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Home My WebLink About1113 DANIELLE DR - Building PermitsCOSTA MESA, CA Zip 92626-1609 .U.n 19'.l l Civil SCOPE OF PERMIT INSTALL FACTORY FIREPLACE, ANSI Z 21.88-2005ICSA 2.33-2005. REF.: E05-01405 ELECTRICAL TO INCLUDE: RESIDENTIAL APPLIANCE. FEE SUMMARY Quantity .ALLOWED Owner: NAFF,ANTHONY P & CHERYL J Address 1113 DANA DR Temp service test PERS_ Busway /100 It Phone: 714-241-95 S0.00 COSTA MESA, CA Zip: 92626-1609XPIRES Contractor: OWNER -BUILDER 0 Misc Electrical Equipment Address: New Res (3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Phone: $0.00 0 ................up to 10 kva/kw Zip: Lighting Fixls $0.00 0 License: 000000 SCOPE OF PERMIT INSTALL FACTORY FIREPLACE, ANSI Z 21.88-2005ICSA 2.33-2005. REF.: E05-01405 ELECTRICAL TO INCLUDE: RESIDENTIAL APPLIANCE. FEE SUMMARY COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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 suspend of r 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: ("4)7546Q6 Lz=: :1] Quantity - Quantity ISSUE FEE $23.50 Temp Dist System I Lighting S0.00 0 Temp service test $0.00 Busway /100 It $0.00 0 Res. a/c package S0.00 Standing Section - S0.00 0 New Res (1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res (3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool I Spa $0.00 0 ................up to 10 kva/kw $0.00 0 Lighting Fixls $0.00 0 ................. up to 50 kvalkw $0.00 0 Recept Outlets S0.00 0 .................up to 100 kva/kw $0.00 0 Switches $0.00 0 ..................over 100 kvafkw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $4.75 1 Low Volt Wiring System I Ckt $0.00 0 Service to 200a $0.00 0 Misc. Conduit $0.00 0 Service to 1000a $0.00 0 Misc. Conductor $0.00 0 Service over 1000a $0.00 0 Circus ( gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus (mech ride or lights) _ $0.00 - 0 Motors to 10hp $0.00 0 Christmas Tree Stand' - $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 1 00h $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 ' Sub panel to 200a $0.00 0 - Plan Check Fee $0.00 ' Pole Light Pkg $0.00 0 Reinspection Fee $0.00 ; Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $28.25 - Intermed Pole $0.00 0 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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 suspend of r 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: ("4)7546Q6 Lz=: :1] WORKERS' COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of Consent to sell-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 Cade, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carder: Policy Number: (This section need not be Completed it the pemlit is valued at 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 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 SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION Was 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 Business and Professions Code, and my license is in full force and effect. Lic. a Class N Contractor's Signature: 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). 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 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 his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement is Id 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.). 0 �l}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.). ❑ 1 am exempt and Business and Professions Code for this reason: -Signature � �� Expires: Verillcetion of Ownership by a of docume .e. roperty tax bill or deed)t' 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, lelsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, 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 WIII 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 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 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. ._.............._-......................__sently...................___....ecti............................_._.___.._....__.............andSa.........................._..._.___._.._........................._.._. __................__........__........___........._._......_. 4 II en RMPP is presently required, hes Section 25534 al the California Health and Safety Cade been fully complied with? []Yes ❑ No 5 Doesor will the applicant or present or future bulltling occupant ragmre for the work which Is the subject of this a plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution Control district or agency? UYes U No (Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ........................................................................... ........ _............ ....................... .... ....-............................................. _................................................ ._................................................ ....................... ......._....... ..................................................... ............ 6 WIII any pan 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). ..... ............................. ......................................................................................I....................................................................................................................................................................................................... 7 a permit from the South Coast Air Quality Management District or other air pollution control district agency is l Yes for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Salary Code Section 42303 beenn made? ❑Ves ❑ No ...................................................................................................................................................................................................................................................................................................................................................................................... 8 (II 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-described propertyfor inspepti n p I agre not to py or allow occupancy of any building authorized by this permit/until final/'y�sDection. jam/ _ vim- g-r1ffiure. gal Owners And/O Authorized Appli Date gQ2 @. INSPECTION TYPE Qr11F INTIRALS CODE@ INSPECTION TYPE Qdg I6IIDALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spe.Final 208 Final Plumbing 200 Final Re-Rdof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Placa 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy TRACT NO. LOT NO. ADDRESS f�� DATE 1"0ld- 7/ The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The undersigned, by executing this agreement, acknowledges that (he -she -they) 7-( was or were)" � advised that this tract has not been given fial inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the city at the time the final tract map was approved. The city assumes no liability for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. The undersigned agrees to indemnify and hold the city harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted condition. representative F z'/o/ss CITY OF COSTA MESA REQUEST FOR 0CCYPANCY TRACT NO. LOT NO. ADDRESS f�� DATE 1"0ld- 7/ The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The undersigned, by executing this agreement, acknowledges that (he -she -they) 7-( was or were)" � advised that this tract has not been given fial inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the city at the time the final tract map was approved. The city assumes no liability for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. The undersigned agrees to indemnify and hold the city harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted condition. representative F PPROVED Building Dept. C' Mes7 ___DAT By ALL TIMES t- NS MUST BE ON JOB •Al 4. .rHESE."PLA jtrCHANGES WITHOUT PRIOR APPROVAL., MAKE` -NO CH OF DEFT. APPROVAL OR GRANTING' OF A PERMIT OR APPRO THE L_ 0 1 F PLAUS; AND SPECIFICATIONS SHALL NOT BE CONSTRUED .1. 7.)F ANY VIOLATIOP -41 0 E TO BE A1,PERMIT FOR, OR AN APPROVAL C RE;.� THIS COOE� NO. PERMIT P OF *ANY �&F�tTHE PROVISIONS OF 'THO Imp �rh �IstF AUTHORITY TO VIOLATE OR CANCEL SHALL 11 "6VIsjCA9OF THIS CODE �R - FAR -AS jHi'WORK OR USE WHICH IT AUTHORIZES IS LAWFUL; THIf,ISSUANCE OF A PERMIT BASED; UPON PLANS AW� SPECIFICATIONS SHALL NOT PREVENT THE BUILDING OFFICIAL • EQ IRING THE CORRECTION OF ERRORS I FROM THE .1 PREVENTING' IN SAWF AND ;SPECIFICATIONS OR FROM P 4 H1 r-1 Sul I E 11OR OF ANIIIIHAN49 L. OFT T IN 1 11 OF E, i d ivat 0i t 0i 7 qr Ild3a VNINN' vs w v 0:1 dc 4 ;It,c JA Ui 71 % ;7D �"A MAb 41 L61-% W 111"a COWA M660, i 10 72 �v "TTY �/"14_ kT I NG., REFRIG rmit j -NUMBE L INSP I . r J i L D I N'G� IPLOY'ED, _ OF;C, L volagala . 1'- I , , I lai APPROVAL ZITS ARE RE( CAL, PLUMPI .NTILATING, P ATIOWWORK IR iI Ly ED ly To NE OF -Rafter Size 6 Spacing _Q w% 2f�. 4 - OL Roof Pitch Specify Roofing L Sheathing ' i i -Continuous Ledger "T" and Angle Straps 6"x6"x]"xl/8" with v 4-16 d nails or bolt c ro � 1 � " c Ref ter Spon 'L '(.I(Z_ �!_ Post at —_-, __ I a 1 V O ✓ �— 1� i1 F� Overall—�_—_-- ° a 0 2.-'/z Pear+ IF144 --- wr. Ar Tnrc Sidi: c st be 656 op_n. oT _ Min. 4'x9•' posts n ; o V(C 1' 2000 p.s.i. Cctx:t'ete— _1 vs, `739 Min. 12"x12" Picrs 12" below +rade - x5" Ing acre into ntuds at 16" o.c. DTL"coryosive LLP+TC F-%• M'- 4,,Cbw� nt7mous Ledger T- '9 mail rafterAnchor `,'�� --\to blodcIIlg`bolts 1 'or Soiid Blocking ' 1 (continuous) ALL CCt31,1 1101 4 - 16 d nails or bolt SHALL CcrITORM M ' INE UNI?URM BU=ING Imbed A chore 7" in cone. CODE 4 V 4 •r + v g y PAPIER SPAN TP9I.E p^,Y D 1 M° Y • r -`,"• Gradii Ig Rules PS 20-70 �y� ;Qhs �_b �•�' �� 2x4 16" o.c. 24" 11-2 9-6 10-8 8-8 7-11 6-5 0-3 6-9 6-4 5-2 2x6 12" o.c. 17-10 11-5 .13-0 1.3-7 7.0-0 ..� ...�• 6x8 ......14' 6x10..... 18' 16" " 16-3 15-1 11-3 11-9. 8-8 24" " 13-3 12-4 9-2 9-7 7-1 32" 10-10 9-11 7-6 7-6 5-9 2x8 16" o.c. 21-5 19-10 14-3.0 15-6 114 24" " 17-6 15-3 12-1 12-8 9-4 32" " 14-5 13-G 10-0 10-2 7-6 1TADEERS dat`71as fir N0.2 SHEA'niING 6 FXMRIOR PLYWOOD grade 02 or eq. size 4x4.. 4x6. e 4x10.. s0an 5, ...... 8' , 14' Panel Index Thick. Spin Blk'd Otblk 16/0 24/0 30/12 32/16 5/16,3/8 3/8,1!2 5/8 1/2,5/8 4xi Z..... 4x14.......20' 1' 1" board............ 32" 2" solid T6G...... 9'-0" 2"x2" self-spaced.6'-0" ..� ...�• 6x8 ......14' 6x10..... 18' Roofing a. Wool shakes 4/12 'pitch (3/12 min. pitch with 309' felt underlay) b. Sbod, oorpositior, shingles 4/12 pitch (3/12 nun. pitch with 15@ felt underlay). c. Built up rolled roof slope to drain d. Peck roof 3/12 reix'.msn pitch. ENVIRONMENTAL REGULATION Di Vli!ON TYPICAL PATIO Ci7hJ[?i BUILDING AND SAFETY !L4iH OFFICE RCGIONAL OFFICE �J �r P.G. so % ae 26052 GEITY DRIVE // 1 �� I 400 CIVIC CENTER DRIVE xE5T LAGUNANICU EL. CALIF. 92677 1( .("l{Is� _ SANTA ANa_ CALIFORNIA 92102 LAGUNA1 NIG IO F. nlal a342626G. tdc L'ELLAN JJR 9/71 ORS F0250-14 OWNER WOLSTEIN JOB ADDRESS Ill GENERAL CONTRACT AP No. _ INSPECTInNS PROP. SWR. LINE SPRINKLING SYSI IRE DATE 12^13.79 12-13 0 SUBCONTRACTOR ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER ROUGH WIRING MHeatingent. TRENCHES IJ FORMS - STEEL REIN F. FLOOR SYSTEM BOND BEAM f1 STEEL REINFORCE rI ncomblete InsijectIVISI FRAME AND FLASHING LATHING AT HEATING. VENT., REFRIG. AND A.C. PLUMBING. FINAL AND GAS TEST ELECTRIC, FINAL BUILDING, FINAL �i COSTA MESA BUILDING -SAFETY DEPARTMENT APP P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 VRECE�!For Applicant to Fill in Completely — Use Ink OnlyBUILDING I 3 ADDRESS 111,51 1'J IEi(F mfr. MAILING 1. UNIT OR SPACE NO. TION FOR STRUCTURAL PERMIT PERMIT 0 eb4l 12/W794934. i -- o:Z _7_ - 3o I'/ 1113 PAN) (ELLE i AUUNCJJ /� T R.NQ79 / LOT / BLH. TEL. `tet (O(� —f�f CITY NO. NEW ADD ALTER IREPAIR I MOV INGI DEMOLISH CONSTRUCTION LE LENDER BRANCH• /. t OWNER (�(� ADDRESS �s � VALUE IZ47 ARCHITECTT EL. USE (a(yro-- $ OR ENGINEER ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR V DATE ADDRESS 3(01AL I� 5 TEL. CITY NO.. G STATE CITY APPROVED SETBACKS LIC. NO. LIC. NO. SIZE NO. OF BLDGS. /FRONT (FROM C RE T) OF LOT NOW ON LOT USE OF EXISTING BLDG. E+�1G� Separate permits are required (or L. SIDE FT. electric, plumbing and heating work.f 0 REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION DAW ETE AADVEO APPROVED79 ! 1 I hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any parson In violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SO. FT. the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, end that su h licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from th ovislons of th State of California Business VALUATION PERMIT FEE E and Professions C , Div sl 3, ter 9 .^ O Signature of^� PLAN CHECK E Permittee $ // �0 TAX E �� or s • Authorized Agent Date �� TOTAL PAID E S� 50 TL COSTA MESA BUILDI1% P.O. BOX 1200 COSTA For Applicant to Fill in I BUILDING ADDRESS / w OWNER BRANCH ETY DEPARTMENT CALIFORNIA 92626 telv — Use Ink Only TEL. NO. ARCHITECT TEL. OR ENGINEER NO. ADDRESS ADDRESS TEL. CITY NO. F STATE CITY i LIC. NO. LIC. NO. W SIZE NO. OF BLOCS. D. OF LOT NOW ON LOT Q USE OF EXISTING BLDG. y FSeparate permits are required for C electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED AwQ r ..1 W a IEC -9-772r ,00 466 �-***199.00 APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY DATE RECEIVED DATE ISSUED A.P. NO. PERMIT NO. BUILDING ADDRESS PERMIT FEE $ TRACT LOT BLOCK W A D A OWNER VA E a% ' FIRE ZONE TYPE s' GROUP APPROVED Ry DATE ' ZONE IPS I BUSE OF ILDING NEW YARDS APPROVED YARDS APPROVED VAR. 996 C.U.P. sls APPROVED C 1 hereby acknowledge that I have read this application and state 09 that the above Information is correct and agree to comply with 0. ail laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of W,W the State of California. 3 1 hereby certify that I am properly licensed as a contractor under SQ. FT. DATE APPROVED the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALU Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERP am exempt from the provisions of the State of California Business and Professions Code, lvision 3, Chapter 9. VALUATION PERMIT FEE $ PLAN CHECK S w Signature of Permittee (/✓ f!`�_ TAX $ TOTAL PAID $ Authorized Agent ON IS FEE Oi COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING j ADDRESS IBJ Properties West,Develppment MAIL ADDRESS 508 29th Street TEL. c1TvNewnnrt Reach. Ca. No.675-1191 BRANCH ADDRESS ARCHIECORFN(TNF A Frank Soan,�,ler NM?3-0952 P CONTRACTOR Owner ADDRESS TEL. CITY NO. F STATE CITY LIC. NO. LIC. NO. w SIZE NO.OF BLDGS. C, OF LOT NOW ON LOT a USE OF EXISTING BLDG. y FSeparate permits are required for C electric, plumbing and heating work. Iw. USE OF BUILDING AND WORK TO BE PERFORMED a 0 Construct sin le family be a j„ roo house, Plan #2 w a. PAIU x 44 t )ov 10-77LWsa 539•• 103.36 APPLICATION FOR STRUCTURAL PERMIT BUILDING ADDRESS r TRACT IIM111 Atd. Gar, VALUE 55.100 k - - -- V DAT - 'DU NO. OF USE OF L PLAPIS BUILDINROB APPROVED I YARDS APPROVED VAR. 0 C.U.P.q BET. MAIN ACCESS RI.fYCS. 0 0 Wany S 3 1 hereby acknowledge that 1 have res Is application(And state that the above Information is correct and agree to comply with all laws regulating building construction, end I ens not employ person In violation of Me workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Coda, Division 3, Chapter 9, and that such licenses are in full force and effect, or I am exempt from the provisions of the State of California Business end Profaaslons Cod Division 3, Chapter 9. Slpnstura of ell Permittee �.-��L� �/i. 'n e e - a m v � 0 LL t HOLD F''fl SPEC. .+ � --1� ^.L REf`!.°":MENT SO. FT. 2,057 THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION s55,100 PERMIT FEE $ PLAN CHECK f 99 - 50 TAX f 3.86 r�/(f Authorized Agent TOTAL PAID E O 3