HomeMy WebLinkAbout3112 COOLIDGE AVE - Building Permits, .-, '.
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CITY OF COSTA MESA �
� BUILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www costamesaca.00v
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT TYPE B_ROOF2
APN: 14165125
JOB ADDRESS: 3112 COOLIDGE AV CM
Vicinity:
Squares: 150D � .
PERMIT NUMBER: B12-00149
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
Valuation:.
ISSUED
07/05I2012
MDM
$6,500.00
SCOPE OF WORK: RE-ROOF. INSTALL COMP SHINGLES, 2 LAYERS OF 15LB FELT, RE-SHEATHING AS NEEDED, PITCH 2:12
NOTE:RESIDENTIAL RE-ROOF`. Final approval of permit shall nofbe granted until access to dwelling`unit(s) is provided for
verification of the installation of smoke�and carbon monoxide alarms by the City Inspector. See �Attachment w/Inspection Card
OWNER: ABUNDEZ JOSE�C & MARIA T O� �-� Address: � 3112 COOLIDGE AVE �� � � ��. Unit:
PHONE: 714-751$412 -- '- � City/State/Zip: COSTA MESA, CA
APPLICANT: ABUNDEZ JOSE L& MARIA T O� � Address: 3112 COOLIDGE AVE . � � - Unit: :
PHONE: 714-751-8412,,; � � � , �- _ City/State2ip: COSTA MESA, CA �- _ �
CONTRACTOR: bWNER-BUILDER - License No. 000000
Address: Unit: � PHONE:
Cily/State2ip: � - - - - � . CELL:
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
$0.00 '
�139.25
$0.00
$1.00
TOTAL FEES $140.25
HOURS FOR CONSTRUCTI(
Monday thru Friday - 7:00 am thru 7:00 pm.
New Years Dav. Memorial D��
License No.
License No.
e
PHONE:
PHONE:
ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
3turtlays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal
Indeoendence Dav. Labor Dav. Thanksaivina Dav and Christmas Dav
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) -
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspectlons and final approval must be obtained. Failure to obtain inspedions and final approval will result in the expiration of this permit.
�E INS7EGTIONTYPR QAT� IN�L$ � INSPEC710NTYPE QTF, X7ITIPL
1616 Fixed System Final Pire Prevention 206 Final Mechanical
1266 Pool Spa Final �—/—� 208 Final Plumbing
200 Final Re-Roof � �� � 9_Lt—f' � 210 Final ElecVical
201 Final BIocWRp�aining Wall 212 Final Fire Prevention
202 Final Factory Kire Place � 220 Final Planning Approval
2�3 Final Sign 222 Final Site
204 Final Demolitip� - 250 Final Bwltling/Omupancy
WORKERS' COMPENSATION DECLARqTlO� • . .
I hereby affirm under penalty of perjury one of the following declaralions:
❑ I have and witl maintain a certifcate of consent to sel/-Insure for workers'
compensation, as provided for by section 3700 of the Labor Cotle, for the
performance of the work for which Ihis permit is issue0. ��
❑ I have and will maintain vrorkers' compensation insurance, as required by
section 3700 of the Labor Code, for the peAortnance of the vrork for which this
permit is issued. My workers' compenoation Insurance carrier and policy
number are:
Carrier.
(This section need iro! be compefetl Alhe peimtt is vali:ed af orie �untlmtl dollars (8f00) orkss)
Policy Number:
❑ I cerlify that in the performance Of lhe work �or which ihis permit is
issued, I shall nol employ any person in any manner so as lo become subject
to the workers' compensation laws of Califomia, and agree that if I should �
become subject to the workers' compensation pmvisions of Section 3700 of
the Labor Code, I shall forihwith comply wilh ihese provisions.
Appivanfs SgnaWre Da�e
WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARA710N:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 0( t�e 9usiness and Professions Code, and
my license is in full force and effect.
Lic. # Class #
ConVadols SiB^aWre �ace
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrm that there is a consWction lending agency for the
perfortnance of lhe work (or which this pertnit is issued. (Sec. 3097, Civil Cotle).
Lendets Name:
Lender's Address: _
SignaWre Date
OWNER-BUILDER DECLARATIONS:
I hefeby afffm tha� Undef penalty 0f perjury tha[ I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for t�e following reason (Sec. 7031.5,
Business antl Professions Code: Any city or counry which requires a permit to
construct, afler, improve, demolish, or repair any stmcture, prior to its
issuance, also requires the apP�icant for such permit to file a signed statement
that he or she is licensed pursuant to the pmvisions of the Contractors
License Law (Chapter 9(commencing with Sec[ion 7000) of Division 3 of the
Business and Professions Code) or ihat he or she is exempt therefrom and
Ihe basis (or Ihe alleged exemption. Any violalion of Section 7037.5 by any
applicanl for a permit subjects the appliCynt to a civil penalry of not more than
fve hundred dollars (8500).):
\�� ❑ I, as owner of the properry, or my employees with wages as their sole
yl compensation, WILL DO THE WORK, and the simcture is not intended or
oHered 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 tloes 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 huilding 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.).
❑ I, as owner of lhe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CON7RACTORS ro wnstruq Ihe project (Sec. 7044, Business and
Professions Code: The wntractors License Law does not appty to an ovmer of
property who huilds or improves thereon, and who contracts for such project with
a contraaor(s) license pursuant to ihe Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
SiB�aWfe Date
3051-06 (3IW)
� 4
Owner ID verifed.by driver s license. ❑ Yes ❑ No �•
Dnver's License No. Expires:
Verifcation of Ownership by (rype o( document, i.e. - proDerty tax bill or deed): �
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth inb which a
person is required to descend, vrill be matle in connection with vrork authonzed
by this pertnit, and that no builtling strucNre, scaffolding, falsework, or demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Title 8, Califomia Adminisirative Code).
❑ As owner-builder, I will not employ anyone to do work which would
require a permit fmm the Division of Industrial Safery, as noted above, unless
such person has a permit to do such work from the tlivision.
Applicanfs SignaWre Oate
Division o( Industrial Sa(e�y Permit Numher:
HAZARDOUS MA7ERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or tulure building occupant neetl to fle and
certiry a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes � No
(Section 25505 of the California Health and Satery Code requires, with some
exceplions, that a Business Plan be fled with the Cos[a Mesa Fire
Department by every business which has al any one lime during a reported
year a quantity o( hazardous materials equal to or greater [han a weight of
500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressed gas
at standartl tempereture and pressure).
2. Does or will the applicant or present or future building ocCupant need b fle
a registration form for awtely hazartlous materials? ❑ Yes ❑ No
(Section 25533 0£ the Califomia Health and Satety Code, with some
exceptions, requires regisiration with �he Costa Mesa Fire Departmen� by
each business w�ich at any one time has on hantl a quantity of acutely
hazardous malerials equal to or grea�er ihan a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at slandard
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
(Seclion 25534 of the Califomia Health and Safety Cotle provides that ihe
Costa Mesa Fire Department may require the preparation, certification and
filing with ihe Fire Department of an RMPP by businesses which are required
[o register acutely hazartlous materials with ihe Fire Department.
4. If an RMPP is presently required, has Sec�ion 25534 of the Califomia
Health and Safery Code been fully complied with? ❑ Yes ❑ No
5. Does or will ihe applicant or present or fuNre huilding occupant require for
ihe vrork which is the subjec[ of this application a permit for such constmction
or modifcation from Ihe South Coast Air Qualiry Management District or (rom
any other air polWtion conirol district or agency? ❑ Ves ❑ No
(Section 658502 of the Califomia Govemment Code requires ihal lhe requested
infortnation be fumished on applications tor non-residential builtling pertnits).
6. Will any part of the faciliry [o be constructetl under Ihis permit be within
1000 feet from the outer boundaries o/ a school? ❑ Yes ❑ No
Qf "yes", ihe faciliry must meet the requirement of Sections 25534 and 42303
o( the Califomia Health and Safery Code).
7. If a permit from the South Coast Air Qualiry Management District or other
air polNtion coNml district or agency is required for the work which is Ihe
subject of this application, have all of ihe disclosures prescribed 6y Califomia
Healih and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes", attach certi(cate of compliance from the appropnate air pollution
control officer). '
CERTIFICATE OF COMPLIANCE: I certiry ihat under penalty of perjury the
information given above is correcL I agree to compy with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
SignaNre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury Ihat I have read Ihis application and siate [hat
the information given is correcL I agree to compty wi[h all state laws and city
ordinances relating to building construction, and authorize representatives of
the Ciry of Costa Mesa to enter. upon the above-described property for
insp .ction purpo s. I agree not Io occupy or allow occupancy of any builtling
aut r 2ed byk �permit until fin 1 fnspecti
SignaWreolLegalOwner�5) Dale
MNorPuNorrzetlApPlicant Date
�
����° Cit o Costa �I�lesa �uildin 1�ivision
�'_ __•_�_1 �' f �
Costa Nlesa �� Fair Drive, Costa Mesa, CA 92626
714-754-5273/Fax 714-754-4856
OWNER BUILDER VERIFICATION
Permit #
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the
property improvements specified at
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner-Builder. We will not issue a buildi�g permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting
authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECT/ONS: Read and initial each statement below to signify you understand or verify this information.
,\,� 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder
and am aware of the limits of my insurance coverage for injuries to workers on my property.
�2. I understand building permits are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
y�3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that
I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
or her name instead of my own.
�4. I understand Contractors are required by law to be licensed and bonded in California and to list their
license numbers on permits and contracts.
�5. I understand if I employ or otherwise engage any persons, other than Califomia licensed Contractors,
and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may
be considered an "employer" under state and federal law.
p�6. I understand if I am considered an "employer" under state and federal law, I must register with the state
and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
��. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is performed under contract with a licensed general building Contractor.
3148-30 CALBO Jan t, 2009 OB Packet lemplate 1 of 2
�8. i understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable
for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the workmanship or materials.
�' 9. I understand I may obtain more information regarding my obligations as an "employer' from the Internal
Revenue Service, the United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of Industria! Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or wwv✓.cslb.ca.gov for more information
about licensed contractors.
Jv'10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
that I am the party legally and financially responsible for proposed construction activity at the following address:
�11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will
abide by all applicable laws and requirements that govern Owner-Builders as well as employers.
y� 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the
public. If you contract with someone who does not have a license, the Contractors' State License Board may be
unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may be in civil court. it is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's
driver's /icense, form notarization, or other verification acceptable to the agency is required to be
presented when the permit 's issued verify [he property owner's signature.
Signature of property owner Q O Date: Li L .� '
Note: The following Authorization Form is required to be completed by the property owner only when
designating an agent of the property owner to apply for a construction permit for the Owner-Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents
necessary to obtain an Owner-Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form
notarization, or other verification acceptable to the agency is required to be presented when the permit is issued
to verify the property owner's signature.
Property Owner's Signature:
Date:
314830 CALBO Jan 1, 2009 OB Packet template 2 Of 2
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' ` � .Mr.. Pan Bullis . , '; - - �; . -. , - .
f . 3112 Coolidge -Ayenue � � ' _ ' , - �
�' - `Costa Mesa, California 92626 •
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� •A buil`ding permit �has-.been�lsaued to �Sunset Pools to construct � � - --
�' a �priva[e= awimming pool o our property _ �. .' ; ' '
' In order fhat 'your,pool will'• b�►a'safeNone agd :foz, the purpose x_ ,
' ?'of advi"aing you of your�responsibi'li[y:.regarding :the.requlre'-
-`.ments'of':the Costa Mesa Municipal Code� ve�refer you to'Section ' •- .
- •�8107� a copy of, cfi•is ettached. , - ' �- ± � '-
° uThis•Letter is`direc to you 1n order that you mill.be aware �� �,r
.' of our`ordinances and'�can`make a completeJsafety:check of your •._ ,
`� pool, area. _ -. : � ' . ` . . • , _ _ ` z - .
-... . � . " Sincerely yours� y�� ".
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. - RICHARD.HANHART., - �
'� _ . '. . .,.Building Safety Direc[or `,.. �_ `` ,
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TESTIN6 �s�..o�.. . �..,,. .->. ;:..o.�...., ,.�
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April 19, 1974
Examination: 5 C %4 -188$
COMPRESSION TESTS ON GUNITE CYLINDERS
Mr. James White
12050 loch{ea lane �69
Huntington 8each, California 92646
PROJECi Pool for PAM BULLIS �" �4�
ADDRE55 3112 Coolidge, Costa Mesa
9AMPLE FROM 1-4 Shallow End: 2-5 Deep End: 3-6 Bond 8eam
ARCNttEGT CONTRACTOR
Sunset Pools
ENOIHEF0. SUBCONiRACTOP
Enterprise Gunite Co.
SPECIFIED
MIX Gunite STRENGTH Z OOQ Si
DATE CAST
DATE TESTED
CYLINDER NO,
COMPRESSION
,TOTAL LOAD, LBS.
POUNDS PER SQ. IN
SIZE:
GOMPLIANCE
�1-12- ]4 SIUMP
4-1g-74 4-19-7b
� 2
7-Day 7-Day
95,000 97,250
3�824 3,746
5-5/8" x 12-1/2" 5-314" x 13"
7-day test complTes with speciftcations.
. A
b-19-74
4 "HOLD"
3 5 "HOLD"
6 "HOLD"
7-Day
95,500
3,680
5-3/4" x 12-t12"
MADE er DEIIVERED BY RECEIVFO ON
CYLINDERS - - - J, White 4-13-74
oisrxieutioN: ll�'�UIfV9a .7Q�Cli V��rr
"—` �•esa s►dy. Dept. �,�� 2 � 1y74
Enterprise Gunite Co.
Jim White - 2 •
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•I,� Nlnpia{y �4� yUtllnlf�FD �5 1��1. Cl1M1iIpFNi1�� 4�HOYlRir Oc CLIENiS. �ULHO� •"7N 40H PU9LIC�i10N O� OUA REP04iS CONCLUSIONS, OR YM_
1H�Ct5 �ROM [1R wf�.��aO�hG �r�t� 'S w�S�uYlO CENOiNG OVA WA1ii£N nnnFOVaI a �`Va� nMOlEC110N TO CIIlNTS, }M! PVBLIC FND OVASELVES
3?Q'12
l
OWNER gULLIS, PAN
� �JOB ADDRESS �
�a GENERAL CONTftAC�ITOR �
.�
�� AP No.141-651-25 LO
INSPECTIONS
�
�1 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 Fecep. Final ,
Fencing Final
DATE 3-27-7�
BUILDING PERMIT N0.
N of WORK Pvt.Swjm Pool
SUBCONTRACTOR
Plumbing
3-��-� 3�av
3-a7-� Gs��
� 38206
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
Fo� Applicant to Fill in Completely
BUILDING
ADDRE55 � � V��
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CITV A/VAI�`�M N���
STATE ��/��� CITV
LI0. NO. LIC. NO.
SI2E i NO. OF BLDGS.
OF LOT ' NOW ON LOT
USE OF ����
EXISTING BLDG.
S12E OF NO.OF
NEW BLDG. ROOMS STORIE:
EXTERIOR WALL - ROOF
COVERING COVERING
VSE9F BUILOING AND Wj�(iK TO BE PERFORMED
I hereby acknowletl8e that I have read this application antl state
that the above information is correct and agree to comply with
all laws regulating building construction, antl I shall not employ
any pe�son in violation ot the wo�kman'S compensatiOn laws of
ffie State of Califomia.
I hereby certify that I am prOpBrly licensetl as a contractor under
Ne State ot California Business antl Protessions Cotle, Divisicn 3,
Chapter 9, antl that such licenses are in tull torce antl aftect, or 1
am exempt from the provisions ot the State of Calitornia Business
antl Protessions Cnoe, Division 3, Cha ter 9.
Sipnature o�� ���
Permittee �
Auffiorized Agent
�.�r.� 2�-��,`°`—`00 975+= �r,fi:;:39.5Q
��<;
TION FOR BUILDING PERMIT
A.P. NO. ��'F� �p�� /C.�7 � f
BUILDING � �
A DOIi ESS
TRACTYS�aFJ LOT
W ADD A T R P
OWNEF ��a ����,s
VALVE
use�WfM C�b�, s
FIRE I r I./�
BLOCK
�
• •
N NO.OF USE OF NEW �`
PLANS � BVILDING
YARDSAPPROVED VARDSAPPROVED
MAIN BUI�DING ACCESSORY BVILDING
iOMGLSTREET) �� �
�
FT
DISTANCE eET. BET. MAIN &
MAIN BLOGS. ACCESS. BLDGS.
VAR.,'k DATE
C.U.P.# APPROVED
APPROVED
o.. G�``D„�� „�T� 3 —27—
W
�
SQ. FT. � O
THE AMOUNT SNOWN UNDER VALUATION IS FOR �
THE PURP�E OF ESTABLISHING A PERMIT FEE ONLV: Q
VALUATION � y
PERMIT FEE $ �
� � �
m
$ �/DD P�N CHECK $ - E
r1 G. o
� LL
l�922
COSTA MESA BUILDING-SAFETY DEPARTMENT
�P.O.BOX 317 C08TA M86A.CALIFORNIA
For Applicant ►o •Fill In Completely
TYPE OR PRINT
A�DRE59 11.2
COSTA MESA, CALIF NIA
TEL. L
NO. _
/�/
A ORE976L �r�e '" ..
�iL811 t.
CITY - � ��i+ - - ��Q
STATE S 3. ' TEL $ S�O�
LIC. NO. � � r
SIZE ' rvo.oFe�oae.
OF LOT n I now oN LAr
USE OF
EXISTING BLO6. '
B£TBACN 4N[ FROM " ' ' ' �
CENTER OF GTRER REAR YARD
SIOEYARDI LEFT /� I RIONT %
DESCRIPTION OF WORK
OR
1 HEREBT ACKNOWL 1
AND 6TATE THAT T A H
PLY WITH ALL CI 1
BUILOINO CONST 1
SIGNATURE
PERMITTE
AUTHORIZ6D A6GNT
S
�
FEE ���EIVED
JUR1�
APPLICATION FOR PERMR �
C I�F NA� ��T.
'o F"COSTi�S�I EgR'r
R6C61PTN0, r�Np�
9 i
f� D�.'6�'�D .. ..JUL 4S'OE1L
APPROVED ' (�
Bl' DATE
ZONING
ZOX[ NO.01 UBlO�Ni �
R-1 PLAN9 n eui�o�rvo W/ Stt EF
c
DiGCRIRION �t 66, Tract 4536
A. P. NO. - IIOIIe
NOTE: NO EAVE OV ERHANO BHALL BE LESS THAN
80" TO SID6 R RBAR P. 4. ,
EAVES
ALLOWED (U.B.C.RE�UIREMENTI
YARDSAPPROVED YARDSAPPROVED
MAIN BUILDIN(3 ACCESSORY BUILOING
DISTAfiCE BET. BET.
MAIN BLD¢9. ACCE
VAR. � DATE
> s / 37�60.��2/�30 �" o
��XIB AP ftAT10N YMF��MOUNT 6HOWN UNOEF VALUATION IB FOR TXE E
IO qO [ TO C PUAPQSC O� fiBT.�BLI6HINe A PERMIT FEE ONLY. p
'. uw R¢auu Nc , �, y LYU, ION
' /�� PERMIT FEE S ��'� i
%y9�a� w c crc aY— o
4
TOTALFEE $ �'�