HomeMy WebLinkAbout333 REIMS LN - Building Permits • a
•
0110 •
41111,
• CITY OF COSTA MESA
olellt° BUILDING DIVISION
F a 1 = 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714)754-5626 .. //
PERMIT NUMBER:kSC07-00353
PERMIT TYPE: B_COMBO STATUS: ISSUED
Sub Type: RES_RRIP DATE ISSUED: 11/26/2007
ISSUED BY: SOK
JOB ADDRESS: 333 REIMS LN CM Suite/Unit:.
APN: 43914150
Vicinity:
Const Type: V-N SOFT 0 - -Valuation: $65,000.00
SCOPE OF WORK: REVISION ON 12/26/67'40 ADD PL AND MECH FIXTS. FIRE DAMAGE.REPAIR FOR AN EXISTING 2-STORY
CONDO UNIT. WORK INCLUDES•2 UPSTAIRS BEDROOMS, ROOF FRAMING, INSULATION, WINDOWS/DOORS. REPAIRS TO
AESTHETICALLY MATCH:EXISTING STRUCTURE(S). ELEC, MECH, PLUMBING, . . .
OWNER: VANCE, NEIL TR'- .. 1 . .Address:- 21576AMBUSHERS ST - - ' Unit:
Phone: - - - - - - City'/State/Zipn DIAMOND BAR,CA . .
APPLICANT: JEFF GARCIA - • Address: - - Unit: :
Phone: 714-996-3200 - .City/State/zZip: . :
CONTRACTOR: ALtERHOLT CONSTRUCTION AND INTERIOR License No. 572282 • -
Phone: 714-996-3200 , . Address: 175 W ORANGETHORPE AVEUnit: .
Cell: - ' -City/State: PLACENTIA,-CA -ZipCode 92870
ARCHITECT: -- License No. . . • PHONE:
ENGINEER: H.C. HANSON - License No.S3027 -- • PHONE:714-573-0073
.
COMBINTATION PERMIT FEE SUMMARY
Building Plan Check: - .-$486.69 '.
Building Fees:
Electrical Fees:
Mechanical Fees: $77.35 - " -
•
Plumbing Fees:
SMIP Residential: - _' $6.50 - •-
SMIP Commercial:
TOTAL FEES: $1,560:14 " ' T---:...- -
"Refer to fee receipts for all fees paid for project
NOTICE: The work authorized 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE I. INSPECTION TYPE DATE INIITIALS CODE I INSPECTION TYPE DATE INnTIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 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 P/A. ---71771f -jyµ.
illWORKERS'COMPENSATION DECLARATION: Owner ID verified by driver ❑Yes ❑ No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
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 Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
number a person is required to descend,will be made in connection with work authorized
(\a----- Dy this permit,and that no building structure,sca(fdding,falsework,or demolition
barrier.- Q�� -to dismantlingthereof,will be more than thirty-six(36)feet high. (Chap.3.2,
(This season need tufty completed the penitis valued al one hundred dollars(5100)ot less.) rty- 9 Gm
-z �J 2,Art 2,Sec.341,Title 8,California Administrative Code).
Policy,Number: ti-):71532)
Ci---, ❑ As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
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 shall forthwith comply with these provisions. Applicant's Signature Dale
r I2(Zb O'7 Division of Industrial Safety Permit Number:
Applk3nl's Signature �Dat� - HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the Califomia Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is infull
Z2—d y full force nand effect. a registration form for acutely hazardous materials? 0 Yes 0 No
bfCtf c_I re-1;;T---->t— i' S (Section 25533 of the California Health and Safety Code, with some
/ - exceptions, requires registration with the Costa Mesa Fire Department by
- 21 �!�T /-� each business which at any one time has on hand a quantity of acutely
tractor's Signature Date.2i hazardous materials equal to or than a weight of 500 pounds, or a
volume of 55 gallons, or 200 ubic fe of compres d gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or s or future riding occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk On e t and Preve ti Program for acutely
Lender's Name: hazardous materials)? AM Y s ElNo
(Section 25534 of the a i or is Health and Safer Code provides that the
Lender's Address: Costa Mesa Fire D part ent ay require the rebaration, certification and
filingwith the Fire of an RMPP b • esses which are required
q
to register acutely h rd s materials with 7e Department.
Signature Date
4. If an RMPP '\gre eptly required, ha coon 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and S fiery ode been fully mpI///ii�����1e 'th? ❑Yes ❑No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does • wi I pplicant o res nit Lure building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work I s the subject t 's p cation a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or m •Ic! rom the South C t Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its an oth r ai Ilution control district agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement ( ct 6 50.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors inform ' be fumished on applications for non-residential building permits).
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 6. Will y part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No
thereon,and who does such work himself or herself or through his or her own 8. (If"yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If. however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
El I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction. and authorize representatives of
Business and Professions Code for this reason: 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.
Signature gal Owner(s) ((( Date
Signature Date %/0/26707JOS]-a6(3I07) d/or.Aulhorized"Applicani. r D-- ates
CITY QF COSTA MESA
lb .
4 Q BUILDING DIVISION
i•4 ;," 77 FAIR DRIVE,COSTA MESA,CA 92626 •• (714)754-5273 •• Fax(714)754-4856 • www.ci.costa-mesa.ca.us
1-1 w�e..✓�- i
4.Qttr'1� FOR INSPECTIONS CALL: (714)754-5626 h'
iron in^4.1
J. 2PERMIT NUMBER: BC07-00353
8'ra4
PERMIT TYPE: B_COMBO STATUS: ISSUED ,
Sub Type: RES RRIP DATE ISSUED: 11/26/2007
e ISSUED BY: SOK
JOB ADDRESS: 333 REIMSN CM Suite/Unit ,
APN: 43914150 , Zomng
Vicinity: „ ' ,it't. ii, i, ut , iit:fiii.HPrimary Occ:' .'
Const Type: V-N .'-r - SQ:FT - 0 - , .,Valuation: $65,000.00
SCOPE OF WORK: FIRE DAMAGE REPAIR FOR AN EXISTING 2-STORY CONDO UNIT: WORK INCLUDES 2 UPSTAIRS
BEDROOMS, ROOF FRAMING,IINSULATION,WINDOWS/DOORS. REPAIRS TO AESTHETICALLY MATCH EXISTING
STRUCTURE(S). ELEC, MECH,PLUMBING.
-
OWNER: VANCE, NEIL TR; - ' Address "21576 AMBUSHERS ST Unit:
Phone: ' `City/State/Zip: DIAMOND BAR,CA
APPLICANT: JEFF GARCIA , Address: - «'' Unit :
Phone: 714-996-3200 . -..City/State/zZip: i .'Y ,^i
CONTRACTOR: ALTERHOLT CONSTRUCTION AND INTERIOR `. License No. 572282
Phone: 714-996-3200 s, Address: 175 W ORANGETHORPE AVEUnit
Cell: ii, City/State:-PLACENTIA,CA ” 1..„ZipCode 92870
ARCHITECT: '„ -! License No. ' 'PHONE
ENGINEER: H.C. HANSON ""t ' - License No.S3027 • PHONE:714-573-0073
COMBINTATION PERMIT FEE`SUMMARY.
Building Plan Check: $486 69
Building Fees:
Electrical Fees:
Mechanical Fees: $59 45
Plumbing Fees: . ..V; -
SMIPResidential:
SMIP Commercial: "- $0.00
TOTAL FEES: $1,399-.99;
"Refer to fee receipts for all fees paid for project
NOTICE: The work authorized 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE/. INSPECTION TYPE GATE 1N1111AL COD If INSPECT1 N DATE !VITALS
1616 Fixed System Final F e Pr ention At 20 Final Mec ical
1266 Pool Spa Final . 20 Final Plumbing i
APT ,
200 Final Re-Roof 21 Final Electrical
201 Final Block/Rata ng 2 Fina 'r ention
202 Final Factory Fire Place 2 Final Planning Approval
203 Final Sign - 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS'COMPENSATION DECLARATION: S -'_ Owner ID verified by driven. ❑Yes ❑No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document.i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
perfo ance of the work for which this permit is issued.
CrI'have and will maintain workers'compensation insurance, as required by
section 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
1 i[' by this permit,and that no building structure,scaffdding,falsework,or demolition
Carrier: t?t au f`c.f.- 't- or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This seem need not be competed a the perm4 is valued at one hundred dollars($100)ortess.) 2,Art 2,Sec.341,Title 8,California Administrative Code).
Rolicy.Number: L.371 35 908
Cl ❑ As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
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 rode.I shall forthwith comply with these provisions. Applicant's Signature Date
if/7-646-7/ Division of Industrial Safety Permit Number:
r -Appl^mot's Signature l( re- HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑No
Lic.# 5.77-2-82-- Class#_ .1 (Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
iy/2-1!/07 each business which at any one time has on hand a quantity of acutely
anuacto_s Signature _ Dal 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affum that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the Califomia
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑ No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications fa non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑ No
thereon,and who does such work himself or herself or through his or her own 8 (If'yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
0 I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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.
Si nal o.Legal Owner(s) Date
Signature Date i(/ 0''
305746(3/07)
And/or Authonzetl Applicant- - L__ ate
:vitt l tf.: CITY OF COSTA MESA
y I,, BUILDING DIVISION S
I:.
I DEVELOPMENT SERVICES DEPARTMENT
' � PERMIT PERMIT JMBER
E99-00168
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 333 REIMS LN Status: ISSUED
Suite No Applied: 03/03/1999
Vicinity: Issued: 03/03/1999
Parcel Nunmber: 43914150
Applicant: JOHN PENSO
Address:
Phone:
. • Zip: -
Owner VANCE,NEIL
.
Address 333 REIMS ST - _
_ Phone: 647-4938 - '
COSTA MESA,CA Zip: 92627 . , '
_
Contractor: ' ECONO AIR
Address: 4522 EISENHOWER DR , ,
Phone: 800-503-2666 `
ANAHEIM,CA Zip: 92809 i
License: 445220 .
' SCOPE OF PERMIT
FAU CHANGE-OUT, INSTALL NEW 4 TON NC UNIT. INSTALL ONE CIRCUIT, INCIDENTAL TO MECH
WORK, RE:M99-00100.
FEE SUMMARY
• . Quantity _ J _ Quantity ,
ISSUE FEE $22.00 Temp Dist System/Lighting $0.00 0 -
Temp service test $0.00 - Busway/1008 i $0.00 0
Res. a/c package • $0.00 Standing Section $0.00 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/Spa $0.00 0 up to 10 kva/kw $0.00 -• 0
Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0
Recept Outlets •$0.00 0 up to 100 kva/kw $0.00 0
Switches $0.00 0 over 100 kva/kw $0.00 0
Non Res Appl - • $0.00 0 . Low Voltage Equipment $0.00 0. , .
Res Appl $0.00 0 Low Volt Wiring System/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 $11.00 1 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 • 0 Fireworks Stand $0.00 ' 0
Motors to 100hp $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 $33.00
Intermed Pole $0.00 0
COMMENTS/SPECIAL CONDITIONS
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
DECLARATIONS fl n
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 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.
❑ I have 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 workers nation Insurance carrier and policy number are: �) /�
Carrier.
��//0/ie_f. Policy Number. N�� 18 c7 C) J
(This section need not be completed i/the permit is valued at one hundred dollars($100)or less.)
❑ I 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: SC67(,0 / ,1ti / Date: ''"-
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(s100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under rovisions of Chapter 9(commencing with Sectiory7000)of Division 3 of the Business and Professions Code,and my license is In full
force and effect.Uc.# .57��e1 �rp ' o ( Class#
Contractor's Signature: c'7LeL � Date: 3-3- `f Y
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 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
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 Professions
Code:The contractors Ucense 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 Ucense Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes ❑No Drivers 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 Live(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? 0 Yes 0 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? 0 Yes 0 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 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apernit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 yes 0 No
(Section 65850.2 of the California Govemment Code requires that the requested information be fumished 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? 0 Yes 0 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? 0 es 0 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 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 property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Sire Of Legal Owner(s)
3 99 Date
ndlO
p r Authorized Applicant Date
CODEL INSPECTNINTYPE gATE Mae CODFE INSPECTION TYPE gag 111>m6�
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1268 Pool Spa Final 208 Final Plumbing �p {�
200 Final Re-Roof _ 210 Final Electrical ,- Q L Y 1 Q'
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
244&46
/0{1:11.!4.,
..,., CIT
t 1:L!-
CITY OF COSTA MESA
� DEBUILDING DIVISION
�; DEVELOPMENT SERVICES DEPARTMENT
�asIrocli t PERMIT PERMIT NUMKA
M99-00100
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
•
Job Address: 333 REIMS LN Status: ISSUED
Suite No • Applied: 03/03/1999
Issued: 03/03/1999
Vicinity:
• Parcel Number 43914150 - - - - ' ` ,
Applicant: JOHN PENSO
Address: . _
Phone:
Zip:
Owner: VANCE,'NEIL
Address: 333 REIMS ST • - . .
Phone: 647-4938 - '
•
COSTA MESA,CA Zip: 92627
contractor: ECONO AIR
Address:"/ 4522 EISENHOWER DR ' v -
Phone: 800-503-2666 ,
ANAHEIM,CA Zip: 92809
•
License: 445220
Arch/Eng: -
Address:
Phone: ,
Zip:
. - License:
/ .
SCOPE OF PERMIT .
FAU CHANGE-OUT, INSTALL NEW 4 TON A/C UNIT.
FEE SUMMARY
" Quantity Quantity
ISSUE FEE $22.00 Repair!Alt'Absorbtion Unit $0.00 0 •
Inst FAU<100 k BTU $13.25 1 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $0.00 0 Evaporative-Cooler $0.00 0
Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $13.25 1 Domestic Incinerator $0.00 •0
Ref rig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 - 0
Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 ' 30 To 50 hp/1,750 k-BTU $0.00 0
Vent Fan/Single Duct $0.00 - 0 Over 50 hp/O_ ver 1,750 BTU ' $0.00 0
Appliance $0.00 0 Boilers . '
Fire Dampers $0.00 0 • Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000cfm $0.00 0" 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0
Floor Furnace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $48.50
•
COMMENTS/SPECIAL CONDITIONS
•
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
DECLARATIONS fl r
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain 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.
OVI have 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.
MyVers'rs'cympensatlon Insurance carrier and policy number are:
Carrier: A/Jee ( Policy Number. /J WA/)784.4' 9
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I 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. //ff
Applicant Signature: EC6/JO Date: -3-3-9 9
THOUSAND
FAILURE ETO(SECURE WORKERS'COMPENSATION COVERAGE IS UN,DAMAGES A SHALL SUBJECT I N SECTION
TO CRIMINAL OCODE,
AND FINES UO N ONE HUNDRED
T/gUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTIIXJ 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 Sectiirr 7000)of Division 3 of the Business and Professions Code,and my license is in full /-
force
force and effect.Lic.N '19 U Class# C/0-C.
Contractor's Signature: .:. nMA AM / Date: 3-a-q 9 /
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 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 fore 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
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 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.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: • Date:
Owner ID verified by driver's license. ❑Yes 0 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,Califomla 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? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be fled 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? 0 Yes 0 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 Califomla 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 Califomia Health and Safely Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ppermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes ❑No
(Section 65850.2 of the California Govemment 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? 0 Yes 0 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? 0 Yes 0 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 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 property for inspe 'on purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
S' re Of Legal Owner(s) 5- ' Date
3 n 7 /9
And/Or Authorized Applicant Date
CODE L INSPECTION TYPE DATE ICAC/ Oat INSPECTION TYPE ^ PATE MEDALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical S-9
-99 T,]rY
1268 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 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
2446-48
OWNER DOYLE & SHIELDS Development Co. ,Inc. DATE 6-3-63
JOB ADDRESS 333 Reims BUILDING PERMIT NO. 19635 .
GENERAL CONTRACTOR Doyle & Shields Dev.Co. ,Inc. VALUE $ 19)5240.00 --
AP No. LOT 50 TRACT 3433 FIRE ZONE DESCRIPTION OF WORK Rassw/att.gar.
INSPECTIONS Signature DATE GROUP I&J TYPE V ZONE R-2
SOIl177-r"-‘'3 i SUBCONTRACTOR PERMITS ISSUED
Gas /61a0� DATE NUMBER
Water ,r/' J
Rough Corn. Refrig. 0 Air Cond. ❑ /-r/-G30-N"--1 2 2 196 Z
Rough Heating /f$ /
Rough Plumbing S /6"O-03 .44f....,c,•6u-e/gED '0' -, - to N
� n!'
Miscellaneous t�0 fir
_ - \ p
Prop. Swr. Line Wil House Con..gylt. Swr. ❑/V{--C /Z Z--C3 t ® /.t• i7/i Cf emo- /.t--a 44292 N�
Sprinkling System / ly
Construction Pole ,Y t.
'
Underground jd Power El de0e , t
Roth Wiring %fscreQ�/J.� Safe• 3-/n3 ' 7�7
re
Tnches Forms rn/Steel Reinf. 0
Floor System _ he 7-9"-yc'' ( , \
Bond Beam 0 Steel Reinforce 0 is _ r'
Sheathing ! /�/f!/
Frame and Flashing 'Trit t' .AV .AV
Lathing —In)- Out "JJ %/ 2./� " � 11/Plaster, brown coat /-yy�,1/4)1,1c2- � c
— / -- - � 3 \ /I 1
Refrig. ❑ Air Con. ❑ Final UV 1
Heating, Final /lift- 2.2-7-e.9 \ W
Plumbing Fixtures, Final „ /3/-04/ W' _
Final Gas Test/„-- �/� , .j —04' U
Electric Fixtures, Final ' /tPs��(�J
Building, Final /Jij/-C J-/-(may _
OCCUPANCY .
Form BU4-5M-3-63—S-B P I-IOID t•UK Jrt L1Ha- 1nQUIKLUVILIN 1.y
� 8
��,� FEE RECEIVED
JUN 3 1963
COSTA MESA BUILDING SAFETY DEPARTMENT INANCE DEPT.
P.O.BOX 917 COSTA MESA,CALIFORNIA -
N CITY OF COSTA MESA
For Applicant to Fill In Completely , APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
•
3 For Office Use Only
BUILDING
ADDRESS
RECEIPT NO. P$ReI { 030
COSTA MESA, CALIFORNIA �I 141'.{1
\\ L J /�J'�� /' / •HIVED -V DATE
St �RECEIVED
� DATE ISSUED
OWNER.\LL it. /,Si///Wit / .... W_the ?/��J JUPI ., 1963
MAIL 'J/ /// / A di DING g i ( �J .
ADDRESS Aar defier Cr A••REBS ^
O 74-
FIRE ((�� - "
CITY /IJ/�/ C ' y r/ ITALW
xpO.J.G ZONE TYPE GROUPe-jL yU�^
APPROVED
AR[" ,TECTTELpBY - DATE
OF INEER 4 / (� 77/9J NOOOO �/ isy7L
�(// /,/ .// //�/ /'�I ZONING .
ADDRESS 4 00 ✓fk 62,b/`Jm"U/f CuedI 20p/p'�� NO.OP USE OF _ * ".
'S) 16/ oi I PLANSI( I BUILDING;"
CONTRACTOR (`w" e- V L I ..-1- y b /,raW L 3 y33
LEGAL /-G r -it
1 "
DESCRIPTION
ADDRESS rQ...L. +1
(� A.P.NO. 40
J
CITY ( . Q..
STATE Js/ ^ a _/ NOL �o ' NOTED SIDEO DAVE OVERHANG L. SHALL BE LESS THAN
LIC.NO. ... ...eta p D 90"TO Et REAR P.L.
EAVES
OF LOT 33rICs3.a / I NO.OF BLOOD.NOW ON LOT-"--P. ALLOWED (U.B.'C.REQUIREMENT)
YARDS APPROVED YARDS APPROVED
USE OF ...--••-•••••--..--..... MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
• (FROM C/L STREET) .
SETBACK LINE FROMO U O /
FRONT O FT.- FT.
CENTER OF STREET REAR YARD
SIDE YARD! LEFT „r I RIGH R.SIDE 0 FT. FT.
•
. DDESCRIPTION OF WORK L.SIDE 0 FT. Ff.
NE / ` ALTERATION._ ADDITION REAR D Fr. FT.
DISTANCE BET. BET. MAIN @
REPAIR MOVING DEMOLISH . MAIN BLDGS. ACCESS.BLDGS.
j I VAR.# DATE
BUILDING
SIZEUI / .S 7 `�rSB ROM
OS 2 STORIES C.U.P.# APPROVED
EXTERIOR WA ROOF APPROV I ,/�(W.��/]��J 'CA
�r�
COVERING ✓L CO COVERING a1 MS D BY � \P�f " DATE Ob O
USE OF BUILDING AND WORK
p,T,�L/O�B'E�PER/FOR/ME �±
,;-;dQTCt; C Tr i/Qde (Srvc
SQ.Fr. telfN
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SH UNDER VALUATION IS FOR THE F'
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION O-
BUILDING CONSTRUCTION, $ J �L
l/D� / / Yeo• C PERMIT FEE �J
SIGNATURE OFDa, )�(�•�j {J CQ
PERMITTEE n (t(♦ Z S(J F
J/-/'� •��A�� f // $/7/✓ /r/ PLAN CHECK $ J/
AUTHORIZED AGENT rl l� /•I.tt4 .O'/k E
TOTAL FEE $