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Home My WebLink About2359 COLLEGE DR - Building Permits{»a� �sa-s2�s • Fax (�ia� �sa-aess CITY OF COSTA MESA evao�N� �►v►a�oN DEVELOPMENT SERVICES DEPARTMENT PERMIT MECHANICAL PERMIT Job Address: 2359 COLLEGE DR Suite No Vicinity: Parcel Number: 141485'1'I Applicant: BURR, DAN E. Address: � l � � i; � 7� : ` owner: RIVERA,-EDDIE E TR , Address:� B06 CABRILLO ST` � ' � �,.�;�j/ � � .,-�__ _ ��/ COSTA MESA� CA j' Contra ior. CUST M�HEATING & AIR , , �,,�;� ��Address: 8682 WAGERS CI � ': � � HUNTINGTON BEACH, CA � ArchlEng: ' . Address: � � , ( 4, ,��'��• : .. . , Phone: (714)596-9796 Zip: Phone: � Zip: 92627 Phone: 714-596-9796 . ., Zip: 92647 �_ � � License: 649444 � '� _�-, � , NUMBER TI FAIR DRIVE. COSTA MESA, CA 92626 -ISSUED BY: Status: ISSUED Applied: O6/03/1999 Issued: 06/03/1999 L� , �� :A;�,�� `��V� , � � . � _ �� ';� A �� , � \ \ � ,� � �� , , � �.,a- - Phone: . ''- / .i_. . . , ' l� � i `� � Zip: � , � � ' �„ ' License: - � - , � • ' ' � � � � SCOPE OF PERMIT • `, REPLACE EXISTING FAU & AC WITH NEW UNITS.' �C�C�-QQ�O� ' . Quantity � ISSUE FEE � $22.00 Inst FAU <100 k BTU $26.50 2 Inst FAU >100 k BTU So.00 � o Repair/Alt CoolinglHeat so.00 0 � Inst! Rep. Recess Wall Htr � $0.00 0 Refrig Sys <100 k BTU � � � $0.00 � 0 � Refrig Sys >100 k BTU �� $0.00 0. Gas Piping, . . $0.00 0 , , Factory Flreplace � V ' �$0.00 - 0 , ; 7 � Hoodw/MechExhausl' : �$OAO � -0'�-; ��' � � VAV Box � - �;' -$0.00 � 0 �-' - Vent Fan / Single Duct - $0.00 ', 0, Appliance �� , � � � � � $0.00 -��0 � _ , Fire Dampers � � . $0:00 0 ' Smoke Dampers \. :, ;� , ; $0.00 0 � Inst or Relocate Appl Vent- <� $0.00 �� 0� ` Air Handlers < t0000cfm . $0.00 � 0 Air Handlers � 10000cfm 50.00 0. Floor Furnace $0.00 � 0 Floor or Suspend Heater $0.00 0 . FEE SUMMARY Repair /�Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillation System � Evaporative Cooler � Commerciallncinerator " Domestic Incineretor � - Co�ressors / Absorption Systems � � Upto3hplt00kBTU - -'.� 3To15hp/SOOkBTU - � . _. . 16To30hp11,000kBTU�� ' , 30 To 50 hp / 1,750 k BTU .� Over 50 hp / Over 1,750 BTU -"�� Boilers - , - Up to 3 hp 3To15fip . . . .... .. 15to30hp . ' , , 30 to 50 hp Over 50 hp � � Other Mechanical Fee - � � Investigation Fee- � Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS . Quantity $0.00 0 � , 50.00 0 $0.00 0 � $0.00 , 0 ' $0.00 0 � $0.00 0 � .� $0.00 �0" , �' $0.00,��0 $0.00 � 0 $0.00 0 $0.00 0 � i �� i $0.00 0 � � $0.00 0 � $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 548.50 � NOTICE: The work euthorized by this permit shall comply with all epplicable handicep access requirements under California statutes and releted regulations. (Ord. No. 92•28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire end become void if work is not commenced within 180 days, or if work is euspendad or abandoned for a penod of 1 BO days. INSPECTIONS: In order lor ihe work autharized under this permlt to be considered legal, such work must comply with all applicable codes, and ell required Inapectlone and flnel approvel must be obtained. Feilure to obtain inspections end final epproval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARATON: I hereby aflirm under penalry of perjury one af the tollowing declaratlons: ' . �, .- ❑ I have and will meiNain e certifiwte of consem to setl-Insure for workere'. compensation, as provitled for by seaion 3700 oi the Lebw Cotle, for the pertormance ol Ihe work for which ihis permit is issuetl. �I hava antl will maintain workers' compensetion insurence, as requiretl by sectlon 3700 0l Ihe Labor Cotle, tor Ne pedortnance of ihe work for which ihis pennii is issued. My workers' compen atio�n/,1 nsurence carner end policy number ere: Carder. (lit///`�r� �Y.�4L/F!(- POIIcyNumber. ii�f��J /�%PrI�%% �� (Thls sectlon need not be cromp/eted i/ the permit is velued et one hundred dallers ($f 00) or less.) � ' ' " � � ❑ I certity that in the performance of the work for which this permit Is issueq I shall not emplay eny person in eny manner so es to become subject to Iha workers' compensetion laws ot Cali ia, and egree thet if I should become subject to the workers' compensetion provisions of Section 3700 of ihe Lebor Code, I shall forihwith comply with ihese prov ons. Applicant Signature: � Date: WNRNING FAIWRE TO SECURE ORKERS ATION COVERAGE IS UNIAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FWE$ UP TOIXJE HUN�PED THOUSAND Oq1AFE ($100,000), IN ADDRION TO THE COST OF COMPENSATION, DAh41C�ES AS PROVIDED WR IN SECiION 37060F THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTFiACTORS DECLARATION: I hereby aHirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Divislon 3 of ihe Business anntl Professions Code, antl my license is in full force entl eflect. Lic. N G�Pi��%�7^--n_-y Class # l." ContractoYs Signature: / 1/ i _ Dete: (z .? c C � CONS7RUCTION LENDING AGENCY: ❑ I hareby eMirtn that thera Is e consiruction lending agency for the pertormence of ihe work far which this permit is issued. (Sec. 3097, Civil Code). Lentlers Name: Lentlels Address: Signeture: Date: OWNER-BUILDER DECLARATIONS: � I hereby aflirm thet undar penalty of perjury ihet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reeson (Sec. 7031.5, Business and Prafesslons Code: Any city or counry which requires a permit to construct, el�er, impmve, demolish, or repeir eny stmcture, prior to its issuanca, elso requires the applicant for such permit to file a slgnetl stetement that he or she is Iicer.setl pursuant to the proNsions o1 the Contractors License Lew (Chapter 9(commencing with Section 7000) of Division 3 oi the Busineu antl Proteuions Code) or that he or she is exempt theretrom antl the basis for ihe allegad exemptlon. Any violation of Section 7031.° by any epplicant Por a permit sub�ects the applicant to e civll penelry of nat more Ihan five hunCretl dollars ($500)J: ❑ I, es owner oi the D�aPetly, or my employees with wages es thelr sole compensation, WILL DO 7HE WORK, antl the strucWre is not Intendetl or oNered for sale (Sec. 7044, Business end Protessions Code: The Contracbrs Llcense Lew tloes not apply to an owner of DroOerry who builds or improves thereon, and who tloes such work himself or herself or through his or her own employees, providad that such improvemenis ere not intentletl or oflered for sale. If, however, the building or improvement is sold within ane yeer of completion, the owner-builtler will heve the burden of proving ihet he or she ditl not 6uild or improve far purpase of sele.). ❑ I, es owner oi the proparty, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consWct the project (Sec. 7044, Buslneu and Protesslons Code: The con�rectors License Lew does not appry to en owner of property who builtls or improves ihereon, antl who contrecis tor such pro�ect with a contrecmr(s) license pursuant to ihe Contractors License Lews.). ❑ I em exempt under sec. Business end Professions Cotle for ihis reeson: Signature: Date: Owner ID venfied by drivers licanse. ❑ Yes ❑ No DriveYs Licanse No. Expires: Venfication of Ownarship by (rype of daument, i.e. - properry tax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICA710N: ❑ I hereby certity that no excavetion flve (5) or more feet In tlep�h Into which e person Is requiretl to tlescend, will be made in conneclion with work authorizetl by thls pertnl�, antl t�at no builtling sirudure, scettolding, falsework, or demoliiion or tlismantling ihereof, will be more than Nirry-six (36) teet high. (Chap. 3.2, Grp 2, An 2, Sec. 341, Title 8, Califomia Administrativa Cade). ❑ As owner�builder, 1 will not employ anyone to do work which would require a permit irom ihe Division of Intlustrial Safery, as noted ebove, unless such person has a pertnit to da such work fmm Ihe division. Signature: Dete: Division ot Indusinal Safey Pertnit Number: CERTIFICATE OF COMPLIANCE AND AUTHORVA710N OF ENTRY: I certity under penalty ot perjury Ihat I heve read Ihis application and stete that the iMormation given is wrrect. I agree to comply with ell state lews and ciry ordinances relating to huiltling wnstruction, and euthorize represen�atives of ihe Ciry of Costa Mesa to enter upon ihe above-tlescdbetl property tor inspec�ion purposes. I egree not to occupy or ellow occupancy ol any bullding authodzed by this pertnit until flnel Inspection. � netur ner(s) n O d Apphcant CODE �. INSGECTIONTYPE 1616 Fizetl System Flnal Fire Prevention 1266 Pool Spa Final 200 Finel Re-Rooi � 201 Final BIaWRetaining Wall 202 Final Feclory Fire Placa 203 Finel Siqn 204 Final Demolition 264646 . . . � IMIfIALS Date � � '� Date 40DE� 'INSPECTIONTYPE'� 206 � Final Mechenical' 200 Finel Plumbing 210 Finel Elecirlcal � � 272 Flnel Fire Prevention 220 Final Plenning Approval 222 Final Site 250 Final Building/Occupancy -�r.• _ . q'�'�.,� � � :.:..:: � ' ��, �»a) �sa-sz�a • Fax pia) �saoass Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: Address CITY OF COSTA MESA BIIILDING DIYISION DEVELOPMENT SERVICES DEPARTMENT PERMIT 2359 COLLEGE DR 14148511 RAY AMBURGEY RIVERA, EDDIE E TR' 306 CABRILLO ST COSTA MESA, CA ELECTRICAL PERMIT PERMIT NUMBER E99-00404 77 FAIR DRIVE, COSTA MESA, CA 92626 status: ISSUED Applied: OS/14/1999 Issued: 05114/1999 �SSUED BY: �iCl � 'Phone: 949-645-0729 � . Zip: � _ Phone: � Zip: 92627 ��`.`�� . � , Contrector. ELECTRIC RAY '. Address: 817 W 18TH ST `� UNIT 9 . . Phoner 949-645-0729 COSTA MESA, CA . %Zip: 92626 � License: 480485 SCOPE OF PERMIT SERVICE UPGRADE, NEW A/C UNIT. ISSUE FEE Temp service tesl Res. a/c package New Res (7-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over t000a Molors to ihp Motors to 10hp Motors to 50hp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole $22.00 $0.00 $D.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $2725 $0.00 $0.00 $4.25 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 so.00 $0.00 $0.00 Quantity FEE SUMMARY� -Temp Dist�Systein�/-Llghling _Busway/100;ft Standing Section - Misc Electrical Equipment Transformers up to t kva/kw ................up to 10 kva/kw .................up to 50 kva/kw � :................up to 100 kva/kw ......::..........over 100 kva/kw Low Voltage.Equipment Low Volt Wiring System / Ckt Misa Conduit � . , Misa ConduCor Ciras ( gen or ride) � - Circus (mech ride or lights) � Christmas Tree Stand Fireworks Stand - Other E�ectriwl Fee Investigation Fee Plan Check Fee ��Reinspection Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 so.ao $0.00 so.ao ' ' ' TOTAL' CALCULATED FEES 553.50 COMMENTS / SPECIAL CONDITIONS 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 expira 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 aulhorized under this permit to be considared legal, such work must comply with all applicable codes, and all required Inepeetlona end final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiretion of this permit. FOR INSPECTIONS CALL: (714) 754-5628 WORKERS' COMPENSATION DECLARA710N: I hereby efflrm under penelry o� perjury one ol the following tleclaretlons: ❑ I heve en0 wlll melntaln e certillcete of consent to seli-Insure for workers' wmpensetlon, es pmvidetl for by sectlon 3700 0l the Lebor Cotle, for the pertormence ot the work far which t�is permit Is Issued. ❑ I have and will melntein workers' compen58fion InSurance, as requlretl by Seclion 3700 ot ihe fabor Code, for Ue pertortnence of the work tor which this permit Is issuetl. My warkers' crompensetion Insurence cartier end policy number ere: Cerrier. Poliq Number. (lhis secNon need nat be comp/efed ll the permi! is valued et ane huntlre0 dollers (5100) or Iess.J 1 certify thet in the pertormance of Ihe work for which this permll is Issued, I s�ell not emplay eny person in eny manner so es to become sub�ect to the workers' compensatlon laws o ifo la, antl e9ree thet If I should become subJect to the warkers' wmpensetion provislons oi Section 3700 of the Lebor Code, I shall forthwith conSply.vAM�thes rovisio . '/�\ , nJ S gneWre: w� Dat : S� —�''� ��Ci INO: FNLURE TO SECURE WORKERS' WMPENSATIIXJ COVERAO UMAWFUT AND SHALL SU&IECf AN EMPLOVER TO CRIMINAL PENALTIES AND CML FlNES UP TOONE MUNORED iANO Wl1FRE (E100.00p), IN ADORION TO TME COST OF COMPENSATION, DAANGES 0.S PROVIDEO FOR IN $ECTION 3]OB OF THE IABOR COpE, INTEREST, AND ATTORNEVS FEES. LICENSED CONTRACTOHS DECLARATION: I hereb� ttirtn Ihet I em ' d undar pmvislons ol Chapter 9(wmmencing wlih Section 7000) ot Divislon 3.ihe.Huslness end Professions Code, antl my Iicense Is In tull force�antl ettect Lic. a r+l-f c 't BS /Class #� C-' —' � Date: CORSTRUC710N LENOING AGENCV: — ❑ I hereby eXirtn that there Is a consirudion Iending egency tor the peAormance ot the work for which Ihis permit Is Issued. (Sec. 3097, Civil Code). Lenders Nama: Lenders Address: Signeture: OWNEH•BUILDER DECLARATONS: Dete: I hereby etfirm Ihat under penalry of perjury that I am El(EMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Business end Pratessions Coda: Any ciry or counry which reQuires a permit to consiruct, elter, Improve, demolish, or repair any strudure, pdor to its issuance, elso requires lhe epplicant for such permit to file e signed stetement thet ha or she is licensed pursuant ta the pravisions ot the Contractors Llcense Lew (Chflpter 9(commencing wiM Section 7000) of Division 3 of Iha eusiness end Prolessions Code) or Ihat he or sha is exempt therefrom end the basis tor t�e allegetl exemption. My doletion of Section 7031.5 by eny applicent tor e pertnit sub�ects the epplicent to e ciWl penalry of not more Ihen five hundred dollers (5500).): ❑ I, es owner of the propeny, or my employees with wages es thelr sole compensation, WILL DO THE WORK, end the strucNre Is not Intanded or oflered for sele (Sec. 7044, Business end Pmtessions Cotle: The Contractore License Law does noi apply to an owner ot properry who builds or improves thereon, and who tloes such work himself or hersell or ihrough his or her own employees, provided thet such Improvemenis ere not Intended ar aHereO for sele. If, however, the bulitling or improvement is sold within one year of completion, ihe owner-bullder wlll have the burden of proving thal he or she tlltl not bulld or improve for purpose of sale.). ❑ I, es awner ot Ihe pmperty, em EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRAC70RS to construct the project (Sec. 7044, eusiness end Protesslons Code: The contrectors License Lew does not epply to en owner of pmperry who builds ar improves thereon, entl wha contrects tor such pm�ect wlih a contrector�s) license pursuant b �he Contracrore License Laws.). ❑ I am exempt under sec. Business end Protessions Catle for this reeson: Signature: Owner ID varllied by Erlver's license. ❑ Yes ❑ No DriverS License No. Venficatlon oi Ownership by (rype of document, i.e. - property tex bill or deetl): OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Deie: Fxpires: ❑ I hereby cenHy that no aacavation five (5) or more feet In depth Into which e person is requiretl to tlescend, will be made in connedlon with work authonzetl by this pertnit, entl t�at no builtling siructure, sceMolding, telsework, or demolitian or dismantling Ihereot, will be more Ihen Ihirty-six (36) feet hig�. (Chap. 32, Grp 2, Art 2, Sec. 347, Title B, Celtlomla Atlminlstrelive Cotle). ❑ As owner-bulltler, I will not employ anyone to do work which would require e permit from the Division of Industnel Sefery, as noted above, unless such person hes a pertnit ta do such wark irom the dlvision. SignaWre: Date: Division of Industnal Setery Pertnit Number. CERTIFICATE OF COMPLIANCE AND AUTHORVJITON OF ENTRV: I certity under penelty of perjury ihet I have �eatl this application and state that the iniormation given is cortect. I egrae to comply with all state laws flnd ciry ortlinances releting to building construction, and euthoAze representatives of the City oi Costa Mesa to enter upon the ebova-tlescrlbetl proparry for inspection purposes. I agree not to occupy or allow occupancy ot any bulltling aut�orized by Ihis pertnit until tinal inspaction. COpE1. INSPECTIONTYPE f�¢ INTITIALS 1616 Fixetl System Finel Fire Prevention 1266 200 201 202 203 Paol Spa Final Finel Re-Root Finel BIocWRetaining Wall Finel Fectory Fire Placa Finel Sign 204 Final Demalitlon zaas�ae CODE� INSGECTIONTYPE 206 Finel Mechenital S'— IK-q� �e°'e—� PeIE Iti�ALfi 208 Finel Plumbing 210 Finel Elecidcal 212 Final Fire Prevention 220 Flnal Plenning ApDrovel 222 Finel Site 250 Final Bullding/Occupanry OWNER COStB M053 ESt8t8S DATE 4-12-56 JOB ADDRESS 2359 �ollege Drive BUILDING PERMIT NO. 2716 GENERAL CONTRACTOR �ven-Spiegel �o VALUE $ 11aZOO.00 LOT ll6 BLOCK TRACT 2�5� Single Res. W�att gar GROUP I& J TVPE V ZONE � FIRE DISTRICT 2738 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE I NUMBER Footing Trench Z/U�t Foundation Forms and Grede to Garage 1 Rough Framing " e�-+ Plumbtng. Rough to Slab y v...(,'�j Plumhing, Rough Complete VV� C�j Temporary Pole Wiring, Rough �////� Heating,Rough �CS Heating, Final 1N1,G �Sewer, House (�{L sewer, st.�y� °L 5 Se ptic Tan k or Cesapool �Lathing,ln OutX � Plastering " Plumbing, Final, Fixtures Complete yYLES Plumbing, Fin.al GasTest S" mC Wiring, Final R �. Occupancy �;R ] FORM 210 3M 10�55 Q � Costa Mesa �uilding Department � 111 EAST 20th STREET , COSTA MESA, CALIFORNIA FOR APPLICANT Tp FILL IN Owner ��/TH /l1�/"/% �%/�%�i Mail Address sle� S� (,(/, � � ��id—/ Tel c,cY�o�7 /f�'�c—'cEs 36 rvoll/�'�� Arohitect�or p �� Lic. Engineer l/�ii��-� No. e,�,,.a�a!/d1.�Gr_„/�Giid, _ 11�T.9 � ContraCtor �V�� i��r "� Address .S b5% L�%/ �/ '� .�� Legal I Lot /// I Blxk Deseriotion No. k Size ot Lot cJ S X Center of New No. ot Bldgs. Now on Lot No.of No.ot Famllles Rooma Rear Vard �T Side Yard .S� E' Addition Demolish APPLICATION FOR PERMIT g BUILD,LNG '� �'OR Og'FICE USE ONLY . . Receipt No. . Permlt No. � %�� ;eived by I Date Rec'd. I Date Issued • '.ii7.� � /J' � 1 � // .- / 1 �1 Costa Mesa, California Nearest Cross St. CORRECTIONS i Covering yT7/PGp I Covering C/y%y(.�L(2 APPROVAi C Use of New �j/�� f� „/�� (��/� Foundation Location Inapeeto Building �/7�% �l�� Forms, Materials, ��I`%'/�(i/� .;.r.�.�t-rizT' Under-Pinning Frame: Fire Stops, Bracing, Bolts I hereby acknowledge that I have read this Application Lath. Int. and state that the abo�e is mrreM and agree to comply �ath. Ext with all City Ordinances and State Laws regulating building construcflon. Signature of /I'��,� /1 /�� F�.�T�j P�aster. Int. Permittee � ��t � `� � � Plaster, Ext. Valwation rerry�cree5 y�� Pla(� Check $ � Bond B� $ � �d� Total � Fee $ �� FINAL FORM 204 �-H 2M 5•94 O � � 2 D r Show locatlon and distances from ; property line and between buildings ' .. � . ��t r. . j - . . . cosrr ,� '^ i � �-Pp ��,�:_ ._ _ .. �,2 „� li E S:, uwntK �Y4.. ..��^. DATE -'-" "" JOB no�RESS 7359 r�iiA„A n,-;..o BUILDING PERMIT N0. no�z� AP No. 141• INSPECTIONS SOIL WS W ATER AOUGM PLUMBIN SPRINKLING SYSTEM MISCELLnNC0U5 ROUGH HE�TING �NO MR CONDITIONING TEMPOR�RY SEPVICE OA POLE UNDERGROUNO � POWER � ROUGH WIRING TRENCHES FOHMS ' STEEL REINF. FLOOR SYSTEM BOND BEAM n STEEL REINfOftCE � $HERTXING FRAME AND FLRSJIINLi _ ./ L ...�..�n.. — n-y PLP57ER,BROWN VAIUE SUBCONTRACTOR �� A j''; o s, COSTA MESA BUILDING-SAFETV DEPARTMENT � P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING � � �� AD�RESS OWNER OR ^ � G ' _/ � TENANT `7 (L� MAILING ADDFE55 TEL.c CITV � NO.�J CONSTRUCTION E� � 4 Q y � 2 F � La7 F Q C .] Q 7 } � � W G � a a z W �" 3 BRANCH ADDRE55 ARGNITECT CONTRACTOR ADORESS CITV STATE � IIC. NO. SIZE Of LOT USE OF TEL. TEL. � NO. CITV LIC. NO� NO.OF BLDCS. NOW ON LOT Separa[e permits are required for elec[ric, plumbing and heating work. USE OF BUILDING ANO WORK TO BE PERFORMED I hereby acknowlatlpa that 1 have reatl thls eppliwtlon antl state ihat the ebove information is correct antl agree to comply with all laws reguletinp buildinp cOnctructlon, and I shall not employ any person In violation of Me workman's compensation laws ot the Stata of Californla. I hereby cerUfy that I em properly Iicensetl as a controctor untler the State of Californle Business and Professions Cotle, Division 3, Chepter 9, and that such licenses are in tull torce antl ettect, or I am ezempt from the provlsions ot tha Stata of CalHornle eusinass end Professions Code, Divlcion 3, Chapter 9. Si8^atura of Permittae or Authorized Ageni Date TIONFOR�STRUCTURALPERMIT��59 TL A.P. NO. I f I� / U— �� BUILDING�.359 Lcx_��c ADDRE55 UNIT OR SPACE NO. TR.NO. � LOT I' � NEW ADD ALTER REPAIR MOVINC OWNERV� �� —�c USE 1 �rl �f��ALUEs ROVED APPROVEDSETBACKS (FROMC/L$TREE ) REAR � �/ I FT. PLANNING ACTIOIV DATE J /� DATE THE AMOUNT SHOWN UNDER VALUAT THE PURPOSE OF ESTABLISNING A PERMIT VALUATION PERMIT FEE S � PLAN CHECK $ � ! §�q // TAx E p'{ , % �( / TOTAL PAID E m � > v w � IS FOfl m ONLV: � �- a \O� „ n .�� o LL f U