HomeMy WebLinkAbout1444 DEAUVILLE PL - Building Permits(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 Zoning:
Applicant: PEARSON, VESS
Address: P O BOX 3908
Phone: 562-429-7663
SEAL BEACH, CA Zip: 90740
Owner: FRENCH QUARTERS HOA
Address 2020 E FIRST ST
SUITE 500 Phone: 714-285-2626 X211
SANTA ANA, CA Zip: 92705
Contractor: G M ROOFING COMPANY
Address: P 0 BOX 3908
Arch :
Address:
Phone: 562-429-7663
SEAL BEACH, CA
Zip: 90740 License: 472566
Phone:
Eng:
Address:
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
NOTICE: The wurk authorized by thio 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 it 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
�o-oa lo,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 Leh 0-0
Right 0-0
PARKING
Existing: 0
Required: 0 Proposed: 0
NOTICE: The wurk authorized by thio 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 it 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
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WORKERS' COMPENSATION DECLARATI
I hereby affirm underpenalty of perjury one of the following declarations: -
❑ I have and will rifleintain 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 required by section 3700 of the Labor Code, for the pedormance of the work for which this permit is issued.
My workers' compensation Insurance carrier and policy number are:
Carrier: S lyi-jjy_ tj Policy Number: LU jlj W'L - c C l(
(This section need not be completed i1 the permit is valued at one hundred dollars (5100) or less.)
❑ I cenity mat In the performance of me work for which this permit Is Issued, I shall not employ any person in any manner so as to became 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 thes provisions. (j
Applicant Signature: �� 6. kJ�,l R.. r,Date:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLL ARE (s100, WO). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR M SECTION 3706 OF THE IABOR 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 Business and Professions Code, and my license is in full
force and effect. Lic. a \1 (r Class e L -3 r1
Contractofs Signature: Dale:
ewe ovs•
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).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that 1 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 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 nis 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 contractors)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Dale:
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:
❑ 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? ❑ 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 Th
.............................
eapplicant or present or future building occupant need to file a registration form for acutely yhazardous . .............. .........
malerials7 ❑Vas ❑ 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 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 II 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 2pplication apamut for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
....... ...I...... .......... ............ .......... ............ ............. ... _... _ ........ ...........
6 Will any pan of the facility to be constructed under this permit be within 1000 lost from the outer boundaries of a school? ❑ Yes
❑ No
(It 'yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
iii .................... ...........-.......................................,,.... ....................... ..........._....................... ...,......_......................,............ ................._..............._.._.................... I—..........................._........ -.............................
7 II 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 Cl No
....... .. ... ........ ..._........., ..... .............................. ........................ -..........
6 (If "yes', attach certificate of compliance from the appropriate au 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 Io 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.
5nnature Of Legal Owners) Date
�r1, 11'4 ,rA, (C•i incl.
And/Or Authorized Applicant Date
CODE r, INSPECTION TYPE DA F, INTTIALtI COPEI INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof —/7 a4f,� 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
(✓f 8L .'L fl Cac.".E4af ...
Applicant to fill in all spaces except those within heavy border Tines and sign all appropriate declarations.
CITY -OF, COSTA M (/,(Z',JQN j�jJUC/T'I/OWN PEj/EMIT PbRMIT NO. TRACT NO. LOT NO. IINiT Mr)
Project Address/ /t`�C/C/
Applicant's Mail' Address
Oweer•s Namngi�z f Pho
Address f J/• 0.( ��� iAS.�.�U�iC.`S� '�?
Arch/Eng. License No.
Address
Contractor's Nam Ph n
Address (mailingYl
City Licence No."_2
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensetl under provisions of Charter 9 (commencing
with'section 7000) of Division 3 of the Business and Professions Cotle, and
I
license is in f force n ffect.//'
Licensee lass _Laice se o C/
Dater Signature [/
WORKERS' COMPENSATION D LARATION
+.reby affirm that I have a certi care of consent to self -insure or a certificate
workers' Compensation Insur ce, or a certified copy thereof (Section
0, Lab.
Policy No. Company
8 Certified copy is hereby furnish .
Car ii, js-{fled with the c y B '1 'vion
Date Applicant 'p
EXEMPTION FROM WORKERS' C PENSATION DECLARATION
(This section neer) not be completed' the permit is for one hundred ($100) or
less).
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. ,
Date Signature
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
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 (Section 3097 Civ. C.)
Lender's Name
Lender's Address -
OWNER BUILDER DECLARATION
I hereby affirm that 1 am exempt.from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of
r.e Contractor's License Law (Chapter 9 (commencing with Section 7000) of
'ion 3 of the Business and Professions Code) or that he/she's exempt
'rom and the basis for the alleged exemption. Any violation of Section
.5 by any applicant for a ;permit subjects the applicant to a civil
.Ity of not more than five hundred dollars ($500).
LI I; as owner of.the property or my employees with wages as their sole
compensation, will do the work, and the structure is not Intended or offered
for. sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however,'the building or Improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im.
prove for the purpose of sale).
❑ 1,, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply.to an owner of property who
builds or improves thereon, and who contract$ for such projects with a con-
tractor(s1 license pursuant to the Contractor's License Law). I am -aware that.
proof off their Worker's Compensation insurance should be provided to me.
❑ I am exempt under. section _B. & P. C. for this reason
Date Owner
I hereby certify that I have re this -application and state that the above
information -is correcLl agree omply with all city and county ordinances
and sta aws relating'to bu g construction, and hereby authorize repre-'
sentat' es tf, this city tip er upon the above-mentioned property for
TYPE OF CONSTRUCTION ; LJ NEW LJ ADD LJ ALTERATION LJ REPAIR'
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
"DESCRIPTION OF WORK/USE OF BLDG.
'
$ 3
A.P.#
S
,
Main Building:
TYPE OF PERMIT El GRADING ❑ FOUNDATION STRUC` URAL
Q TENANT El ELECTRICAL 11 PLUMBING 11 MECHANICAL
❑ OTHER
T
Front'
B
A
Rear
PROJECT DESCRIPTION SQ. FT. OCCUPANCY
CON STRVCTION TYPE VALUATION $
' ZONE GRADING CU. YDS.. ACRES
C
Right
KLeft
$
'
ping. Ref. #
Remarks:• _ '.
Planning Notes:
- SUMMARY OF FEES
BUILDING PERMIT $ '.SMIP" _ $
PLAN CHECK $ PERMIT' -
_ PLUMBING $ oCUANCE $
PLAN CHECK, ;25% $ ENERGY P.C. $
ELECTRICAL $ GRADING '$
PLAN CHECK , 50% $ - MICROFILM $
MECHANICAL $ TOTAL FEE $
PLAN CHECK 25% $ ,
PLUMBING
-FEES
Bar Sink; Showers
T
Backflow Preventer Service Sink
Automatic Washer
Backflow Irrigation ^' Sewer Cap
- Construction Pole Sub.
Bathtubs Sewer Connection
-
Cooking Unit -
Clarifiers __ Solar Collectors
$ 3
Dishwasher , -
Dishwasher Solar Piping
Dryers ❑Gas ❑Electric
Drinking Fountains Solar Tank `
Fan
Floor Drains - Swimming PooPw/Spa
F.A.U. '
Floor Sinks • Urinal
Fixtures
Gas Service ' Outlets Water Closet
Device Boxes ,
Interceptors - Water Heater .
270Outlets
Kitchen Sink -.Water Service
Switches -
Lavatories .. , Auto -Wash
I Garbage Disposal
P—Trap - Laundry Trays
Generator ❑0.5 KW 05-"
Roof Drains �.
Reinspection Fee
Duct - Under Ground
Duct - Structural
Duct - Ventilating -
Exhaust System ❑ Mul
Firepl/Fact. Bit. ICBG #
Heating System & Ductin
$15 1 1. ' - Issue Fee
Hood or Type ❑
Canopy Type 11 ❑
Refrigeration System
❑0.100,000 BTU 0100,000
e ❑ System Repair/Alteration
Fire Dampers
Registers
❑0-100,000 BTU 0100,000
Drivers' dense or SS # _ I I Reinspection Fee
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
$15 Issue Fee
ar (vT2�JH�`�1"11' 7a,=767
Zone
Accessory Building:
-ELECTRICAL
Transformer El 15-50 KW
❑ 50+KW.
Meter Du to 100 amps .
Meter ❑over 100 amps
Sub Panel
Motors ❑0-1HP❑1'h-8
Inc. Solar ❑9-15 HP ❑16
Microwave
Pole Light
Standing Sections
5 KW Trash Compactor
5.00 TL
E®
'®
Z
O
N
1
N
G
R
E
Q
M
T
S
$ 3
Reinspection Fee -
$15 ` Issue Fee $ 3
FEESI
DEVELOPMENT SERVICES REQUIREMENTS: '
.'Zoning Approved By Date
Building Approved By Date
Application Issued By Data
BTU
- SUMMARY OF FEES
BUILDING PERMIT $ '.SMIP" _ $
PLAN CHECK $ PERMIT' -
_ PLUMBING $ oCUANCE $
PLAN CHECK, ;25% $ ENERGY P.C. $
ELECTRICAL $ GRADING '$
PLAN CHECK , 50% $ - MICROFILM $
MECHANICAL $ TOTAL FEE $
PLAN CHECK 25% $ ,
-
'
'
$ 3
• CONSTRUCTION AND PLANNING ".
APPROVALS Permit #
Date
Inspector
_• " POOL & SPA•
APPROVALS Permit #
Date -
Inspector
1. Temporary Electrical 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
X56. Rough.Plumbing & Pressure Test '
6. Electrical UFER Grnd.
57. APPROVAL TO COVER-GUNITE.
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. -Gas. Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
-
-
60. -Backwash Lines, P -Trap, O Undrgrnd.
10. Structural Floor System ,.
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
'
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final -
14. Rough Plumbing
- h _
65. Electrical -Final
15. Rough Elecfrical-Conduit -
_
66. Solar System -Final
16. Rough Electric Wiring
-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
APPROVALS Permit # _
20: Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
'
22. Ducts, Ventilating
71. Product Piping [-]Gas 0 Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas 00il
25. Roof Sheathing
74. Overhead'Hydro '
26. T -Bar Ceiling (Structural) & 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: 4_ff_W'7 L£F'rcAr b- L•E.a
34. Final Heating & Air Conditioning
O r 17-77 04 y«, 4& PE/L zo, 3 UPG I -A.0
35. Final Gas Pipe -Test
-
36. Hood or Canopy -
37. Final Factory Fireplace
38. Final Plumbing
-
-
39. Water Service -Final
40. Gas Service -Final -
_
• • - ,
41. Solar Domestic -Final
.42. Backflow Preventer
43..Backflow Irrigation
44. Landscape Irrigation System
_ '-
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE&BUILDING
-
48. Special Requirements Completed
i
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
'
2 1687
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 317 COSTA MESA, CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT -
BUILDING
ADDRESS eauville Place
COSTA MESA, CALIFORNIA
OWNER HARBOR HALL OF FAME HOMES IID(
MAILBox 2066 .. _ .
ADDRESS
CITY
Santa Ana TEL Ki 92201
L
OR ENGINEER ER -REi LEVANAS No 6737010
ADDRESS 3432 Via -Oporto N.F. Bach
CONTRACTOR Lifetime Res. Build Corp,
2131 S. Artesia
Santa -Ana, California
208676 No' Ki 92204
. : . I NO. OF BLDGS.
USE OF �mm
EXISTINGBLDG. YL'
SETBACK LINE FROM _
CENTER OF STREET - REAR
SIDE YARD I.
LEFT _0 'RIGHT
DESCRIPTION OF WORK
1240 NO. OF
ROOMS 8
WALL'PST• I ROOF
MP.'vn
I HEREBY ACKNOWLEDGE THAT/ I HAVE READ THIS
AND STATE THAT THE ABOVE/75 CORRES"ND��.AAGG
PLY WITH ALL CITY ORP1,NA ES AND WATE LA
® AUTHORIZED AGENT
TORIES 2
ROCK
FEE RECEIVED
FEB 2 8 196111" •30X
NO. OF I UBE OF NE
PLANB:y� BUILDI
FINANCE -DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
NO EAVE OVERHANG SHALL BE LESS THAN
TO SIDE IN REAR P. L.ESOWED
BUILDING
YARDS APPROVED
For Office Use Only
MAIN BUILDING
ACCESSORY BUILDING
RECEIPT NO.
�rFJ1ylT�lj
-G
RfiCEIVE
BY
OATH 9 V
DAIT9LIJ15SUUUED
ClFT.
FT.
IDE ()FT.
FT.
BUILDING
ra FT.
ADDRESS
BET. MAIN IN
ACCESS. BLDGS.
FIRE
y
ZONE
TYPEGROUP
APPROVED
-
BY
DATE
ZONING
NO. OF I UBE OF NE
PLANB:y� BUILDI
-sj" -RIPTION 1 -EI.NO.
I qI "�LJI LE:
NO EAVE OVERHANG SHALL BE LESS THAN
TO SIDE IN REAR P. L.ESOWED
(U. B. C. REQUIREMENT)
[REAR
YARDS APPROVED
YARDS APPROVED
MAIN BUILDING
ACCESSORY BUILDING
OM C/L TREET)
1.
NT// .IDE
ClFT.
FT.
IDE ()FT.
FT.
FT.
ra FT.
BET.
SLOGS.
BET. MAIN IN
ACCESS. BLDGS.
J
APPROVED / --I e
�'-
DATE
PAR
$Q.FT.
UNT SHOWN UNDER VALUATION IB FOR THE
E OF ESTABLISHING A PERMIT FEE ONLY.
NPERMITFEE/
A CH
J
TOTAL FEE $