HomeMy WebLinkAbout936 CROCUS CIR - Building Permits,
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT N0. ��� !�h DATE �— ��� '3
IAT N0. p y
�D�Ss y�� c� b��s c.;;
The developer of the above entitled tract desires to sell the above set
forth lot prior to the time that the tract has been compl.eted and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreemen:, acknowledges that
(he-she-they) (was or were) advised that th3s txact has
not been given final inspection nor has it been accepted by the City of Costa Mesa
as having complied with the conditions of approval which were impoaed by the City
at the time the final tract map was approved.
The City assumes no liability for the enforcement of the conditiona
necessary for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmleas from
any claim resulting in damage or personal injuzy to the undersigned by reason
of the aforementioned uncompleted condition.
BY ,� w_��n J�. 4�J—c,c_.� �.(' �.V 7
Purchaser
BY G�e��d6�:v ."""�� ' ' �6`� �iY�C/7'L�
Developer and/or authorized
zepresentacive
BY ����,�� � 07--
Lender '
ADUNESSOFBUILpW: MC GINNIS, PAUL HATHAWAY FLOGuNri AHL38
OWNEA'9WWEIfIP�OYIN: TR
GOOPE54: g36 CROCUS CZR
COSTA MESA,CA 92626
1PPL. WUIINfi ADDRESS
ARCNREC7 ON FNOINFiB: IIC.lq.:
AXCH Op FNQ'S /i0DPE54: UNT:
ROGERS ROOFING COMPANY (714)995-2826
�coxmAtT0A9N�11E: qg12 LINCOLN AV
cwrn�crwrs�uwa CYPRESS CA 468874
�� 90630 ��=
UMT:
110EN9EU CONfPRCTONSppDpE�CUXATION: I MngE�y ell'em uMm paiuly d pa�jury thn I un Iceved uMer provimbna d Gheqw B
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�+CRY LIC. NO.: v� JV G ll0. CUSS; LIC. NO.:
`Dele� ��l � /L � 7 J Commtla: � ��+—
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OWNEP BUILDEN UECL�HATION: I Iwaby e1Nm iuMer peeWly d prj�ry Rw I em ezemq Irom tM Coeuemm licwe lew Ip tlr
IdbMiq rauon (Setlbn lW I.5 &nnn� eM Prdwbm Gode: RM ��Y a countY �� �GN� e pertnn io amwd. ellm. impoue.
demoleh, a repv any swctun, prior lo Ge ewenro, abo rpuime ihe eppl'ranl for wch permil lo file e eipneE atetement �het he m eM
n IioenaeA Wn�a�� �o �he pa+iaione d IM Conlreqwt Licenne Lew jCheqer 9(oommendnp vrilh Sedion ]OW) d Orvebn � al �M
Buaimu eM Prdeae'ms Codel or Ihet In a ehe ia axomq �herehwn ud the bava �a �he elb9ad eaemqion. MY v'dmion d Sedion
]031.5 by enY Wd�� lor a permu mibje�� IAe epplicenl to e cY peralry d nd maa tAen live hurdreE ddlen �5500�).
� I, es axnar d tM O��Y ar my empbyaea wih wepea m ihei wle mmpametian, will do tha xaA, end the evunure 6 nrn inteMed
or oilereE br eele �Seciion )OCI, Buvnesa erM Proloaeime Coda: The Con�redon Licanse lawtloes nol eppFy ben oxner W property
wM W dda or inprovae I�areon, aed xho dms eueh work Nmeetl a henaM a thraph h"v or her own ampla/eee. 0��� �� w�h
imparemmta ere na imeMed « Werod Iw eeb. X. Iwwever, ihe Witlinp a inpavemem 6 soltl wnhin me yeer d canpblion, ihe
ownxbuiNr xill heve �M WMen d pavirp M or ehe d'd � W iW a improve lor the puryoae d eeb).
� I, es ovme� d Ihe D�oWM� em aeclueively conlrecl6p wilh licenead conlreclon b consVud I�a projad (Seclian ]W4. Bueinma enE
Vrolessione Cotle: Tha Comredas Lkense Lew doee rw epply io en ovmx d proparly who builtla w impovev iMreon eM wM
convecta lor euM P�qeda xilh e wnireaMn) IicemeE W reueni io iM Camrmon Licama Lewl.
❑ I em eaemq uMer Section; B. 8 P.0., In inie mewn:
oa�a� o,�,a,:
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prwiaiona.
WOXKEH'S COMGENS�TION DECLAPAl10N: I Mreby effimi uMer penelly d perjury aw M ihe Idbwirp Jatlerviona:
� I here eM hil meiMen e ce�dr.eia d conwnl Io wtlinaun M woM1en' companwian, m pariEeE In by Seeion 9'!00 d ihs leEn
Gode. trc iM peRoemu�es d Ne xoA la Mieh INa pe�mE e e�ued.
❑ I Mw ud xil meiman v.a4en' comM�vn imurence. m "vedyn �Seim J100 d Ne leb« Cade. br �he d iM
,.� i« �.nKn m�. w�n �. n.�,ee. rny ..«�A Cs�i���i�.�a��'r�_br£�e oaKv ��mca. �e: X P I R E S
c�..: owr��niaFna 02/26/96
ad:.r H�mc.:
(mia aeeiwr nsed rw�W mnP'ned / Ns P�l "n M me hunEnE ddlan /J�ro/ arlmsJ
❑ I cenN ihel m Ne perlarmerce d tM wak Iw v.fic� Ihie permn u mueE. I ehell mi empb� vry peron in arry meniwr w m �o
Eecome wbjw to tM xarkere' mnpnueiion lew� d CeNomie. aM pree tlel G 1 MwN becmia wEjed io �M �Men'
com ion qwuue tl Seaian �)00 d tM lebor COEe. I NaY IaNv.ith mmp�y wuh a p'wvimv.
`ma � /l —9� .�� �° � ��
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Sxtlon 0)O6 0l tln l�6or Co6, Intw�aq m0 ertomsyY Ira.
CONSTRUCTION LENDINO AOENCY: I Mraby etli�m uMer peneMy d perlNiY �� ��� n e�r�,a� boa�� aaeM.y i« ms
�n�a,m d m. w� ia wn�m me w�� m e.�e Iseao�, wv�, cw. cl.
LENDEfl'4 NUIE:
LENOEH'S AOOflE55:
I ceniN ihm I
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mma thei �he ebove iMame�ion is coirea. I epree �o canpy wnh ell oy erd wunry ordinezea
n eM Mreby eNhorrzs repefen�elivm W tM1e c4y lo enlm upon iM above-menlunetl D�WeM
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CITY OF COSTA MESA - BOILDING PERMIT
�I 1 �:�'7 i TS�o"ij
PERMIT NO: B 074587 PLAN CHECK NO: N --Gt'v i:'—iT''�"Fi---t3 I
CONSTRUCTION TYPE: VN PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : RE-ROOF W/ 25 YR COMP SQ FT: 3,000
CLAIM VALUE: 3,000.00 CALC-VALUE: 3,000.00 GROUP OCC: R-3 /
COMMENTS: SMOK£ DETECTORS REQUIRED PER 91 UBC
��*****�*�******��****�**�**+�*����*���*****�*�+�*�x**�*�****�*�*****�***+�*�r��x**
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
------------ 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
PARFCING REQ• PROV: PARCEL: 41218317 ZNE: REF NO;
PLANNING N(STES>
i
1f iflf !E 1ElElE dE if iF 1E iF if iE 1E 1E if iF iE 1E iF if if 3E iF iE iE if if iE iE iE iE 1E iE iE iE IE 1E 3E iElE 1E iE iE IE IF IF If iE iF 3F fE i6 iE 1k iF iF iElk iE if iE iE iE 3F 3f fE �E iE iE �E 3(-iE iF �E iE iE fE
D E V E L O P M E N T S E R V I C fi S A E Q U I R E M E N-'T S
ZONING APPROVED BY DATE: i
BUILDING APPROVED BY
APPLICATION ISSUED BY: Li
�E�EIEIEiE1fiE�EfE1fiE�EiEiEiEiEiEiEiEiEiE3E 9E E F
LEGALIZATION;N F E S U M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 54.00
DATE:
DATE; � `�
�Fi�**x�*******����',F
STRUCTURAL�'SEGMENT:Y
PIRE SMIP/RES GRADING
50
SMIP/NON-RES
PLAN
ISSUE FEE •
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PPID DUE
TOTALS----> 54.50 0.00 0.00 54.50 54.50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 54.50 OVER/SHORT: .00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
54.0� .50
fE iE iF 16 jf aE IE iE 1E IE iE iE 1E iE iE fE iE iE iE 1E iElE 3Eif iE iE iE if ik iE iE �E iE fE 9E iE IE IE iE 3ElE iF 1E iE �E 9F iE iE iF iE 1E iE iE 1E 1f !F iE if iE ik iE iElE iE iE iE iE iF if iE iE if 1E iE jE iE iE iE �E
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
SFR 3000 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 3,000.00
END OF FEES
O1 0419?.S?4-�C193125 T�3 � 54.,`rU
D�rTE: 20lic; +`� 7It;E: ;1:32
�-
CONSTRUCTIGTv ANO PLANNING POO� cs SPA
Date Inspector Date Inspector
APPRQVALS Permit # APPROVALS Permit # ,-�
7. Temporary Electricai Service or Poie 52. Pool & Equipment Location'
2. Soil Pipe-Undrgrnd. � 53. Steei Reinforcement .
3. Electrical Conduit Utility-Undrgrnd. 54. Forms �'
4. Electrical Conduit�Undrgrnd. 55. Electrical Bondiny '
5. Steet Reinforcement 56. Rough Plumbing & Pressure Test �
,
6. Electrical UFEfi G�ad. 57. APPROVAI TO COVER-GUNlTE •
7. Footinqs 58. Electrical ConduibUndrgmd.
S. Foundation _ 59. Gas Pipe, O Undrg�nd., Test
9. Water Pipe�Undr9rnd. 60. Backwash Lines, P�Traq O Urjdrgrnd.
70. Structural FVoor Sysiem 61. APPROVAL TO DECK �
1 t. Property Sewer Line & House Connection 62. Backwash & Receptor-Finel
12. Sewer Cap .. 63. Heater & Vent-Final �
73. Roof Drai�s ' � 64. Plumbing System � Final� �
14. Rough Piumbing . 65. Electrical-Final
15, Rough Electrical-Conduit - fi6. Sotar System-Finat
76. Rough Electric Wiring 67. Fencing & Access Approval '
77. Rough Wiring Sign 68. APPROVED FOR PIASTERING
18. Ruugh Eiectrica6T 6ar Ceiling 69. POOL/SPA SY5TEMS FfNAL '
79. Rough Heating & Air Condi;ioning FIRE DEPT. REQUIREMENT
20. Rough Factory Firepiace APPROVALS Permit #
27. Oucts, in Structure 70. Underground Hydro
22. Duccs, Ventiiating 71. Product Piping ClGas QOii
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergmd.StorageTank �Gas ❑Oit
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceil�ng iStructurall & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEh� FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall NaiBng HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat � 79. FINAL INSPECTION
32. Electrical power Me[zr�Final . 80. FOOD CERTIFICATE ISSUED
33. Finai Eleciric � Notes:
34. Final Heai�ng & Air Conditioning
35. Finai Gas Pipe-Test
36. Hood or Ganopy
37. Fina! Factory Fireplace
3&. Final Ptumbing
39. Water Service�Finai
4Q. Gas Service-Final
41. Solar pomestioFinal
42. Backfilow Qreventer
A3. Backflow Irrigation
44. Landscape trrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL S7RUCTURE & BUILDING / Zl� Gc�I 6
l'y
48. FINAL P4ANNING
49. Electric Re�ease ro Edison
5Q. Gas Release to Southern Calitomia Gas Co
5L CERTIFICATE OF OCCUPANCY
No Date
A
Applicant to till in all spaces except tnose within heavY eortler lines and sign al1 aooropriate aeclaretions.
CiTY oF COS7A-nn A— CONS UCTION PERM!IT
ProjecFAddress � �� t
Applicant's Mail' g Addr ss r
Owner's Na � n Phort 1
Address
Arch/En9.' ' License No.
Address • �
Contractor's Nam ,\ �"�� hon � f�
Address (mailing) Iv- ��/
City License No. � � Q � �
LICENSED CONTRACTOR DECLARATION
I hereby afiirm.tha[ I am licensetl untler provislons ot Cbarter 9(commencinq
with section 7000) of Division 3 of the Business antl Professlons Cotle, antl
my license is in t W Porce a f ect:
Licen Q s — i ense
Date � Si9nature
WORKERS' COMFENSATION DECIARATION
I hereby affirm that I have a certificate of consent to sel(-insure or a certiticate
of Workerz' Compensation Insurance, or a cerHtletl copy thereof (5¢cti n
3800, Lab, C.)
Policy No. O Company
�Certifietl copy iz he�eby (urnishetl.
C ietl o>y f" tl wtth the cit i� i n
Date � � Applicant �
EXEMPTION FROM WORKERS' GOMPENSATION DECLARATION '
(Thissection neetl not be Completetl if the permit i5 for one huntlretl ($100) or
Iess�.
I cer[ify that in the perfo�manCe of the wo�k fo� which [his perm�t i5 issuetl, I
sltall not employ any pereon in any manner so as to become subject to the
Worke�s' Compensation Laws of Califomia.
Date Signature
NOTICE: If, afte� making this tleclarafion, you shoultl become subject to the
Workers' Compensation provisions ot the Labor Cotle; you must tortM1with
comply with such p�ovision5 or 'this permit shall be tleemed revoketl.
CONSTRUCTION LENDING AGENCV '
I hereEy affitm that lhere is a mnstruction lentling agency for the performance
of the work for which this permit is issuetl (Section 3097; Civ. C.)
Lentler's Name
Lentler's Atltlress- � -
OWNER BUILOEN bECLARATION
I hereby affirm that I am ezempt from the ConVactor'S License Caw for the
followin9 reason (Section 7031.5 Business and Professional Cotlen�Any city or
munty which requires a permit to construct, alter, Improve. tlemolish or repair
any sVucture, p�io� to its issuance, also requires the applicant fo� such permit
to file a signetl statement that M1e/she is licensetl pursuant to the provisions o(
the Contractor's License Law (Cnapter 9(commencing with Sectiori:7000) of
Division 3 of [he Business antl Profe55ion5 Cotle) o� that he/She is exempt
therefrom antl the basis tor [he allegetl exemption. Any violation of Section
]031.5 by any applicant to� a permit subjects [he applicant to a civll
pendlty of not more than /ive huntlretl tlollars (y500).
❑ I, as owner of the property o� my employees with wd9e5 as thelr sole
� compensation, will tlo the wotk, antl tite structur¢ i5 nOt intentletl or Offeretl
for sale (Section �044, Business antl Professional Cotle: The Contractor's
�icense Law tloes not apply to an owner of a properry wM10 builds or improves
tbereon, antl who Goes sucll work bimself/herself or [hrough his or het own
emplOyees, P�ovitletl tM1at such impwvements are not intentl¢tl ot offe�etl for
sale. If, nowever, the builtlinq or improvement i5 soltl wlthin one year of mm-
pletloq Ihe owner wiil'have tne burtlen of proving he/she tlitl not builtl or im-
p�ove to� the purpose of Sale).
❑ I, as owner of the proper[y, am exclusively mntracting with IicenS¢tl con-
trac[ors lo construct the project (Settion ]044, Business antl Professions Cotle:
The Contractor's License Law tloes not apply to an owner ot property who
builtls or Improves theveon, antl who contract5 for such projects with a con-
tractor(s iicense pursuanc to lhe Cantractor's License Law). I am aware tnat �
proof o� their Worke�'s Compensation insurance shoultl be provitletl to me.
❑ 1 am exempt untler Section B. & P. C. for this reason '
Date Owner
1 hereby certify that I have reatl this application antl stat¢ that the above
information is correct. I agree to compty with all city antl county orGinances
antl state laws relatin9 to builtlinq constructlon antl h reby authorize repre�
sen[atives o( [his city o enter upon the ab ve-me tionetl property �
,inspectian p o. .
Signature a«
Drivers' License or 55 � — —
TVPE OF CONSTRUCTION LJ NEW U ADD u ALTERATION u REPAIR'
iO CONVERSION ❑ DEMOLISH ❑ OTHER � : A p # ' �
DESCRIPTION OF WORK/USE OF BLDG.
� I S Main Building:
TVPE OF PERMIT GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MEGHANICAL B Rear �
❑ OTHER A
PROJECT DESCRIPTION SQ. FT. OCCUPANCV C Right
K
CONSTRVCTIONTYPE ' VALUATION$ ' � g Left '.
ZONE GRADINGGU.YDS. ACRES Ping.Ref.�
Remarks: , ' . ' Planning Notes:
Sink
Preventer
Irri9ation
Dishwasher . .
Drinking Fountain.
Floor Drains
Floor Sinks
Gas Service
Interceptors
Kitchen Sink � -
Lavatories
P—Trap -
Roof Drains
Rei�spection Fee
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping .
Solar Tank ' ' '
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service ,
Auto-Wash -
Laundry Trays
$15 � � �� Issue Fee
Boiler
Duct - Under Ground
Duct - Structural
Duct � Ventilating
Exhaust System ❑ Multiple
FirepUFact..Blt. ICBO #
Heating System & Ducting
❑ 0-7 00,000 BTU � 100,000
Reinspection Fee � $15
Hood or Typel LJ
Canopy Type I I ❑
Refrigeration System
❑aioo,000eru ❑�oo,000
System Repair/AI[eration
Fire Dampers
Registers
luue Fee
0
FEES
Automatic Washer
Construction Pole Sub.
Cooking.Unit �
Accessory, B u i Id i ng:
ELECTRICAL
Transformer ❑ 15-50 K6
❑ 50+KW
Dryers'�Gas ❑Electric
Fan �
F.A.U.
Fixtures .
Device Boxes
Outlets
Switches - � �
Garbage Oispoul
Generator �0-5 KW 05-15 KW
Meter LJup to 100 amps .
Merer ❑over 100 amps
Sub Panel ' � .
Motor's�0�1 HP�1%-8
Inc.Solar �9-15 HP �16-75+
Microwave
Pole Li9ht
Range
Sign � '
Standin9 Sections
Trash Compactor
$ 3 '
�-- Reinspection Fee $15, luue Fee
FEES
DEVELOPMENTSERVICESREQUIREMENTS:
Zonin9 APProved By
8uilding Approved By
Appliption Issued By n
$ 3
� SUMMARV OF FEES ,
BUILDING PEFMIT $ SMIP • $
� ' � � � PERMIT �
PLUMBING � < �SSUANCE $
PLAN CHECK .25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM� $
MECHANICAL $ TOTALPEE $
PLAN CHECK 25% $ "
FEES
3
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N
I
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G
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Q
M
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CMF 0865-46, rev. 10/84 White - Builtlin9; Canary - APPlicant Pink - Attounting; Goltlenrotl - Assessor U1 (IUUIJJJJ'WU13:15`J j�{T j,�0
QATE: 09i01iRR TiMC: S�»o
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS; Permit# Date Inspector AppROVALS Permit# Date Inspector
1.`Temporary Elecirical Service or Pole 52. Pool & Equipment Location
; :
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �
5. Steel Reinforcement 56. Rough Plumbing & Pressure TesY
6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE
7. Footings . � 58. Electrical Conduit-Undr9rnd.��_ . .
8. Foundation �• •. _ 59. Gas Pipe, O Undrgrnd., Test�-1
��:
9. Water Pipe,-Undrgmd. 60. Backwash Lines, P-Trap, O Undrgmd.
10. Structural FI or System 61. APPROVAL TO DECK
11. Property Se er Line & House Connection 62. Backwash & Receptor-Final �=
12. Sewer Cap , 63. Heater & Vent-Final
13. Roof Drains � 64. Plumbing System - Final ,
74. Rough Plumbing 65. Electrical-Final '
n
15. Rough Elecv�ical-Conduit 66. Solar SYstem-Final
16. Rough Electric Wiring 67. Fencing & Access Approval . -
17. Rough Wiring Sign 7� 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 f-�- APPROVALS Permit # -
21. Ducts, in Structure � 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Under9round Flush �
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Siructura0 & Monocoat - 75. Dry Chemical .
27. Frame and Flashing 76. Dry Standpipe ,
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT �
31. Plaster Brown Coat 79. FINAL INSPECTION �' �
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED `'
33. Final Electric Notes: � :'
34. Final Heating & Air Conditioning �
35. Final Gas Pipe-Test
36. Hood or Canopy �
37. Final Factory Fireplace � "
38. Final Plumbing N• �b [,�Q
39. Water Service-Final �
;�
40. Gas Service-Final . ' .
41. Solar pomestic-Final � �
42. Backflow Prevenier . I
43. Backflow Irrigation
44. Landscape Irrigation System � � '
45. Sound Attenuation ���n �
Y �•
46. Handicap Regulations ,�"�.�+ .
47. FINALSTRUCTURE&BUILDING , �(,
48. Special Requirements Completed � �� -
49. Electric Release to Edison �'
50. Gas Release to Southem Califomia Gas Co -
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51. CERTIFICATE OF OCCUPANCY
No. " Date
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35108
COSTA MESA BUILDING-SAFETY DEPARTMENT
,C P.O.BOX1200 COSTAMESA,CALIFORNIA92626
For Applicant to Fill in Completely
B^^LDWG �% Crocus Circle
OWNER Larwin Southern Cal
ADDRE5516255 Ventura Blvd
l
��T� Encino "
CONSTRUCTION _ . _ _ _ .
BRANCH 16255 Ventura BZVC1.
AODRESS Encino, Calif.
ARCHITECT _ . . TEL,
ADDRESS ylvv wilsiiire alvu.
CONTRACTOR Laz'win So. Calif., Inc.
ADORESS16255 Ventura Blvd.
TEL.
c�rv Encino, Calif. No9g6-8890
LIC No. 191311 LICYNO. B_1
SIZE NO.OF BLDGS.
OF LOT ( O X�.00 I NOW ON LOT Q
USE OF
EXISTING BLDG.
SIZE OF 1740 NO.OF 1
NEWBLOG. ftOOMS STORIES
EXTERIOR WAI.L ROOF
COVERING '�nn n COVERINGWa. SY11RQ12
USE OF BUILDING ANO WORK TO BE PERFOFMED
I hereby acknowleage that I have reatl this appliwxian antl state
ffiat ffie above information is correct antl agree to comply wi[h
all laws regula[ing building consvuction, antl 1 zhall mt employ
any person in violation of the workman's compansation laws of
the State of Calitornia.
I hereby certify that I am properly licens¢tl as a contractor under
Me State ot Calitornia Business antl Protessions Cotle, Divisicn 3,
Chapter 9, antl that such licenses are in tull farce antl effact, or I
am ezempt trom the provisions of the S[ate of California Business
antl Professions Cotle, Division 3, Chapier 9.
Signnture of D. Downs
Pe�mitiee ��dr/'�t�%�.+
Authorized Agent
PAID
l�UG 15-72crisn001033%F ***�4�.i�5
LICATION FOR BUILDING PERMIT
BV DATE FECEIVED DATE�ISSy'�.
� ' '� -lY
PEFMIT�(J�
A.P. NO.
BUI�DING
ADDRESS
OWNER
FIRE
�^"-
ZONE�� NO.OF ,
PLAN$ v
VARDS APPROVED
DISiANCE BET
oaPaovEo � L G.
B
DATE
USEOFNEW`-+�(N �Iu�
BUILDING Lv/^ % [ �/�;
VARDSAPPROVED
ACCESSORV BUILDING
BEf. MAIN &
ACCE55. OLOi
DATE
L
�-/? �g� W
�
SQ. FT. o
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE FURP�E OF ESTABLISHING A PERMIT FEE ONLV: ¢
VALUATION � � �
� PERMIT FEE $ �
�y� Cr'0 �
m
$ �� V�/ PLAN CHECK $ ��� E
/ J..(� O
- LL
TOTAL FEE S
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