HomeMy WebLinkAbout1440 DEAUVILLE PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.caMILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
1440 DEAUVILLE PL
Suite:
Vicinity:
DETACHED GARAGES
Primary Occ:
U
Parcel Number:
TPN98079
Applicant:
VES PEARSON
Address:
P O BOX 3908
SEALBEACH,CA
Owner: FRENCH
.Address 2020 E FIR;
�Zi
..TEAR OFF
(t REPAIR/RI
11 ��
r
Plan Ch
Pe
Type of Construction: V -N
Zoning:
Phone: 562-429-7663
Status: ISSUED
Applied: 08/02/2006
Issued: 08/03/2006
ISSUED BY: <_0 Uk_�
Phoned -714-285-2626X211
Zip:, J 92705'
1NY
Phone: 562-429-7663����
License: 472566
I Eng: l
( i Address:
Phone: j�.
icense:����
- — scure ur r
2 LAYERS OF 15# ASTM FELT, GAF 4C
:EDED. 24 SQUARES FOR DETACHED
Jv .y r-nSr r1' -- --.-......... r,
��� Tq f / \r,C616Valuation:
� $0.00 � L � �'t���1i n... � 7
1$111.25 _ _ __ --Claim Valuation:
$0.50
l $0.00
$0.00
$0.00
r
✓, TT
ll $111.75 �j
��.,..
AP\a ( ---''—
PLANNING & ZONING
;Front 0- 0 I Rear,, z 0-0� ? o Left-, �,0- 0��. Right 0= 0�
'� 0-0\.YyRearo /0-0 `- -`1'0'Ri,
�Q-0 �`�°ht7 020
C/
Existin'Re u6��0�� `Proposed ' 0
f
:3
NOTICE: The work authori2ed 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 (600)
C
DECLARArIOMS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm untler penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -Insure for workerscompensation, as provided for by section 3700 of the Labor Code, for the performance of the
Nxooork for which this permit is Issued.
I hay e 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-workeWoom nation Insurerrf� Cartier antl p011q number ere: M� V Iv� Policy Number:&ictlon need not be completed 11 the permit is valued art one hundred dollars ($100) or less.)
❑ 1 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 aqre , that If I should become subject to the workers' compensation provisions of Section 37 of the Labor Cade, I shall forthwith
comply with these pr i I s. fp( (y
Applicant Signature: A— Date:
WARN FAILURE TO'SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN Et.1R/'0, "YFA.TO CRIAUNAL PENALTIES AND CIVIL MNES UP TO ONE HUNDRED
D DOUARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed yn a rovisio s f Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prolss' ns Code, and my license is In full
fnd etfact. LJc. q"^� 1. -- Class R� s
nlrecclofs SignaiureF `
te:�-
r_ �...----�—
CONSTRUCTION LENDING AGENCY:
❑ 1 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: Lenders Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affiml that under penalty o1 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
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner o1 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. If, 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 property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professlons
Code: The Contractors License Lew does not appy 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires:
Verification o1 Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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:
I Will the applicant or present or future building occupant need to file and certity a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ 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 lila a registration form for acutely hazardous materials? ❑Yes ❑ No
(Section 25533 of the California 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 theaappplicant 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? ❑ Yes ❑ No
............................................................................................................................................................................................................................................................................................................................................................................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application ap$ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? UYes I -J No
(Section 65850.2 of the California Government 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? ❑ Yes ❑ No
(if 'yes*, the facility must meet the requirement of Sections 25534 and 42303 of the California 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? ❑ Yes ❑ No
..._....._.._.._......__._....._........—........_...._........_........—.............._.............._..._.............._.....__._................................................................_.___.............__............ ._.................... _.......... .......... ......... _........
_..
8 (it yes', attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certily 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
wrract. 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-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
\ Sig ure Of Legal Owner(s)
/y —i
=.AO Or Authorized ApplicamL-
gg E11, INSPECTION TYPE 2&U IIi11�T 64 CODE,( INSPECTION TYPE gdjE gjTITIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1268 Pool Spa Final 208 Final Plumbing
200 Final Re-Rwi 210 Final Electrical
201 Final Block/Retaining Well 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
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 3168 CHEMIN DE FER WY
Suite:
Vicinity: 1440, 1442, 1444, 1446 DEAUVILLE PL
Parcel Number: TPN98079
Applicant: PEARSON, VESS
Address: P 0 BOX 3908
SEAL BEACH, CA
Owner:
FRENCH QUARTERS HOA
Address
2020 E FIRST ST
Issued:
SUITE 500
SMIP Res:
SANTA ANA, CA
Contractor:
G M ROOFING COMPANY
Address:
P 0 BOX 3908
SEAL BEACH, CA
Zip: 90740
Arch :
Address:
Zoning:
Phone: 562-429-7663
Zip: 90740
Phone: 714-285-2626X211
Zip: 92705
Phone: 562-429-7663
License: 472566
Eng
Address
Phone:
ISSUED BY:
Status:
ISSUED
Applied:
06/08/2004
Issued:
06/08/2004
Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF CONDO BLDG WITH UNITS 1440, 1442, 1444, 1446 DEAUVILLE PL ONLY: T/O EXISTING ROOF, INSTALL 2 LAYERS 15# FELT
UNDERLAYMENT, APPLY "GAF 40 -YEAR COMP SHINGLES PER MFGR'S SPECS.- 29 SQUARES
Total: $168.10
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTICE: The work acthonzod by this permit shall comply with all applicable handicap access requirements under Galifornla 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
ovo-4a le,wl
FEE SUMMARY
Plan Check:
$0.00 Calc Valuation: $8,450.00
Permit:
$167.25 Claim Valuation: $8,450.00
SMIP Res:
$0.85
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total: $168.10
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTICE: The work acthonzod by this permit shall comply with all applicable handicap access requirements under Galifornla 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
ovo-4a le,wl
WORKERS' COMPENSATION DECLARATI
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will Aninlain 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.
,Q I have and will maintain workers' compensation insurance, as requited 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:
Carder: }, YVY[E- Fu',) Policy Number: LUW (.'Z - -C C:4
(This section need not be completed it the permit is valued at one hundred dollars (S 100) or less.)
❑ I cemty Inas In the penormanoe of me 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 rhes provisions.. ,
Applicant Signature: Es k�-� ..� r.�� Date: L4 I Qs I OL{
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU61ECi AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE f il=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 DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Businesg and Professions Code, and my license is in lull
force and effect. Lic. amil -I-S L' Class a L - rt
Contractor's Signature: � 6 �Nic,b bo Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 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),
Lender's 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
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ 1, 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. If, however, the building or Improvement is
sold within one year of completion, the owner-builder will have the burden of proving that no or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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 of dismantling thereof, wilt 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 cenity a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safely Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any ono time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pound„ or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
...................................... .... ................._................ ,...... ,.............. ....... ...,........... ......._....... ..._......_................ ........_......................... ............................. .._.._........ ........ _....................... .._....__....._._......................................................................,.,...
2 Docs or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by eacn 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 feel 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 lot acutely hazardous materials)?
❑ Yes ❑ No
(Section 25534 of the California Health and Safety Cade 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.
........... .......................... ................................................................................................................................................................................... ...............................__...................................... .........................................................................
p Y q1. Y Y p ❑Ves ❑No
4 II an RMPP is presently required. nes Section 25534 o.. the California Health and Safety Code been full complied with?
5 Does will the applicant or present or future building occupant require lir the work which is the subject this a plication apermil for such construction or modification
from thehe South Coast Air Quality Management District or from any other air pollution control district or agency?
y? Vos LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
....... .......... ........... ........__..... .......... ..
6 Will an ........._... .... .aschool? within boundaries El Yes ❑ No
(If -yes", the facility must moot the requirement of Sections 25534 and 42303 of the Caldomia Health and Safety Code).
..................... ..................... -............. .................. ............................................................... ................................................... ............................... ..................................... ............ ......................................... ....................... ............... ............ I.................
7 It a permit from The South Coast Air Duality 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? ❑ Yes ❑ No
.............._.................................................................._.....__...._......................................._.................................................... ......................_..............-....._..........__._..._.......................... ......_..............._.........._............. _........_......................... ..
8 (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 slate laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cenity under penalty if perjury that I have read this application and state Thal 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-described properly for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
nature 01 Legal Owner(s) Date
And/Or Authorized Applicant Date
CODE I, INSPECTION TYPE DATE INTITIALli 9999A 1_145PECTION TYPE PAN INTRIAL6
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Root 210 Final Electrical
201 Final Block/Retaining 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
21689
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 917 COSTA MESA, CALIFORNIA
For Applicant to Fill In Completely
-TYPE OR PRINT
COSTA MESA, CALIFORNIA
OWNER HARBOR HALL OF FAME HOMES INC.
MAIL 'BOX'2066-•
ADDRESS
CITY Santa Ana TEL Ki 92201
ARCHITECT RAY LEVANAS TEL. 6737010
OR ENGINEER NO.
ADDRESS 3432 Via'Oporto. N.P. Beach
roR Lifetime Res., Build C
2131 S. Artesia,'
Santa Ana,-,Califonia
208676 - NEIL.. Ki 92204
SIZE
1438
RECEIPT NO.
NO. OF
I
R8C81V DBY
OF LOT
DATEISSUED
NOW ON LOTS
0
USE
NONE
UILDING
[BY
EXISTO NG BLDG.
DDRESS
BETBACX LINE FROM
110"
CENTER OF STREET-
REAR YARD2
ONE
0
I 0
BIDEYARDI LEFT -
RIGHT
DATE
DESCRIPTION OF WORK
NEW
'x
ALTERATION
ADDITION
REPAIR
MOVING'
DEM LISH
BUI
880 NO. OF
S ZE�ING
ROOMS
7 1 RIES
2
COVERING
COVERINGEXTERIORWAL"" "'TER'
ROCK
1HEREBY ACKNOWLEDGE
AND STATE THAT THE AS
PLY WITH ALL CITY OR
BUILDING CONSTRUCTI
SIGNATURE OF ' L
0 AUTHORIZED AGENT
1 HAVE READ
FEE 1UGEIVED
FEB 2 8 1984
FINANCE DEPT.
APPLICATION OkFP O IT MESA
BUILDING
For Office Use Only
ZONING
ZOt 8 PLANS 2� BU EOF IEW �A ,_
LEGAL `
DESCRIPTION //
A. P. NO.
NOTE: NO SAVE OVERHANG SHALL BE LESS THAN
ARDS APPROVED YARDSAPPROVED
YMAIIN BUILDING I ACCESSORY BUILDING
DISTANCE BET. BET. MAIN Q •1 _
MAIN BLDGS ACCESS. BLDGS. 1 A'
VAR..$ _ � DATE " ,0� 'av
?Se SO
THE AMOUNT
PURPOSE OF
9 Big
UNDER VALUATION IS FOR THE
18HING A PERMIT FEE ONLY.
PERMITFEE $ ✓�
e,.. .... vai s
29
RECEIPT NO.
R8C81V DBY
O 8i� 84G
DATEISSUED
UILDING
[BY
DDRESS
IRE
/
ONE
TYPE GROUPIJ
PPROVED
DATE
ZONING
ZOt 8 PLANS 2� BU EOF IEW �A ,_
LEGAL `
DESCRIPTION //
A. P. NO.
NOTE: NO SAVE OVERHANG SHALL BE LESS THAN
ARDS APPROVED YARDSAPPROVED
YMAIIN BUILDING I ACCESSORY BUILDING
DISTANCE BET. BET. MAIN Q •1 _
MAIN BLDGS ACCESS. BLDGS. 1 A'
VAR..$ _ � DATE " ,0� 'av
?Se SO
THE AMOUNT
PURPOSE OF
9 Big
UNDER VALUATION IS FOR THE
18HING A PERMIT FEE ONLY.
PERMITFEE $ ✓�
e,.. .... vai s
29