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Home My WebLink About758 ALLEGHENY AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa��DING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 758 ALLEGHENYAV Suite: Vicinity: HOUSE & ATTACHED GARAGE Parcel Number: 14153310 App�icant: GALITSKI, GUY Address: 19792 POTOMAC HUNTINGTON BEACH, CA Owner: PERCIVAL, BRET Address 758ALLEGHENYAVE COSTA MESA, CA Contracroc G G ROOFING CO INC Address: 19792 POTOMAC Arch : Address: HUNTINGTON BEACH, CA Zip: 92646 Phone: Zoning: R1 R1 Phone: (714)965-2387 Zip: 92646 Phone: Zip: 92626 Phone: (714)965-2387 License: 364151 Eng: Address: ISSUED BY: StaWs: ISSUED Applied: 12/OS/2000 Issued: 12/OS/2000 Phone: Zip: License: License: SCOPE OF PERMIT REROOF PITCHED AREA OF EXISTING SINGLE FAMILY RESIDENCE & ATTACHED GARAGE (24 SQ). TEAR OFF & RESHEATH WITH 7/76" OSB. INSTALL 1 LAYER OF 15# ASTM FELT UNDERLAYMENT & REROOF WITH 25 YEAR "GAF TIMBERLINE" COMPOSITION SHINGLES. Plan Check: $0.00 Permit: $13925 SMIP Res: $0.66 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $139.91 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existinq: o NOTES: Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY Calc Valuation: $s,soo.00 Claim Valuation: Ss,soo.00 PLANNING 8 ZONING Lek 0-0 Right lek 0- 0 Right Proposed: 0 _ - 2 9 �� '+�� ' �' ?,,i �_,: i � � - / r I �� / '� ,, �� NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all raqulred Inspeotlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2aasrs �sroo� WORKERS'COMPENSATON DECLARAntllr � � � I hereby atFirtn untler penalry of perjury one of the following declaretions: ❑ I have and will maintain a cenifiwte ot consent to selbinsure for workers' compensation, as provided for by section 3700 ot the Labor Code, for the pertormance of the work for which this pertnit is issuetl. /' ,❑ I have and will maintain woAcers' compensation insurance, as requiretl �y section 3700 oi the Lebor Cotle, for ihe peAortnence W tha work for which this pertnit is Issued. '--- My "workere' compensatio�nsurance carner en olicy number are: 4 Carrier: �':��L�- � i"`� �r Policy Number. �� Z�'.:� � l~� � .(This�section need not be complefed il the permif is velued et one hundred dollars ($f 00J or less.) -- " ❑ I certity thet in the pedormance of the work for which Ihis permit is issuetl, I shall not employ any person in eny manner so as to become subject to the workers' compensetion laws oi Celifornia, and agree thet Ii I sh yil me subject ro the workars' compensation provislons of Section 3700 oi ihe Labor Cade, I shall forthwith comply with ihese provisi s /, AppllcantSignaWre: � Date: � ? — J — � � WMNINGt FAILURE TO SECUFEyf � KERS' ATION COVERAGE IS UNLAW FUL AND SHALL SUBIECT AN EMPLOVER ip CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUN�RED hKK15ANODqlARE�5100,000)�(NADDITIIXJT ECOSTOFCOMPENSATIIXJ,DAMAGESASPROVIDEDFORINSECTION3]OfiOFTHEIABORCODE,INTEREST,ANDATTORNEYSFEES. LICENSED CONTRACTORS DECLARATION: I here6y aNirm that I am licensef� nder provisions of Chapter 9(commencing with Section 7000) of Division &ot ihe Business and �P Dteujons Cotle, and my license is in full torce end eflect: Lic. x 1 v � 7 � Class q— � C._.� �� ContracroYs Signa(ure: �7_�j -�"'J ( Date: � ^ `� 'CX� CONSTRUCTION LENDING AGENCV: . ❑ I hereby affirm Ihet there is a construction lentling egency for the Derformance of Ihe work tor w�ich ihis permit is issued. (Sec. 3097, Civil Code). LendeYs Name: Lentlefs Address: Signature: _ OWNER-BUILDER DECLARATIONS: Date: I hereby aNirm thet under penelty of perjury thet I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7037.5, 8usiness end Protessions Code: Any ciry or county which requires a permit lo constmct, elter, improve, demolish, or repair any stmcture, prior to its Issuance, also requires the eppllcent For such permit to �ile a signetl stetement ihet ha or she is licensed pwsuent to Ihe provisions oi the Contrectors License Law (Chapter 9(commencing with Section 7000) ot Divislon 3 of the Business and Professions Code) or that he or she is e:empt therefrom and the basis for the allegea azamption. Any violation of Section 7031.5 by eny applicent for e partni� subjecis the applicant to a civil penalty of not more then five huntlred dollars (5500).): ❑ I, as owner of the property, or my employees with wages es their sole compensatlon, WILI. DO THE WORK, and the siructure Is not intended or oHered tor sale (Sec. 7044, Business and Professions Code: The Coniractors License Law tices not apply to an owner of property who builCs or improves Ihereon, and who does such work himself or herseN or ihrough his or her own employees, provitled that such improvemenis ere not intendetl or oHered for sale. It, however, t�e 6uiltling or improvement is sold within one year of completion, the owner-builtler will have �he burden of proving ihat he or sha ditl not builtl or improve for purpose ot sale.). ❑ I, as owner ot Ihe property, am E%CLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to construct tha prolect (Sec. 7044, Business end Protessions Code: The contraaors License Lew does not epply to en owner ot propeey who huilds or Improves ihereon, and who contrects for such prolect with a comrecbr(s) license pursuant to ihe Contractors License Lews.). ❑ I am exempt undar sec. Signature: Owner ID veritied by drivers license. ❑ Ves ❑ No Business and Professions Code for this reason: Verification of Ownership by (type of document, i.e. - property taz bill or tleedJ: DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Driver'S LiCen50 N0. Date: Expires: ❑ I hereby certify ihat no excavetion tive (5) or more feet in depth into which a person is requiretl to descentl, will be made in connection with work authorizetl by Ihis permit, and that no building simcture, scaHolding, telsework, or demolition or tlismantling �heraot, will be more Ihen �hirty-sia (38) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Celifomia Administrative Code). ❑ As ownerbuiider, I will not employ anyone m tlo work which would require e permit from tha Division ot Industriul Sefety, es noted ebove, unless such parson hes e permit to do such work from the division. Signature: Date: Division of Indusirial Safery Permit Number. CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRY: I cenity under penelty ot perjury ihat I have read ihis epplication antl state Ihat the infortnation given is wrrect. I agree to comply with all state laws and city ordinances relating to building consiruc�ion, and authorize representatives of t�e City of Costa Mesa lo enter upon ihe ebove-described property lor inspec�ion puryoses �I agree not to occupy or allow occupancy of eny building authorized by this permit until final inspection. y�� y... r'-�- � ;'" �Antl/OrAuthorizedApplicent _� ___ CODE 1. INSGECTONttPE DA7F �MTrtia�s 1616 Fixed Sys�em Final Fire Prevention 1266 Pool Spe Final 200 Final Ra-Roof 201 Final BIocWRetalning Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demoli�ion Z CO�E 1 INSPECTION TYPE 206 Final Mechanical 20B Final Plum�ing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 FinalBuildinyOccupancy QE� 1[�Lfl � 0 PB�ECTIIODNESS: %SE; ALLEGHENY AV OWNEF1'S NAME: SHOOK LINDA RUOflE55: E)139 �12A CASITAS CARMICHAEL,CA 95608 850-9800 UNIT: RflCN/ENGINEEH: flEG.NO.: AOONESS: UNIT: PEHMITTEE: SERVSCE FIRST ( 714 ) 573-2200 FDDNE55: 1 B O 1 I R V T NE 'PUSTIN CA 92680 LILENSEO CONTPFCTOB OECIANATION: I �ereby allum �ha� I am IicenseA tler pmvision of Chapt ( mmencing wi�� Section 7000� ol �ivision 3 otlhe Business antl Pm�essions Code, an0 my bcense i lulltorce a e�tect. cirruc.:097q64Q6 sTpTEuc.:556812fc s: — 9 �yt¢; S— r��` / SignaWre: / _—__ WOflRENS' COMPENSFTION OECLAHATION: I herehy afiirm iha� I �ave a cetlihcate o� consent �o setl-insure or a certilicate of Workers' Comvensaiion lys�acr� ��ae�t�e8 �� t�e�ol �Semion 3800. Lab. f)'S / 1 S/ 9 S ".POUCY NO.: CNA E%P. OpTE: �OMPpNY: � CeNh¢tl capy i5 hefe6y �umished. ❑ CetlifieA toDY �5 �ii . �h �ry IOing 0 i5ion. Daie' �� I " I Applicani: EREMPTION FpOM WOPRENS' COMPENSFTION OECIABATION: (This sec�ion nee0 na� be completetl if the permi� is tar one hunAreO (3100� or less�. I cetli�y ��al in �he pedormance af Ine work for whic� Ihis permit is issued. I s�all not employ any person in any manne� so as �o become subleci lo Ihe VJorkeri Compensa�ion Laws ol Califomia. Date- Signalure: NOTICE: IL afler making Ihis Oeclaration, yau s�ould become subjec� �o the Workers' ComDensa�ion provisions of �he Lahor COd¢. you mu51 forihwilh tomply wiih suCh pmvi5ion5 or �his permi� shall he tleeme0 revoketl. CONSTHUCTION LENDING FGENCY: I hereby athrm that there is a constmction lentling agency for tAe De�ormance ol ihe work for which Ihis permi� is i<5ue0 (Sec�ion 3097. Civ. C�. LENOEP: ADOXESS: OWNEB BUILDEB OECLABATION: I herehy afhrm �hat I am exempt �mm �Ae Con��actors' $Iaie License Law �or Ihe �ollowinA �eason (Section 703L5 Busine55 an0 Pwfessional Code: Any ci�y of county wh¢h reQuires a permii to cons�mc�. alte�, improve, tlemolis�, or repau any stmdure, priar �o i1s issuance. also requires ��e applicant lor such permi� to �ile a signetl siatement that he/she is Iicense0 pursuani lo Ihe pmvisions of ��e Conlractors' State License Law (Chapter 9(commencing wi�h Sec�ion 7000) of Oivision 3 0� the 8usiness an0 Prolessions Code) orl�at helshe is enempitheretmm antl IM1e basis �o�ihe alleged exemption. Any violation oi Sec�ion 7031.5 by any applicani for a De�mi� sublec�s Ihe aD0licani to a civil penalry o� nol more Ihan �ive huntlred dolla�s ($500). I. as owner of the pmpeny or my employees with wages as Iheir sole compensation, will do tAe work, an0 the �❑ stmcmre is nol in�eneetl or otieretl for sale (Section 7044, Business and Pmiessianal Cotle: The Coniractors' State License Law tlaes no� apply lo an owner o� a pmperly who bui105 or impwves Ihereon, and who does such work himselt/�ersel� ar lhmugh his or �er own employees. pmvitletl �hat suth improvemen�s are no� inlentled or ollere0 �o� sale. I�, however the 6uiltling Or � impmvemen� is soltl wi�hm one year ol compleiion. Ihe owner will have Ihe burtlen o� pmving helshe ditl not builtl or impmve lor ihe purpose o1 sale�. I. as owner ol lhe proDerty, am exclusively conVac�ing wi�h licensed contractors to constmct [he pmlect (Section 7044, Business ❑ and Pm�essions COAe: The Contrac�ors' S�a�e License Law Aoes noi aDPly �o an owner of property w�o builds or impmves Ihereon and w�o contrac�s lor such prolec�s with a canVac�or�s)license pursuant�o Ihe Contractors' S�ate License Law),I am aware Ihal pmol ot I�eir Worker'S Compensation insurance 5hould be pmvideA Io me. � I am exemp� untler $ection: B. 8 P. C. for inis reason�, �ate'. Ownec I ao hereby cenify ihal I am aware ol antl undersland Ne repuirements o� Cah�amia Health and Safeiy Cotle Settions 25505, 25533, antl 2553a antl ihai I or any future buil0ing occupan� willlwill noi (circle one) neeU lo comply with said sia�e codes and I�e reQuiremen�s lor a permii br cons�mclion or modilicalion �mm I�e Air Oualily Managemenl DisVici. flesi�enlial cons�mction applications are exemD� ��om these pmvisions. oate ApplicanC /� I here�y cer�ify Ihat I have read Ihis apphca�ion antl 51aie Iha� ��e above inbrm n is carrecl. I�¢e to comply w Ifi �f ci�y antl couniy or0inancesaneslatelawsrelatingtobuiltlmgconstmctionan0�erebyauihorirer eseNaiivesoit � irytoen�erup � abave-mentioned prOperry �Or mspce}cbon purpa5e5. / Daie' � ( �� SignaWre. J � �nver's Lmense ar Somal Searity n: I6aF46 Whi�e—Bmltling'. Green—Catle Enlorcemenl: Canary—Applicant: Pink—Revenue: GOltlenro0—Assessor CITY OF COSTA MESA - HUILDING PERMIT . PERMIT NO: H 052012 PLAN CHECK NO: N , , , CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION : T/OFF REROOF W/ BUILT UP SQ FT: 999 CLAIM VALUE: 1,966.00 CALC-VALUE: 1,966.00 GROUP OCC: R-3 / CUMMENTS: REROOF u��r�**�*x��+�*��****�r********�r+r+��r*******��r�*�*******�r��x*+�*��r**��**�***�*****x*�* Z O N I N GS ERTEBQAUCIRRSE M E N T S ------------ MAIN HUILDING ---------- --------- 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 PARKING REQ• PROV: PARCEL: 19153310 ZNE; REF NO: PLANNING NtSTES> i if if if if IF �E jf if iF �F if ik if if IE ik �lf ib �f �E iF iE iF iE iE �F IF �1E iF 1F iE if 1E iElFif iF iF 1E iE 1E if if if iE:f 1f �f af 7f if iE iE if lE iE iE iF 1E 1F iE 3F iF i6 iF iE iF �IE iE if )E if ik 3f iE * if iE �f D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY r I� _ / DATE; APPLICATION ISSUED BY�-� �� DATE; iEiFk43fiE1Fik3ElE�E�E#E1fiElEiFiFiEifiE�f . . � . . iEkiEiEiEiEififfFif � iE if�ififiF3EiFIk�FiFiEifiEiM1fEil�EiFfEiElElEfEiEifiEkiF�lfiEif3fiE3F3EiF3E3fiFiE lfififi iEftiEiFiE±fjEifiFiEiFiFiEiEiflflE�lfiFiflEif�EiElEiEiEiFiEiFiEiFjEiF LEGALIZATION:N F E E S U� A R Y STRUCTURAL -SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 45.00 ,50 SMIP/NON-RES PLAN ISSUE FEE HUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE TOTALS----> 45.50 O.OQ 0,00 95.50 95,50 .00 REVENUE DIVISION TOTALS--> COLLECTED; 45,50 OVER/SHORT: .00 BLDG PMT PLUMHING ELECTRIC MECAANIC FIRE SMIP/TOT GRADING PLAN-CHECI( 45,00 ,50 ik if iE iF 3f if ff !E iF iE iE 1F 1F if iE if 1E iF 3k if lE iE iF iF iE IE IF �E 3E iF Ik iF IE �E �E if iF 1f if if iE �F iE iFiE 1E k IE iE 3E iF iE 1F if iF iE if if if iE jf iF if iF iE iE ik iF iE 1f iE iF if If 1F iE iE IF iE 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 SFR 1966 � REROOF BY VALOE RESIDENIAL NOZONE END �F FEES EXPIRED ' �ncomplete Inspections • uate �_ _ Sig �— ��`�1A'V � L17,��If1i�I�7YlY 1.00 � .. ... .. •� /_ TOTAL COST 1,966.00 CONSTRUCTION AND PLANNING P� � SPA APPROVALS Permit # Date Inspector p�ppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical Conduit Ut�ility-l)ndrgrnd. 54. Forms 4. Electrical Condu�t-Undrgrnd. - 55. Electrical Bonding 5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test �� 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE � 7.. Footings 58. Electrical Conduit-Undrgrnd. - 8. Foundation 59. Gas Pipe, � Undrgrnd., Test .� 9. Water Pipe-Undrgrnd. 60. 8ackwash 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 65. Electrical-Final 15. ftough Electrica�-Conduit 66. Sofai $Ystem-Final 16. Rough Electric W�ring 67. Fencing & Access Approval 77. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20: Rough Factory Fireplace � � . APPRDVA�LS - Permit #' � . ,. 21, Ducts, in Structure; �. � -_ , .� 70. Und'erground Hydro 22. Ducts, Ventilating _ - 71. Product Piping O'Gas O Oil 23, Gas PipE�Rough & Test ,� 72. Underground Flusfi - 24. Roof Framing � _ - 73F Undergmd.StorageTank OGaS ❑Oil � 25. Roof Sheathing � ' _ s�� -� ' .4_ Overhead Hydro� _ � 26. T-Bar Ceiling (Structural) & Monocoat �' 75�. Dry Chemical • 27. Frame and Flashing . ' � ' 76. `Dry Standpipe - '_. . � � � 28. Lathing & Siding . , r� ' • • 77. FIXED SYSTEM FINAL � 29. Insulation ` - , . ' . . 78: FIRE PREV. FINAL _ �• 30. Drywall Nailing i +• - HEALTH DEPT. REQUIREMENT • 37. Plaster Brown Coat ' � i 79. FINAL INSPECTION ' 32. Elecvical Power Me�er�Final ' �80.�FOOD CERTIFICATE ISSUED � i 33. Final Electrit • ;,. � � i; Notes: � � . - ' , 34. Final Heating & A�r Conditioning ; 4� � : , � � 35. Final Gas Pipe-Yest � � � � � • ' ' - i i I. 36. Hood or Canopy • , , i j. .. '��-- � - � . 37. Final Factory Fireplace , , ' � ' � ' . - r 38. Final Plumbing � . �� _ - � • . , � . - 39. Water Service-FinaV � � • .- � . • - - � 40. Gas Service-Final , � . . _ . „- . � � 41. Solar pomesticFinal� � _ �'' � 't 42: BackflowPreventer �. � . � � ." . . : , �. 43. Backflow Irrigat�on � � �: ' _ y a 44. Landscape Icripation System ; , . ' � - . _ �i 45. Sound Attenuation IfIC pl 2C I�Sp2Ct10(1S •46. Handicap Regulations ' - 47. FINALSTRUCTURE&BUILDING� � . � � - - ti: 48:,FINAL PLANNING ; � . � 49. Electric Release to Edison i �� e � i . 50. Gas Release to 5outhem Califomia Gas Co , � �� _" 51. CERTIFICATE OF OCCUPANCY , , , ' , No _ Date , , • ! ��`ft COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 3f] COSTA MESA.CALIFORNIA fOR APPL/CAN7 TO f/LL /N COMP[ETELY TYPE OR PRINT BUILDING ADDRESS ALLFGHENY AVENUE COSTA MESA. CALIFORNIA MAIL ADDRESS CITY NEWPORT BEACH CALIF No. ARCHITEGT LIC. OR ENGINEER NO. '1 ADDRE55 I"Z� I"LACENTIA NEWP( LEGAL LOT DESCRIPTION No. 46 BLOCK A.P. NO. IIOIIC nwinT 6�X�� IRREG lu�w�n USE OF EXISTING BLDG. SETBACH LINE FROM f 1 CENTER OF STREET � REAR YARD �O � 5� � 5t SIDE YARD LEFT RIGHT DESCRIPTION OF WORK BUILDING NO.OF SIZE �"32�SF ROOMS STOR EXTERIORd(Jq1. ROOFRED CEDAR COVERING�� COVERING SHINGL USE OF BUILDING AND WORK TO BE PERFORME� SING FAMILY RESIDENCE AND ATTACHED GARAGE PLAN NO. �-� I HEflEBY ACKNOWLEDGE THAT 1 HAVE NEAD TNIS APPLICATION ANO STATE THAT THE ABOVE I6 CORflECT O qGREE TO COM- PLY WITH ALL GTY ORDINA CES AND ST E LPW3 GULATING BUILOING CONSTRUC ION. � �/ �/f SIGNATURE OF i _ /.� _ . / .V � AUTHORIZED AGENT �"�p,� � �"a R..t,.n:� r� �;--r�� =' �� ' ' �� ,-. h� �JAN 1'01969� FIPt�,i�'CE DEPT. !`I�y nr rCcro ,�� APPLICATION FOR' PERMIT4 BUILDING �oR offic� usF aNcy I RECEIPT NO. I APERMITiNO.p COSTA MESA. CALIFORNIA ZONING ZONE NO.OF fI6E OF NEW R�l PLANS 2 BUILDING�� 33 THE AMOUNT 6HOWN UNOER VALIIATION I$ FOR THE PURP09E OF E6TABLISHINO il PEFMIT FEE ONLY, VALUATION � � ! PERMIT FEE $ $ /,�✓ � �� PLAN CHECK S /b TOTAL FEE S `�I,l� F � W 0. Q � � F ., 0��.�,�4'7 �} 6537 10/09/78 �39040 TL' COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 AP I TI N FOR STRUCTURAL PERMIT For Applican[ to Fill in Completely — Use Ink Only REC 6 DATE RECEIVED OATE ISSUED BVI�OING S ADORESS /I� /V 1 •,/� PEFMIT NO. OWNEF Q A.P.NO. ryI—✓33—� MAIL Q BUILDING � /y/� n_ ADDRESS Q (� ADDRESS (�(f�',(p CITV C ' NOL �� TRACT �D 7� LOT BLOCK CONSTRUCTION NEW ADD AITER R fA M LENDER � BRANCH ( /f OWNER V'�OO AODFE55 OALUE�^ ARCHITECT TEL. SE �� I 5'^� �� OR ENGINEER N . FIRE ADDRESS ZONE TYPE GFOUP � APPROVED _ �i CONTRACTOF �lJJ U(r BV DATE U� �7 ADORESS TEL. ZONE �/ NO.OF USE OF NEW rYl IL� CITV NO. P�� BUILDING �Q m L C NO. �(J / '� LI0. NO. YMAIDN e IIDING ACCESDSORV BVILDING SIZE NO.OFBLDGS. (FROMC/ TREET OF lOT NOW ON LOT RONT FT. USE OF EXI5TING BLDG. F I SI E FT. Separate permits are required for L. SIDE � FT. V FT. electric, plumbing and heating work. REAR FT. O Fr. USE OF BUILDING ANO WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLOGS. ACCESS. BLD('aS. � VAR. # DATE C.U.P.# MPROVED O x APPROVED �� / /O 7 i hereby acknowletlge that I have �eetl ihis eppllcation and state that the above information is corract antl agree to comply with ell laws regulating building construction, antl I shall not employ any person in violation of the workman's compensation laws of ihe State ot Calitornia. I hereby cartify that I am ptope�ly Iicensetl as a contractor untle� ��O SQ. FT. ihe State of California Businass antl Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, entl that such licenses a�e in full torce and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ON� � am exempi from the provisions of the State ot California B�siness VALUATION PERMIT FEE $ 2� antl Professions Code, pivision 3, Chapter 9. PLAN CHECK $ Sie�at�re of O Permittee �� / „� $ 2Q �V TAX S e Auihorixetl Agent TOTAL PAID $ / OWNER c�s w•T ROP. SWR. LINE �� NOUSE CON. PRINKLING SVSTEM ROIIGH HESTING �NO �IR CONDITIONING TEMPOA�AY $ERVICE OR POLE UNOERGROUHO � POWER � � ROUGH WIRING TAENCNES I FORMS � STEEL REINF. REI SNEPTHING , FR4ME �NO FLASHING _. � _ 1 PI�STEP. BRON'N C04 TURAL, FINdL h_ . iNG, VENT., REFI PLUMBING, FIN/L ANL ELECTRIC, FIN�L BUILDING, FINAL DATE