr modifimtonhantha Av u�6eTilyTimegemmt Disidd.Reskediel mndnrction eppYeetimaare axemgimmtheee
povalom.
Date: Applicants
WORKER'S COMPENSATION DECLARATION: I hereby affirm under imply of perjury ase of IM following eeciaratixe:
❑
thee and wig maintain a mngode d mnwnt Io seNAmure la w em' m mneaticn, m provided fa by Sedan 3700 d the Lebo
Code, for the performance of the won, for which this permit is issued.
I Mw ane dl maintop oroMae' dmPe worat insuremm, es requires by Section ad the Lehr Code, Aw tM Perlsimanos d int
wok la whkdh this permitpermitie issued. MY waken' comPereaton I.. career and
pdicy number ora:
Carrier: GOLDEN EAGLE EXPIRES
Policy Number: NW(' 391 1 -41 00 09/01/96
(Thom median mind int M completed if the prm3 is M ons hundred ddars I31011 or Aw)
❑ 1 oertlfy that in the performance d be workor which this permit It issued, I mall int employ any Peron in airy manmer m as to
bassinet abject to the woMari campenmtim awe of California, and agree that it I should become subject to the warders'
canpermlon p6mium. of 966In 3700 of IM Labor Code. 1 shall loony%* bompy somespne.
D� Applicant: / /— ( _ iC
Warning; FailuresW securo wodrsrs'rompereatlon corsrege la unlawful, ant atoll n employer ro pdMml Poetry. and
civil Asea up to aro hundred Thousand dialers ($10a"I In addition to d s coat of rottLesmafbM1 damspu as Provlded Aar In
Sactlm 37M of Me Lebo, Cods, /nfereat, and attorneys fess,
CONSTRUCTION LENDING AGENCY: I hereby affirm under Penalty of perjury thin Ihore b a condnAiian ending agency for int
prfamance of the want for whish This pemL a .sued (Sector SORT Cm. C).
LENDER'S NAME:
LENDER'S AOORES is
1 candy that I hew read this application and slats Ihd the bMVs information is coned. I agate to comply with au city and county sidinmme
and we awe refilling to Writing cmmWon end hereby aatharba representatives d this plyup
to enter on p
the abasia memonnd vpany,
fa mdion puimmmes.
RON NOCK
Print e
Dda:
si9retar dowse/ pplmn
(5151d6.WP) Whno-Buildig 8 Wary; Oram,Rle; Canary-Appimd; Pink -Revenue Gddeneae-Aemsmr
CITY OF COSTA MESA — BUILDING PERMIT
]PERM NO: P 078785
PERMIT NO: P 078785 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION C/O DISHWASHER SQ FT:
CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 /
COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
9E iF 9E 9E 9F 96 it iF 9h***9F iE dE SE 9E SE 9F 9F 9E iF 9E*iE dF iF iF***9E iE dE 9F 9E SE 3E SE iE**dE**9E**dF*iE 9E it*iE 9E dE SE iE 9E*1E SE SE 9F iE iE 9E *9E 9F iE dE 9E 9E 9e 9E dE iE
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
------------
F
MAIN BUILDING
----------
---------
ACCESSORY BUILDING---------
FRNT:
FT
IN REAR:
FT IN
FRNT:
FT
IN REAR: FT IN
LEFT:
FT
IN RGHT:
FT IN
LEFT:
FT
IN RGHT: FT IN
PARKING
REQ:
PROV:
PARCEL:
41204316
ZNE:
REF NO:
PLANNING
NOTES>
8.75 22.00
0.00 30.75
30,75 e00
>
dE 1E 1E 1E 9E 1F iE iE
SE SE * dE iE irk 1E if 1E * * iE dE dE lE 1E 1F iE iF * RE SE 1E df IF IE iE RF IF 1E SF 9E SE dE SE elf dE dE dE dE 1E *
SE * dE iE 5E dF dE 9E 9E * it irk irk iE dE yE 1E iE if dE 1F 1F iE dF * iE 9E SE 1E
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
ZONING APPROVED BY DATE:
DATE:
APPLICATION ISSUED BY:DATE:
*9E***SE iE 9E iE 9E dE******iF iF iF 9E****iF*3F****iF3F3F3FTFiFif�iF3f3FiE 9F i�F*�3FTfWWF*11*iF iF iF iE iE**
LEGALIZATION:N
F
E E S U M M A R Y
STRUCTURAL SEGMENT:N
BLDG
PMT PLUMBING
ELECTRIC MECHANIC FIRE
SMIP/RES GRADING
PERMIT
8.75
258
SMIP/NON—RES
PLAN
ISSUE FEE
22.00
BUILDING—DIV—>
PERMIT ISSUE
PLAN—CHECK TOTAL
PAID DUE
TOTALS ---- >
8.75 22.00
0.00 30.75
30,75 e00
REVENUE DIVISION TOTALS--> COLLECTED: 30.75 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
30,75
9E 9f 9E iE iE iE irk irk * iE iF lir it 9E 9F irk iE 1f ff ft dE iE dE k * iE * iE 1E eF irk it 1f 9F 1E k iE iE kt iF iE dE SE ire iE iE iE dEie iF iE iE k 9E k dh dE iE iE k 1F iE iE fir iE it iE dE * 1E iE dE 9E iE 1E irk iF k dE
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 UNIT COST TOTAL COST
PLU 1 DISHWASHER
EXFP�I/RAE /
DATE v G(7L (/ ,
END OF FEES
8.75 8.75
CONSTRUCTION AND PLANNINI
APPROVALS Permit #
Date
Inspector
L &SPA
APPROVALS Permit # �'
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
"3: Electrical Conddit UYilityUndrgrnd.
54. Forms
-4: Electrical Conduit-Undrgrnd.
55, Electrical Bonding r
-
-5: Steel Reinforcement ,
56. Rough Plumbing & Pressure Test
6' `Electrical UFER-�i nd.
57. APPROVAL TO COVER-GUNITE
}=Footings ._ -
58. Electrical ConduitsUndrgrnd.
8. Foundation h
59. Gas Pipe, (] Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, rJ Undrgrnd.
10, Structural Floor System
61. APPROVAL TQ•DECK
11. Property Sewer Line & House Conhection
62. Backwash & Receptor •Final I
12. Sewer Cap -
63. Heater & Vent -Final
13. 'Roof Drains
64. Plumbing System - Final t,
1'4. Rough Plumbing _
65. Electrical -Final
15. Rough Electricat=Conduit
66. Solar System -Final t
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign -
68. APPROVED FOR PLASTERING
18, Rough Electrica_bT Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT- REQUIREMENT
APPROVALS- Permit # _
20. ,Rough Factor -y Fireplace - z
21. -buds, in Stry_cture;
70. Underground Hydro
22. Ducts, Ventilating- t .-
_ " •
71. Product Piping.0Gas 00il
23. Gas Pipe -:Rough &•Test r
•, _
::� r
72. Underground Flush - -
t'
24. Roof -Framing.
73. Undergrnd.StorageTankdGas 13 Oil
25. Roof -Sheathing
74, Overhead Hydro
26. T.Bar.Ceiling (StrLiEt'urall & Monocoat
-
75. Dry Chemical
27. Frame and Flashing _
76. Dry Standpipe
28. Lathing & Siding- -
77. FIXED 'SYSTEM
29. insulation - -
78. FIRE PREY. FINAL '
30. Drywall Nailing
--HEALTH
DEPT. REQUIREMENT
31. Plaster Brown Coat -
79. FINAL INSPECTION -
. 32. Electrical Power Meier -Final
80. FOOD CERTIFICATE ISSUED
33. final Electric
Notes:
34. Final Heatind% Air,Conditionin9� -
-
P
- -
35. Final Gas Pipe -Test •
*
-
. 36. Hooc[ or Canopy
-
37. Final Factory Fireplace- • -
- 38. Final Plumbing
39. Watei Service -Final
y
•-�
- -.
' 40. Gas Service -Final
41. Solar Domestic -Final
42. 9ackflow Preventer
--
43. Backflow Irrigation • _ -
-
44. Landscape lrzipation System
45. Sound Attenuation
46. Handicap RegulatioQs
47. FINAL STRUCTURE & BUIE-DING
48. FINAL PLANNING'
49. Electric Release to Edison
+ •-
-
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY -
No. Date
CITY OF COSTA MESA
CALIFORNIA 82628-1200
DEVELOPMENT SERVICES DEPARTMENT
BUILDING DIVISION
P.O. BOX 1200
NOTICE OF PERMIT EXPIRATION
To: Nock Plumbing
11610 Seaboard Circle
Stanton, CA 90680
Project Address: 1136 Carson Street
Costa Mesa, CA 92626
Date: 5-9-97
Permit:4 P78785
Our records show that the listed permits were obtained for property improvement or alteration at
the above address and the project was not properly completed.
The permits were obtained by: ( X ) Contractor
( ) Owner
Name: Ron Nock Phone:895-1246 License Number: 511971
To construct or install: C/O DISHWASHER
The permits are valid for 180 days from issuance or your last inspection, per Section 106.4.4 of
the 1994 Uniform Building Code. Should we not hear from you within 10 days, your permits
will expire and additional fees will be required to finalize the permit. Your permits will expire on
May 19, 1997
Please be on notice that without a valid permit and required inspections completed, you will have
encumbered your property with an illegal structure.
If you need assistance, please contact THE BUILDING DIVISION, at (714) 754-5273,
between 8:00 a.m. and 4:30 p.m.
77 FAIR DRIVE
Building Division (714) 754-5273 Code Enlorm"nt (714) 754-5623 Planning Division 17141 754-5945
21397
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
ADDRESS BUILDING 11 6 Carson ff
COSTA MESA. CALIFORNIA
Anaheim
APPROVED
FEE RECEIVED
JAN 17 1964
rr''77
FINANCE DEM.
AAUAROR R PEERFAIT
BUILDING
For Office Use Only
RECEIPT NO. I 7 tERK
ZONING
NO.OF-7 -BE
PLANS' // BOUII
ISSUED
0
1,V Fountain Valley ■
215049
16 2
LIC.TNO.
NEL
SIZENO.
6Ox1 OO
OF BLDOS.
O
OF LOT
NOW ON LOT
USEOF 00
FT.
EXISTING BLDG.
BETBACK LINE FROM
O
�]
2
CENTER OF STREET
REAR YARD
SIDEYARDI LEFT
I RIGHT
MAIN SLOGS.
DESCRIPTION
OF WORK
FE: NO HAVE OVERHANG SHALL BE LESS THAN
TO SIDE & REAR P. L.
IES
.OWED (U. B.C. REQUIREMENT;
YARDS APPROVED YARDS APPROVED
MAIN BUILDING ACCESSORY BUILDING
NEW
E
ALTERATIONH
ADDITION
REAR -�
FT.
I
DISTANCE BET.
BET. MAIN e
MAIN SLOGS.
ACCESS. BLDGS.
REPAIR
MOVING
DEMOLISH
VAR.
DATE
BUILDING NO. OF Q
SIZE 1 ROOMS [J STORIES 2
C. U. P.
APPROVED
EXTERIOR l
E /
COVERINGwsI
CCO COVERING BYPRO
sil
DATE
USE OF BUILDING AND WORK TO BE PERFORMED
single fam. res w. att. ar.
4n
2/61 �— J
BQ.FT. G
1 HERESY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
ANO ETATB TH CT AND AGREE TO COM.
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH A CITY OR B AND TATE LAWS REGULATING
yALUATION
BUILDING C NSTRUCT N.
u
00 N
22 PERMIT FEE $ 0
SIGNATOR OF
PERMITTE
$ �5
00
=Gm
34
0
00
AUTHORIZED AGENT
TOTAL FEE