HomeMy WebLinkAbout3081 COOLIDGE AVE - Building Permits�-(�Q�`, 30 � l C=6D-�t.�t �-�
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SUN SAVER FIBERGLASS SWIMMING POOLS, INC., 2587 KELVIN, IflVINE, CA92714 •(714) 754�6341
7uly 11, 1980
Charlie Roberts
DeVelopmental Services Dir.
P.O. Box 1200 --. — . - - - �
Cos[a Mesa, Ca. 92626
F.E; Permit Refund
� ;
Mr, Aoberts:
On November 7, 1979 permits were pulled for building, plumbing�
electrical� and sewerage facilities for the installation of a
pool a[ 3081 Coolidge Ave in Costa Mesa.
The customer has canceled his contract �vith us and we no longer
have need of the permits, and would Like a refund.
The permit numbers are 77171> 49171� 46714, and 5906.
No work or inspections were ever done.
Enclosed please find copies of the above mentioned permits.
Th8 ou for your cooperation in this matter.
l/���`i�
K mberl Ochs
Sun Saver Fiberglass Pools� Inc.
Enrlosure
12ECEIVED
�� 14 �9ao
/����l� `B�.�S�lJ'l0 �
%-�S�o �+r-�.
�1�G�T"�"`� �� OFFICESTHROUGHOUTTHEWEST
� � �
�—rs �-J � ��,o�-- ��
��.
�oon�.naem�axo: 3081 COOLIDGE AV
""i�"s"""E'°'ao"": JEFF AXTON
`°o"Ess 3081 COOLIDG�. AV
UNT:
FLOOD; X 47
�vr�.�.uurw aooxess:
631-1400 S�OKE DETECTOR
�xcxrtECTox �ra�vn:
MCH ON ENG'411UDRE45:
REC�IR�D
CONiP"tT01f5NA1�' STAR COURSE ROOFING CO. ( 800 ) 954-0019
ca,m.croxswuur,c z4981 HON AV
"°o"Eu:LAGUNA HILLS CA °CNOe 532778
92653 �NT
LICENSED CONfflACTORS DECLAF�TION: 1 hereby eMim uMar penapy ot pe�jury thet I�ee�'fRvk rwieiom d CMpm B
(m d�q vrilh Saction ]000) d Dimion 3 d �he Buni�roes aM Pmlmdons Code. en cem ' in hp lor e eM e/letl.
ucNo.:��997 �cuss:�_�9 uc.No.: -J8 : 00/00
oe�e: 1 � � / comreao.:
IOWNEP BUILDEfl DECLAX4T10N: I hereby dfirm uMar parju I em emmp Irom tM Comretlaa Liceroa Lewiw ihe
folbxinp raewn (`"edion ]PA1.5 Buaneas end Proleasbne G � p a couMy which requirea e peimM1 to mruVui1, ellx, improva,
tlemdeh, m repei eny etruclure. qior b us bweze. abo eppli�ant lor wch Po�� to fib e aqmd elalamant �het M or ehe
licenaed W�+�� �a tAe prwisiona W tM Conlredon Lica�sa lew [Chaqar 9(oommmaip wilh Sedian ]000) d Diveion � d Ihe
�sinea eM Prdeuiwu COEe� w Iliei ha or ehe ia aeamq thae4om enE ��a bavia la Na ellped exemqion. My videton ol Sedion
. a31.5 Ey any applicent Iw e parm� eubpas tM epplicant to e evil panely d M mae ihen fwe huMretl Jdlen �ISW��.
� I, as owrer d �he peopeny a my employees wih wapee a+�hei de wmpensetion, will Eo Ihe wark, eM ihe elruelure e rot intaMed
or oHared for aele (`�ion 1a0. Buaneas eM Prafaeaiona Cotle: TM Contreeon Liceme l.aw does ml epplyto an ow�wr ol propeM
wM WiAs a inprwes iheeaon, eM vdw Eros eueh wdk M1unseM a he�ae� ar thrpph he a Mr own empbyees, peotided thet aueh
imOrovemaMs me rot inteiMad or a11emE for aeb. X. Mw'e'ier. iM1e Euidiip w inpmemen� u eoN wilhin aro yeer d oompbian, tM
owrrer-0uikbr will heve IM WNm d provirq M or ehe db � build w improve la iM W�e d mle).
❑ I. ea ovmer at tM peopeM. � eadusiveN �nired'mp vMh IieensaE wnlrenws �a eonmud the P�ol� (Seqion 1014. Busi�wes eM
r�d�. c�: rna com�mo�. ��� �. do� m eodr a� ow� d awe�r .,no n�m. « �mww� m�o� �a wno
conlrecls lor euM prqads wi�h a mntreuor(s) licemed W�suani to ihe ConlraUan Licenae lew).
� I em examq uMer Senbn: B. 8 P.G.. lar Ihu �eevon: �
ova: ow�w.
I do Mreby ceNty iha� I em ewere d vW imdeiswd tha requiramend d Cel[oma HeaXh ad Sdery Cads Saqian 25505, 255�3. end
255�6, end ihm I a eny M1nure buikinB �0�� �II / wAI nd (a2b a�e) rieed to wmpy w1M1 eeid alma oodee enE IM iepuiramanb M
e parmil lawmvuetionor moCifiuiionhwniMAr�erep�r� �nd. HeakeMiel oonsteW ion eppiratiau ero exempt Imm Nme
pranabnn. -
Dale: Appl�:
WONKEF'S COMFENS�TION DECLRHATION: I Mreby aH�mi uMu pmMy d perjury ane d iM blbw'vp detluazima:
� I here uM wil meinten e cenEifate d mmm�l io sellinm+� ��eii compenatbn. m provided la by Sadion 3]00 d tha Leba
Code. la tM pMmmaMa d �M ��ak 1a which I�ia pe�A K ro�d.
�Iheveudwilmeinienxwken'mmpmaetioninurarwe.%nquirsdbySepbn3)WdNelaborCoda.MtMpMwmenrodtM
work lor xTich �hia pemiil ia ianueE. MY ��� Pompanaetion inwrence mrtiar ud pd'iry number ara:
Carror: c�'�TF FUAL EXPIRES
PolicyNumbec �'� o���_o� 03/10/96
his section rwed nw be canplered I tM pemix is M are nundred ddbm �f�w/ a bn.)
�] I cerlly Net in �M pMamerca d ihe work fa xfic� Ihia paimn u iaiwG. I Mell iwl empby erry paia�n in enY mennar n a� �o
bacoma nubjad �o ihe rkers' compenation lexe d Celilanie, anE eprea ihm il I ehauk bxmie wbpc �o �M xwken'
mmoe� m wwiso ��E/I� e,tl ayvno a me t.eb« coee. i enen ionnwnn oomoN wah uwee o�o�ieions. �
Dm . ` APW�"t:
aminp: F�Uun ro��caro wortxi comprwtlon cownp� L unbwNl, mtl �IWI �u!/xt an employsr ro cAMml psneltlo en0
c/v/l Ilnu up ro me �1ndred flnuurtl ao/kn (S10QOWA M NEltlon b Ms ewf ol mmpwwlbM1 damps� u pov/tlM br In
SxUon 9105 0l Me LWor Cotle, /nronst, and ettornsy4 �sla
CONSTNUCTION LENDINO AdENCY: I InreEy eifirm unEer penelry d parjury thel IMre o e mnatruaion kMinp epanry lor Ihe
oano�� a ina wom i« wnKn ma w�+ m awae (seaa, aw�. cw. cl.
LENDEP'S NAME:
LENOEH'S ADOHE55:
I cehiN Ihai I hew reeC �hb eppliceuon eM atete ihet iM ebo�'a inlametion a c�nx1. I aprea lo mnpy wilh ell dly vq munry ordinencae
end aime lewa rnlelinB �o building cona�ruaion eM Iwraby ainharza repeaenlalives M thia ary lo enter upon IM ebova�meniionetl prtqery
fainspedion purposas. -�
(5151�66 WP) Whna-9uik'vq 8 Sdery: GreemFlo: Cenery-Appirant; Rnk-Rerenue; Cioldenrod-Asmv
CITY OF COSTA MESA — HUILDING PERMIT
PERM NO: B 072892
PERMIT NO: B 072892 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: 5—N . PERMIT TYPE: STR PURPOSE; OTH
JOB DESCRIPTION : T/OFF 6 REROOF W/COMP. SHINGLES SQ FT; 2,295
CLAIM C�ALUE: 2,295.00 CALC—VALUE: 2,295.00 GROUP OCC: R-3 /M-1
COMMENTS: SMOKE DETECTORS REQUIRED PER THE 1991 EDITION OF THE UBC
�r��**+t+t�*�+�+�*�� �+���*�rx ��*+t� ��r+t*� *+t+t*rt�*�*x ��**rt� *� x �**�***�****+t*****�r*��*�r*�*+t
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
------------ MAZN BUILDING ---------- --------- ACCESSORY HUILDING ---------
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: 14160427 ZNE: REF NO:
PLANNING NOTES>� '
i•'
*,��,���*����������+�+�*��,«�,���,�*��*�***��+��*,�,���*� � �*�*�*+�*+��,���� �,��*****+����*����
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: '
HUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY: ��i� DATE: �' Z( 4�
iEiFiEiEiFiEiEiEit-iE*ifrt�ltx�*******iF±i�3F�FTF3F7��3E3FiF'iFiFiF�F'iF7F3F i��fifi�iFTF3F3F'�F�F*it*iliF�EiEiti�* iEi�
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLOMBING ELECTRIC MECHANIC FIRfi- SMIP/RES GRADING
PERMIT 54,00 .50
PLAN
ISSUE FEE
, SMIP/NON-RES
.:.
BUILDING-DIV-> PERMIT ISSUE PLAN-CAECK •TOTAL PAID DUE
TOTALS----> 54.50 0.00 0.00 54.50' � 54.50 .00
REVENUE DIVISION TOTALS--> COLLE�TED: 5.4.50 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT' GRADING PLAN-CHECK
54.00 ' .50
1E iE 1k 1f iE IE 1f 1k 1E 1E 1E 1E 1E if 1E 1E �F if 1E 1f iE 1E 1f If iE 1E if 1E if 1F 1E 1E iE 3E M iE iE iF 1F 1f iE fE 1F iF iF 1E fE 1f iE 1E if ik 1E fE 1E 1E fE iE iE iElE iE jE iE iF if !k iE iE 9E fE iE 1E 1E fE �E jF 1E iE
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 UN3�T COST TOTAL COST
SFR 2295 REROOF 8Y VALUE RESIDENTIAL "-NOZONE :j �;1.00 2,295.00
END OF FEES ,
• /7
�0: UU19-`:79-Gt7�345E;� Tp�pT =r.5�7
DATE: loi3?l45 T3i9E� ?Oc21
� POOL dA
a' CONSTRUCT�ON ANDPIANNING , - '
a
APPROVALS Permit # Date Inspector AppROVALS Permit #\� Date lnspector
i. Temporary Electricai Service or Po1e � - 52. Pool & Equipment Location '
2. Sofl Pipe�Undrgrnd. , 53. Steei Reinforcement '
'3. ElectricalConduit,�Utility�Undrgrnd. 54. Forms '
4. Electrical Conduit�.Undrgrnd. 55. Electrical 8onding
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test
_6. Eiectrical UFEft.Grnd. 57. APPROVRL TO COVER�GUN�TE
� 7, Pootings ' 58. Electrical ConduitcUndrgmd.
' , , �
8. Foundation � -. � . 59. Gas Pipe, O Undrgrnd., Test .
9. Water,Pipe-Undrgmd. �� � � � 60. Backwash Lines; P_-Trap, Li Undrgrnd. '
70. Strugiural Floor 5ystem • _ � 61. APPROVAL TO�DECK- �
i t. Prop'eity Se, vwer Une & House Connection 62. Backwash & Receptor-Final
12. Sewe7Cap?t ��� 63. Heater & Vent-Fi�ai ,
13. Roof prair".s� ;r �
64. Plumbing SYstem -, Final
�14. Rough�Plum�bing � ' 65. Electrical-fi�al . },
15. Rough EleCirical�Conduit ^� 66. Solar Svstem-Pinal� '
�76. Rough�Eleeiric Wiring • 67. Pencing & Access Approval �
17. Rough.Wiring Sign 68. APPROVED FOR PLASTERING �
18. Rough ElecvicabT Bar Cr.iling 69. POOL/SPA SYSTENiS FINAL •
19. Rough Heating & A�r Conditioning , FIRE DEPT. REQUIREMENT
��
20. Rough Factory Fireplace " � � " ' :,�' APPROVAl:S ,. Permit #
21. Ducts, in Structu�e '' -_ ' - 70. �Underground Hydro '
22. Oucts, Ventilating �. � �" c� :. 77. Product�Piping GGas ❑Oil
23. Gas Pipe-Rough & Test _ ^ " ' F' 72, Underground Flush�- '
24. Roof Framing � ' � � ." . 73 � Undergrnd. Storaye Tank � Gas G Oii
25. Roof Sheathing �� � � L2' �[s �r.ai� � 74• -Overhead Hydro..
26. T-Bar Ce�ling (Structurali & Monocoat , -. 75. Dry Chemfcal p. .
27. Frame and Flashing � � � • . 76. Dry Staridpipe - - • �
� 28. Lattiing &.Siding � '' � - ' �� �-a 7J��, FIXED SYSTEM'FINAL _.
29. Insulation � •' � . �• ' � 78: FIRE PREV. FINAL � � �
� 30. Drywali Nailing :;. ;;_ _ i � .HEALTH DEPT. REQUIREMENT
t ` _
.31. Plaster Brown Coat• � --�^ • � 79. FINAL INSPECTION : I
32. Eiectrical Power Meter-Final �- ' +�'80.' FOOD CERTIFICATE ISSUED I
F , .
_l
, 33. Final-Electric, � • � � � Notes: •- '•- � '
' 34. final Heating & Air;Conditioning i , a q( e� L ` S`� �
35. Flnai Gas Pipe-Test � � . • � S � " (�
'fl � tRL � ZZ4�
36. Hood or CanoPY ' ` - - � . . '''• - y . , . '.
- 37. Final.Factor FirePlace � �. , - . � .Cj� .. 7 '' (� 'r; ��i�• �' �
Y . l �%i1'..1.. G'S/(r...' ��t�l L.. .�
' 38. Final Plumbing - � ' � . , „f- rLs � ,..�s�'" �.-' yly +, -
39. Water Service•F.inal. � � ��. �SG'S�„�: ' S�G:.i�r,.
40. Gas Service-Final . .' - ' � - ''
�'. �
47. Solar pomestic-Fi�al, ' . �� C� � ^
� �+ B�t.�r
42. Backflow Preventer � • -
(= - �'��o-l�-Q6
43. Backfiow Irrigatio�. ; . � - � • �o Ly 9� �,k1.,Q.
44. Landscape IrrigatiomSystem : r: ` � � � � - - '
� -
45. Sound Attenuadon' � '' . ' , , � - ' . .
. r• ,
46. Handicap�Regulations � �: "• .
,47. FINALSTRUC7UR�&BUILDWG l `�_� , ,(` ` �_ a .
(r'
48. F.INAL PLANNING " a `-: R. _ r
49. Elect�ic Release to Edison ' � � :. �
� �
50. Gas Release to Southem California Gas Co � ._ . ' � ' •
51. CERTIFICATE OF OCCUPANCY^ � - . ^ �
No Date
owtvER Seaview Ho
JOB ADDRESS 30a1 CO
GliNERAL CONTRACTOR
AP No.
INSPECTIONS
Soil
Gas
OCCUPANCY
'ORM BU4 � SM -
LOT ]
1�7:VYDI
�ri5 VALUE $ 11�,471.00
FIR� ZONE DESCRIPTION OF WORK YES W�3b' 7s'
DATE GROUP I� TYPE V ZONE �-
- SUBCONTRACTOR P�RMPCS ISSUED
, DATE NUMBER
: ��.
�7
�
�
✓
� �• � 17308
. .
COSTA MESA BUILDING-SAFETY DEPARTMENT
� P. O. BOX 917 COBTA MEBA. CALIPORNIA
Fo� Applicant fo Fill In Complefely7
� TYpE OR PRINT � l
BUILDING _ -
A�DRESS ��� 0
COSTA MESA. CALIFORNIA
■ ARCXITEGT
s
� BETBACK LINB FROM
TEL.
TEL.
No. oP
� I LEFT (j � I RIGHT
DESCRIPTION OF WORK
� �� � ��
BUILDING�� -(r�ROOM6
srze �
EXTERIOR W� ��'LC�IROOF
COVERING �{.C� COVEF
USE OF BUILDINC AND WORK TO E
FEE �RECEI�VED
�flNANCE DEPT.
CHY 4�. COSTA MfSA
APPLICATION FOR PERMIT
eua�iN�
For Offiee Use Only
HECEIPT NO. PCRMIT NO.
BY
F�
BUILDING
ADDRE65
� COSTA MESA.
FIRE
ZONING
ZON NO. OF UBE OP NEW S'^' "Tdh/Py
—�� r I PLANB � I BUILDIN6 �/�.�
LeG.•� Lo7` �7 TiP 9.�6J
oeaca�rr�ox
¢eNren uqe e�J
?RONT 'SD
i CII]F S_
6
(3ov
y2�
�, �-
6L
1 HEREBY ACKNOWLEOGE THAT 1 MAVC p6AD TXiB APPLIGTION � TMC AMOUM BXOWN UNDER VALUAiION IB FOR THE
ANG BTATH THAT TME ABtlVE IS GORflECT AND AGRE! TO COM- pUPPOBE OF, BBTA�LIBXING A PERMIT FEE ONLY.
PLY WI'LH ALL CITY OPDINANCEB AND HiATE lAWB R60ULI1TIN0
Bu1lDINo CONBTRUCTION. VALUATiON 9
SIGNATURE OPg . . PERMIT FEE $ �O —
PERM17T8 • , / ��/^ . ^ //
$ /� PLAN CHECK $ ..l 7 �-
AUTHORI].��D ENT � �
TOTAL FEE
�.
OWNE&ICHARDOSN, Dale DATE 7-3-78
JOB ADDRESS oo a ge qenue BUILDING PERMIT N0.46331
GENERAL CONTRACTOR e?' B� r- � DESCRIPTION o( WORK Add room to residence �
� AP No.141-604-27 LOT 17 ' TRACT 4565 FIREZONE VALUEt 3300.00
S�7B`,CORT11/A,CT
ROUGN PLUMBING
PROP. $WR. LINE �
SPRIHKLIHG SVSTEM
NG ANO AI
UNOERGROUNO U POWER
ROUGN WIRING_ .
TRENCNES �' FOPMS�f STEEL REINF
iL00R SVSTEM
BOND BEAM [] STEEL REINFORCE �
SHE�TNING
FR�ME AND FLASNIN (7J�YL
L�TMING - IN � OUT
PLASTER, BROWN COAT
STRUCTURAL, FINAL
XEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINRL ANO GAS TEST �]
ELECTRIC, FIN�L
BUILOING. �INAL
bL-6r�r a'�
(�'.Q�t�O-� •w� "2/� »O 9Nrsvb�U�I
.,y ��331
� COSTA MESA BUILDING-SAFETY DEPARTMENT
' P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626
�a�s�.,
7855 7/03%78-,...•;.:.:.:42.,50.. TL.
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Comple[ely — Use Ink Only
RECEIV DATE RECEIVED D E ISSU
BUILDING �
ADDRESS % � '�
}�( A.P. NO. / / � PERMIT NO.
OWNER v�, S{'�r� L
MAI L BVILDING _n
ADDRESS ADDRESS (x,
TEL. �
CITV Cp �� NO. s $ TRACT LOT BLOCK
CANSTRUCTION (� .n W AD A P
LENDER .�.� r r�'W O�'� .
BRANCH � (���^ J s v �
OWNER
ADDRESS VALUE /1
.o.A'6MMPECT �PS�,�( TEL. Tq_ $
/�
ER !
ADDRESS �S 3 3� J�f//K�G�� /..te ZONE TV E GROUP �
L /'s APPROVED
CONTRACTOR �Lf/ lqQ.h �/ Y e ( C( �'J� BV DATE
ADDfiESS �Q c« Q Q-�O 6.� �„
TEL. ZON NO.OF USE OF NEW
CI7v ' C • N0.7J % ^�/,J�
PLANS BUILDING
STATE CITV �'ARDSAPPROVED VAROSAPPROV
LIC. NO. � LIC. NO. MAIN BUILDING ACCESSORY BUIL ING '
SI2E ' NO.OF BIDGS. (FROM C/L STREET)
OF LOT -" NOW ON LOT RONT I FT. FT.
USE OF /
EXISTING BLOG. � FT. 'f�
Separate permits are required for �. sioe � FT FT.
electric, plumbing and heating work. ' �
REAR . FT.
USE OF BUIIDING AND WORK TO BE PERFORMED DISTANCE BEf. BEf. MAIN &
" MAIN BLDGS. ACCESS, BLDGS.
q / VAR.� DATE
`F G! � O U ti? C.U.P. gJb APPROVED
APPROVE %
I hereby acknowledge that I have read ihis eppl7callon and state � / �^
n
that the above intormation is correct and agrea to comply with m
all laws regulatlnp building construction, and I s�ell not employ �
any parson in vlolation of Me workman's compensation laws of m
the State of California.
m
I hereby certify that I am properly Ilcensetl as a contractor untler SQ. FT. �v
tha State of California Business antl Professions Code, Division 3, THE AMOUNT SHOWN UNDER VA�UATION IS FOR m
Chapiar 9, antl thai such licenses are in full force antl effact, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: e
am ezampt trom Me provlslons of the State of California Business VALUATION PERMIT FEE $ a
and Profezsions Code, Dlvision 3, Chapier 9. / �� vi
///'''��� Od PLAN CHECK $ oD o
Signature o� � o�� /�� $ f�' �OD�
Permittee ���� �f 7 TAX § O LL\
� V y
AuthoflzedABent TOTAIPAI� E 2� � � 1
OWNER
ICHARD
)81 Co
INSPECTION$
Pool Location
Forms
Main Drain
Steel Reinforce
Elec. Bond
Approval to Cover
Underground Electric _
Gas Piping Test
Filtering System Lines —
Backwash Lines and Recep.
Electrical Final
Heater and Vent Final _
Filter System Final
Backwash and Recep. Final
Fencing Final
n.....,..,_i o,., c:..:..�.
unsaver rooi
1] TRACT
T
DATE �1-14-7�
BUILDING PERMIT N
SUBCONTRACTOR
Electric
Plumbing
•t
COSTA MESA BUILDING-SAFETY DEPARTMENT
. P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use [nk Only
ADIDRESS UU' ����-���
T�ENANT�R A(,.C� R/C!'�A.e�R%
MAILING �.._ il
BRANCH
ADDRESS
ARCHITECT �yyy��� �J//��
OR ENGINEER fILNl /GC/�
ADDRE5�5� G`C���,�
CONTRACTO�(JNSAU(( �(
TE
A.P. NO.
BUILDIN6
ADDRE55 i
UNIT OR
SPACE NO.
TR.
NEVJ C
OwNER �
USE v
ZON
APPROVED
__
TIONrFOR�STRU(:TUK:4"LPERMIT 60.50 TL
� PERMIT N° � 49171
// �— � U— 7 %
LOT / BLK.
ALTER EPAIR MOVING �EMOLIS!
i.
:E �C6�A2D�� �J
� VALUE ��y�o -
S � S�ti�
ADDRESS � � N I�}L.L�
CITV y� (�Q� NOL�ISV�3y�
F STATE `I CITY APPROVED SETBA
� �IC. NO.��-{I ��o^% LIC. NO.
{c� SIZE NO.OF BLDGS. (FROM G T ET) ��
S OF LOT NOW ON LOT ROM FT.
a USE OF S J T li' ,/
'�„h,� EXISTI
Vi � � !/ s, - ?'.
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F U O BU DING W K TO B PE F MEO PLANNING ACTION
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� i DATE
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QI hereby acknowletlge thet I have �eatl this application antl state m
y� that ffie above intormation is correct antl agree to wmply wiih
0+ all laws ragulating builtling constructlon, antl I shall not employ �
,'� any pereon In violation of the workman's compensaiion laws of :'
� the Siaie of Californla. [JT '
SQ.FT.' Ov �
3 I hareby certity that I am properly licenutl as a contractor untler n'
the State of California Busin ntl Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and t ch license are In full force antl effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: �
am ezempt fro the ovisions t the Stete of Calitornia Business a
VALUATION PERMIT FEE $
antl Professions od D vision , Chapter 9. � �
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PLAN CHECK $ '� '� o
Signature of LL
Permittee S� TAX $ C>O f
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AuthorizatlAgant Date �� /�U�i%� TOTALPAID $ /r���