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HomeMy WebLinkAbout1175 DORSET LN - Building Permits a`. 5T (CITY OF COSTA MESA 4 BUILDING DIVISION o> %�,,,,. �, DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER t;t a !i PERMIT 4. !0 �1� E07-00150 itbeft 40 IMISO (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaElLECTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1175 DORSET LN Status: ISSUED Suite No Applied: 02/26/2007 Vicinity: Issued: 02/26/2007 Parcel Nunmber: 14114114 Applicant: JAVIER, NICOLE Address: 1175 DORSET LN "Phone:-•,714.979.2029 ISSUED BY: COSTA MESA,CA ---,A � :_ Zip" 92626'" Owner: JAVIER; DANILO BALASTA ' ' ' ' - •/ . '-' ...i-:•_,>--, Address 1,175 DORSET LN , . _ / . COSTA MESA,CA - ` Zip: 92626 •- '‘ /----,, <' �/ >\\.V , .. Contractor: tor: 'OWNER'BUILDER -. .\\('AV \' '/- ��\\`, Address:1 \...1\.-\-\\..\./ _. /7217•// Phone. . A. \ Zip: ,y S r,. License!'000000c ti�) '� \1� r,Uc - • ' - - � ' ',-7; ' - SCOPE OF•PERMIT , & ' UPGRADESERVICE TO 200 AMPS. -� '/ 1 v, FEE SUMMARY \, \ ;r;!',1 V. 'Quantity- - _ _ - _ _ _. Quantity' S,'r', l i- -- ' , . . ISSUE FEE • $23.50 , . , , ;/ y --r r;;Temp-Dist System/Lighting;w $0.00 0 ! -r . � tl 1 Temp service test $0.00 " ' /s Busway•/100-ft ;'�, h' _ $0.00 0 �� , Res..a/c package $0.00 - - -. - - Standing.Seclion -- $0.00 0 ' • !:. ; L" New Res(1-2 units) $0.00 \ 0 Misc Electrical Equipment / $0.00 0 . rf,,, , r_ \l , New Res(3+units) $0.00 0 - Transformers up 10,1 kva/kw - $0.00 0 //i _ Pool/Spa $0.00 0- tv'- _ _,- - ' _ iupao-10k'va/kw -�_, $0.00 0 IJ' Lighting Fixts $0.00 ---',-• -- z -'''-- up to 50 kva/kw". i $0.00 Recept Outlets - - $0.00 - 0 - 'up to 100":kva/kw - $0.00 Switches• ' ' $0.00 0 .over100 kva/kw i $0.00 0 r P I ., /r; Non Res Appl" $0.00 0 Low Voltage Equipment $0.00 Cr*,j jj. . - ' Res Appl - $0.00 - 0 Low Volt Wiring System/Ckt $0.00 0r,/ - l�- Service to 200a • $30.50 : 1 Misc.Conduit '$0.00 %0'/ _/ • Service to'1000a - • , $0.00 0 . '-ivtMisc.,Conductor '$0.00 c/-0: : Li , / '/ Service over 1000a - ,� • $0.00 0 v`-;ti p .Circus,(gen or ride) 1$0.00 i/�/o A / //,,,7 ." Motors to 1hp $0.00 0 <<�`,✓'- - ` Circus(mach ride or lights) $0.00 / 0 �/ /-ri Motors to 10hp $0.00 0 ,Christmas Tree•Stand $00"0,' 0-,' ; / Motors to 50hpN- $0.00 .i. �r,0. =, ' ,Fireworks Stand;.' i :J Y-" '-'$0;b0.' 0, , ;�/ Motors to 100hp` 7- $0-00 07" • - :Other Electrical Fee • $0-00/ - Motors over 100hp- '$0.00 . 0 , - -- '/-/.< "" . ' '� ' ' Communication drops . `721, $0.00 '.--•'/\--`,10..\, ' )-- '-Investigation Fee ,--/" $0:00.1,622/1(% Sub panel to 200a,�,\ ' $0.00 • -CO \c, Plan_Check Fee-----51,c5.2 $0100\ G Pole Light Pkg '-•'N "$0.00 , 0 ' '_` Reinspection Fee', -- ./i $0'.00' ` /)/ Sign Circuits . $0.00 i , - "0 = - L� "/ ce•\ Temp Pwr Pole , V TOTAL CALCULATED-FEES '$54:00 Intermed Pole " -$0.00 . ' /'"0• -,' • - - - - ,- ' ' ` ..-/":-/'77 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 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(6,00) • WORKERS'COMPENSATION DECLARATION: S ' 1 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. ❑ I 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: 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 to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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.a Class 4 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: 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 lsubjects the applicant to a civil penalty of not more than five hundred dollars($500).): 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.It,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.). • ❑ I,as owner of the properly,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.). xempt r Sec. ma���yyyy,,,, ����-��- Business and Professions Code for this reason: Signer ID 7 ,I{F[L P/` y1WettLer2 7--161 Owner ID verified by d vers lice jj�Yes 0 No arts Lloe - xpires: , Verification of Ownership by(type of docurhent,i.e.-property tax bill or dee : 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? 0 Yes 0 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? 0 Yes 0 No (Section 25533 of the Califomla 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. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes C]No (Section 65850.2 of the California Govemment 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? 0 Yes ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If 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? 0 Yes 0 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-describ=•.property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final )inspection. L-24 -0 / And/Or Authorized Applicant Date CODE. INSPECTION TYPE gLg INTIML@ CODE t INSPECTION TYPE PATE PALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final • 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical /, 201 Final BIoctdRetaining 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 • PROJECT ADDRESS: 1175 DORSET LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 05575`_ OWNER'S NAME: MINTON, CARL D ` rd. ADDRESS: MINTON, JEANETTE J PERMIT NO: B 055755 PLAN CHECK NO: N GOVT: N SUPP: N 1175 DORSET LN 11 COSTA MESA, CA 92626 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REROOF 2400SF RESID & GARAGE W/COMP SHIN SQ FT: 2, 600 ADDRESS: UNIT: CLAIM VALUE: 2,600 . 00 CALL—VALUE: 2, 600 . 00 GROUP OCC: R-3 /M-1 PERMITTEE: CAL—COMP ROOFING CO ( 714 ) 982-3802 ADDRESS: 9830 CASIANO CAVET COMMENTS: SMOKE DETECTORS REQUIRED IN HOME RANCHO CUCAMONGA CA 91730 **************************** **************** E** E********** nvD TmtoLICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professi ns Code.and my lice is in full force and effect. SETBACK S I��y�Y" CITYLIC.: 05 56 STATE LIC.: s.374.2 ss. s5. 3 U CGn UJ( ED Date: /�/ 7//� 2 Signature: �S / Z1 MAIN BUILDING ACCESSOR��$TTILDIN WORKERS'CO ENSATION DECLARATIO . Ihereby affirm that l have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT: FT IN REAR; FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab_C). LEFT: FT IN RGHT: FT IN LEFT: • FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 14114114 ZNE: REF NO: ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> Date: Applicant: ********************************************************************•*********** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section n •ot be completed it the permit is for one hundred 1$100)or less) DEVELOPMENT SER VICES R E Q U I R E M E N%T S I certify that in the performance of the work for w ch this perm is issue, :Il not pl y any person in ny manner so as to become subject to the Marken' nj�,�atlon Laws California. ZONINGZONING APPROVED BY DATE: %y. Date: �7 Signature: /2.a...-/. NOTICE:If.alter making this declaration,you should become subject to the Workers'Compe sation provisions of the Labor BUILDING APPROVED BY : DATE: •.A Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. nJ' CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; 1/� <. DATE: IO I cJ Z *. which this permit is issued(Section 3097.Civ.C). ************ ****.***1(.***************.**TFiF 3F1E**�J************************* * *999FFF***** LENDER: ********************************************************************iE********** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL' SEGMENT:Y F. OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES:, GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 5 4 . 00 5 0, repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON'-RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 'l any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(8500). ISSUE FEE .../ I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID %i_ DUE ❑ structure is not intended or offered for sate(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 54 . 50 0 . 00 0 . 00 54 . 50 54 . 50 . 00 does not apply to an owner of a property who builds or improves thereon.and who does such work himself/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 will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 54 . 50 OVER/SHORT: n ,00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING/PLAN—CHECK I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 . 00 . 50 (1 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *****)(.**********************************************************************IF** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.8 P.C. for this reason: TYPE QTY DESCRIPTIO N • UNIT COST tTOTAL COST Date: owner SFR 2600 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 � 2, 600 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that!or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a �, permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. Date: pplicant: 41 A I hereby certify that I have read this applicati n and state that the above i motion is correct.I agree to corn ly with all city and cI ' c.ordinances and slate laws relating to building onstrtionandsofthiscitytoent upon the above-ment 02 00 10603 00106034 TO ti.SO property for ins ection purposes. (/ V/�/� DATE. 91/10/92 TIM: 09:17 Date: ' ✓ - Signature: ''Y Driver's License ir Social Security a: 1641.46 White—Building:Green—Code Enforcement:Canary—AoolicanC Pink—Revenue:Goldenrod—Assessor tCONSTRUCTION AND PLANNING - - - _ POOL ?A - APPROVALS Permit# Date , Inspector APPROVALS Permit # Date - Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil-Pipe-Undrgrnd, - - - 53. Steel Reinforcement 3. Electrical CondiiitUtility-Undrgrnd. t 54. Forms ' '4. Electrical ConduittUhdrgrnd. - - 55. Electrical Bonding 5. Steel,Reinforceinent 56. Rough Plumbing & Pressure Test 6. •Electrical UFER Grnd. - T 57. APPROVAL TO COVER-GUNITE 7. _Earnings ‘,_ 58. Electrical Conduit-Undrgrnd. . 8. Foundation ^' -, 59. Gas Pipe, 0 Undrgrnd., Test T 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, 0 Undrgrnd. . - 10. Structural Floor System - 61. APPROVAL TO DECK 11. Property Sewer Line_& Hous Connection 62. Backwash & Receptor-Final 12. Sewer Cap .' 63. Heater & Vent-Final ' 13. Roof Drains - - 64. Plumbing System - Final 14. Rough Plumbing - - • 65. Electrical-Final 15. Rough Electrical-Conduit - 66. Solar System-Final • 16. Rough Electric Wiring r 67. Fencing & Access Approval _ 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL - 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT • " 20.-Rough Factory Fireplace r. - - • 4• APPROVALS .. --Permit # 21: Ducts, in-Structure. - -r: x a70. Underground Hydro 22. Ducts, Ventilating , ' _ - ' :71. Product Piping Litres OOil 23.-Gas Pipe-Rough & Test r _ d - 72. Underground Flush' 24.-Roof Framing - - , ' •73. Undergrnd.Storagejank f Gas 0Oil 25. Roof Sheathing - _ '' 74.Overhead Hydro • 26. T-Bar Ceiling (Structural) &Monocoat '. em ' 75. Dry Chical 27.,Frame aFlashing- nd >. z* , 76. DilyStandpipe : _ 28: Lathing& Siding . . 2 • •• • - 77.- FIXED SYSTEM FINAL- _ t.'29. Insulation - - - - , , 78.- FIRE PREV. FINAL •-30. Drywall Nailing i r• t HEALTHAEPT:REQUIREMENT r31. Plaster Brown Coat ; • 79: FINAL INSPECTION e = 32.. Electrical Power Meter:Final' E` ,• •80.•FOOD CERTIFICATE ISSUED 1 33. Final Electric - ' T _ Notes: :r `. 34.-Final HeatinAir.Conditioning, c91.' •- y ' g& _ 35::Final Gas Pipe-TestL. _ _ " _ _ _ . • _ d , 36.Hood or-CanoPY7 - 37.-Final Factory Fireplace f 38. Final Plumbing ,. - - - -39. Water Seivice:Final - } , I _- :40. Gas Service-Final a „ . . "41, Solar Domestic-Final . �' ' • 42:--Backflow Preventer r _ 43. Backflow.Irrigation •. =� 44. Landscape Irrigation System � - _ - 45._Sound Attenuation ' • I' , - 46. Handicap Regulations - - - _ , 47'FINAL STRUCTURE & BUILDING /-I1126 644M, SIQ ,_ 6,�� 48. FINAL PLANNING ` • `` /" ,./- le ,0 i -49.=Electric Release to Edison - 50. Gas Release to Southern California Gas Ca .- - 51. CERTIFICATE OF OCCUPANCY , • No. Date LOT 32 TRACT 4 9 r Lt. I%C.I,LI Y Ll! COSTA MESA BUILDING-SAFETY DEPARTMENT CITY OF COSTA MESA P. O. BOX 317 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING ADDRESSG //75 2arset 44,1 c COSTA MESA. CALIFORNIA ' For Office Use Only RECEIPT NO. PTyIT�N}'I.7 OWNER �K BL K DEVELOPMENT CO. , INC. ILL...��I�'Jf(iUJ} MAIL RECg1V D BY DA REC Ve DATE ISSUED ADDRESS 1555 PLA CENT IA AVENUE (ice I � ZZ-1ANgt1962 CITY NEWPORT BEACH TNGMI 6_322 BUILDING ADDRESS ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER NONE NO. ---- FIRE - ��qq// ADDRESS - — ZONE TYPE I/ GROUP., o' CONTRACTOR K. W. KOLL APPROVED BY DATE ADDRESS 1555 PLACENTIA AVENUE ZONING ZONE NO.OF USE OF NEW S�+y. �...A. CITY NEWPORT BEACH !Z-I I PLANS I BUILDING w/yZf pL - STATE TEL. LIC.NO. 61 195 NO. .M1 . 6=3227 DESCRIPTIONLEGAL 1-41-t- 3 a id? 413 9s SIZE � ,/ NO. OF BLOCS. o OF LOT (Arj /I /60 NOW ON LOT A.P.NO. USE OF YARDS EVES EXISTING BLDG. NONE APPROVED ALLOWED . SETBACK LINE FROM cif?t // . (CENTER LINE ST.) CENTER OP STREET J' 9' t P REAR YARD .C� FRONT -'SO FT. e. IN. SIDE YARD I LEFT / I RIGHT J / R.SIDE S FT. �� 5 IN. DESCRIPTION OF WORK f -- L.SIDE J FT. IN. NEW I X II ALTERATION I II ADDITION I REAR 2 -5— FT. IN. REPAIRI II MOVING I II DEMOLISH I BYPROVED wi NN'' p,s.9.52 DATE //301/4-Z SIZESyy/kG / � 7rNO OF' ROOMS '0 STORIES 1 EXTERIOR WALL ROOF COVERING STl CCO I COVERING QC4ee l" USE OF BUILDING AND WORK TO BE PERFORMED j/5 a SINGLE FAMILY RESIDENCE WITH P� ATTACHEDIT�G7ARAGE. / .�CJ ' PLAN M JA / I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT TME ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION^ VALUATION PERMIITTEF OF , , / �� /H yv� PERMIT FEE $ 3� 'y S l PLAN CHECK $ /7 50 AUTHORIZED AGENT J 5-0 O TOTAL FEE 1.0/.