HomeMy WebLinkAbout362 SANTA ISABEL AVE - Building Permits .' A .
CITY OF COSTA MESA
frail 9 BUILDING DIVISION
: , DEVELOPMENT SERVICES DEPARTMENT ERMIT NUMBER
F t P/ PERMIT
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� 601-00932
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(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 362 SANTA ISABEL AV Status: ISSUED
Suite: Applied: 06/19/2001
Vicinity: GARAGE ONLY Issued: 06/19/2001
Parcel Number: 43914353 Zoning:
Applicant: HANSEN, DUKE ISSUED BY:
Address: 260 E.ALTON AVE
Phone: (714)557-7440
SANTA ANA,CA Zip: 92707
Owner BACKBAY GARDENS HOA
Address 960 CALLE AMANCER
Phone: (949)498-1129
SAN CLEMENTE,CA Zip: 92673
Contractor: ROSS & BARROWS INC.
Address: 260 E.ALTON AVE
Phone: (714)557-7440
SANTA ANA,CA
Zip: 92707 License: 327802
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF GARAGE OF EXISTING CONDOMINIUM.TEAR OFF EXISTING&INSTALL NEW BUILT UP ROOF SYSTEM.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $2,050.00
Permit: $83.25 Claim Valuation: $2,050.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.75
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0.0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
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: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS I '.•
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'compen n Insurance carrier and policy number are:
Carrier: 5 j 4-j f€ Ji r Policy Number:' 0Y6 —O 1 O >o 63c_
(This section need nor 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 alifomia,an{{{{{{{{{{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 pr ions. / _ 6 -/-?-
/?_Q/
Applicant Signature: C[ ! r [ C
Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100000),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.LIc.M ' Z-3 V OZ ' Class k C- -3 Y
Contractor's Signature: / Date: g —L 7 — or
r
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 properly 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 drivers license. 0 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,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 ❑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 en 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 a_perm it for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes LJ No
(Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 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 inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
o� Signature Of Legal Owner(s) Date
� G —r5c 6(
nWOr Authorized Applicant Date
CODES INSPECTION TYPE BATE PMI21.4 CODES IN$PECRONTYPE PATE gioneL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final208 Final Plumbing
� as
��
200 Final Re-Roof
"1--691 C 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
ll PROJ' ADDRES'; 362 SANTA ISABEL AV UNIT: CITY OF COSTA MESA - BUILDING.PERMIT PERM NO: P 054063
• OW BR'SNAME: SHUREEN, DONALD L TR
. ADDRESS: 3201 W AVE L PERMIT NO: P 054063 PLAN CHECK NO: N GOVT: N SUPP: N
LANCASTER,CA 93536
CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH
673-2790
ARCHIENGINEER: REG.NO.: JOB DESCRIPTION : WATER REPIPE SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /
PERMITTEE: KIMBERLY SHUREEN ( 714 ) 673-2790
ADDRESS: 362 SANTA ISABEL CA 92627 COMMENTS: REPIPE WATER
CM
**** **xi******************> **********>E* ***>E** ESE**************************aF***
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 01 the Business and Professions Code,and my license is in lull force and effect. SETBACKS
CITY LIC.: STATE LIC.: CLASS:
Date: Signature: MAIN BUILDING_7.===,...-- -- ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR// FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGH FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ: PROV: PARCEL: 43914353 ZNE: REF NO:
0 Cemfied copy is hereby furnished. 0 Certified copy is tiled with the city Building Division. PLANNING NOTES>
Date: Applicant: ********************************************lei(:%iF********)E*Ik****i!********1F******
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES• REQUIREMENTS
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 A,
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY §- DATE:
Date: Signature: BUILDING APPROVED BY DATE:
NOTICE:de, If. making this declaration,lywith you shouldo become
spbjmit the Workers' rempensation provisions of the Labor
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. A
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: l��__�m. DATE: c,� Z
which this permit is issued(Section 3097,Civ.C). ******************** • --- ::s:�'r.',•—T' '********** ***** * **
LENDER: ******************** . . .*** - *****************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason • BLDG PMT PLUMBING EL'CTRIC MECHANIC FIRE SHIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish,or PERMIT 2,00
,
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 2 5% - SM I P/NON-RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN •, .
and Professions Code)or that he/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). ISSUE FEE 3. 00
I. as owner of the properly or my employees With wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISS E PLAN-CHECK TOTAL PAID DUE
❑ structure is not intended or of fered for sale(Section 7044.Business and Professional Code: The Contractors'State License law TOTALS----> 2 . 00 3. $0 0 . 00 5. 00 5 . 00 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or altered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 5 . 00 OVER/SHORT: 00
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve
for thepurposeolsate). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
rcf I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business
5 . 00 ?"
la and Professions Code: The Contractors State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors State License Law).I am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUA 'L F E- E BREAKDOWN
❑ I am exempt under Section: B.&P.C.
for this reason: 7( TYPE QTY DESCRIPTION UNIT COST TOTAL COST
Date:__�C�7 �— D rte T �4a‘--)5.- PLU 1 WATER RE-PIPE r
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25517,and 'END OF FEES
2 . 00 2 . 00
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification Iron the Air Duality Management District.Residential construction applications are exempt from
IheSe provisions.
tEL
Date: Applicant: 4
I hereby cerldy That I have read this application and state that the above information is correct.I agree to comply with all city and county t
ordinances and slate laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspectiony. purposes. ^'
Date: 2 T --! (` ( Signature `-"`-- ' 247E: ../ty t.'V'. Tr_ --a ..
•
Driver's License or Social Security na •tt . x0• iY
164146 White—Bolding:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
•
CONSTRUCTION AND PLANNING POOL & SPA
},; APPROVALS Permit Date Inspector APPROVALS Permit Date Inspector
•1. Temporary Electrical Service or Pole 52. Pool & Equipment Location "t-
F
.'2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement v
• 3. Electrical Conduit Utility-Undrgrnd. 54. Forms - '
• 4. Electrical Conduit 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. .
•
•
-8t Foundation ~'-- 59. Gas Pipe, 0 Undrgrnd.,Test -
'9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. '
,10. Structural Floor System 61. APPROVAL TO DECK /, 1
-11. Property Sewer Line House Connection 62. Backwash & Receptor-Final '
&
12. Sewer Cap 63. Heater & Vent-Final '•
_ t
13. Roof Drains c 64. Plumbing System - Final ,
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval sA
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20:rRough Factory Fireplace , , . . 'APPROVALS Permit #
r
21/Ducts, in Stryctuie, " r70. underground Hydro •
22. Ducts, Ventilating -i - - -71. Product Piping b Gas ID Oil
23.'Gas Pipe-Rough & Test - - ' _ 72. Underground Flush
,�
24. Rodfi Framing •73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing - • - •74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 4 - 75. Dry Chemical
27._Frame and Flashing' '-' - 76. Dry Standpipe .
28: Lathing& Siding . - ••• 77. FIXED SYSTEM FINAL
29. Insulatidn -r - I 78;;FIRE PREV. FINAL - -
30. Drywall Nailing . - .« HEALTH DEPT. REQUIREMENT
i
_31. Plaster Brown Coat , • 79.-FINAL INSPECTIQN .
32. Electrical Power Meter-Final; . . • •. . ,80.. FOOD CERTIFICATE ISSUED
33. Final Electric _ . - Notes: 11/ S/ti •if. anti 410.i0. �.Pf�Q- Lail
34: Final Heatind& Air'Cbnditioning (Z ' •-
35.-Final Gas Pipe-Test- - •
,36. Hood or Canopy . .. - - -' , '
r
37."Final Factory Fireplace � ',
38. Final Plumbingq/,2WV 4,JO ' ' t. ••
-39. Water Service-Final •
40. Gas Service-Final • _ - , -
•41. Solar Domestic-Final - _ - •
42. Backflow Preventer - •,.
43. Backflow Irrigation '
44. Landscape Irrigation System • , . '
45.-Sound Attenuation r ' r
.46. Handicap Regulations - -
47. FINAL STRUCTURE & BUILDING - 4.
48:`;'FINAL PLANNING # . ,
. 49.Electric Release to Edison , - r
'50. Gas-Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY •
No. Date
OWNER DOYLE & SHIELDS Development Co. ,Inc. DATE 6-3-63
JOB ADDRESS 362 Santa Isabel Ave. BUILDING PERMIT NO. 19743
GENERAL CONTRACTOR Doyle & Shields Dev.Co. ,Inc. VALUE $ 16,790.00
AP No. LOT 159 TRACT 3433 FIRE ZONE DESCRIPTION OF WORK Res.w/att.gar.
INSPECTIONS Signature DATE GROUP I&J TYPE V ZONE 11-2
Soil / ti y— '— SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Gas ,1� q g
/ C Water '�
Rough Corn. Refrig. 0 Air Cond. 0 "�•
Rough Heating /tit Q_ c-C7' ,/ ,c, -rn JUL 2 2 196; �.9 ri4
Rough Plumbing • M 1$66:1 ,4.10141.41) O G• 13/ ,347, �J
Miscellaneous id—
Prop. Swr. Liner
p. House Con. �'St. Swr. 0 /�/J•f-S /o�q-L3 �.o i,�>u-�- f. i6-a3-�3 v.�a r �'�
Sprinkling System � I
Construction Pole R'� „tlij�l,
Underground - Power ❑ Pe 9-?:65 0 ow
Rough Wiring .eft _e- AUG 7 7 196J 27;0.7.7 0 —
Floor y ID. Forms p1 Steel Reinf. 0 lf -1 �,
Floor System y o'-ya.`5
Bond Beam 0 Steel Reinforce 0 .. _
Sheathing 1,-27.- 3ar-/
Frame and Flashing , d O ^ j//`
Lathing— In Out�- m-Z .,/,--%
•s R,/1 -
Plaster, brown coat (/.-7 -c' V .--1
Refrig. 0 Air Con. 0 Final
—Lac"
Heating, Final /2/-L//"� 1 1,
Plumbing Fixtures, Final _� / f r7 d
Final Gas Test �1n /y�
Electric Fixtures, Final v/ - C-?7
Building, Final /:��4 7 I .
OCCUPANCY . !,o enrl^r n r orty ifgFMFNTM •
Form BU4-6M-3-63-S-B P 1�_�_� r
97FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT ilU N 3 1963
P.0.BOX 817 COSTA MESA,CALIFORNIA ANCE DEPT,
i
For Applicant to Fill In Completely APPLICATROWIFCK FNMA MESA
TYPE OR PRINT BUILDING
2 li Q For Office Use Only
BUILDING (3�'j-Y�C
ADDRESS
DATE RERECEIPI'NO. PI RM1,'LN43
COSTA MESA. CALIFORNIA � I
RE ;ED s REce1vBD3 LNTIY ISSUED
OWNER Doyle & Shields Dev.Co. Inc / G // Jll J 19/6`
BU INS .ZIl.3.,142..a.../
` r �1
MAIL AD;'•ESS✓
ADDRESS 831 So. Manchester Ave.PR FIRE
TEL. V
CITY Anaheim NO 2-0020 ZONE TYPE GROUP '
ARCHITECT TEL. 871- APPROVED DATE
OR ENGINEER Hai C. Tan NO. 2810
ZONING
ADDRESS 4100 W Commonwealth
Z• O.OF USE NE 1I `
FLANS - I "I G IA`71
CONTRACTOR Same Fullerton9i.,' •„ • III A r4A
LEGAL Lot 159, Tract 3433
ADDRESS Same DESCRIPTION �
CITY Same A.P.NO. -7/
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
LIC.TE NO.151-25O-B-1 NO' PR 2-8020 SO TOSIDE BREAR Q.L.
EAVES
. SIZE
OF LOT 33 x 53 .50 I No.OF BLDGB. ALLOWED (U.B.C.REQUIREMENT)
NOW ON LOT --
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. --
(FROM C/L STREET)
SETBACKOF LINE FROMSTREET 47 I REAR YARD FRONT 0 FT. FT.
CENTER --
. SIDE YARD LEFT -- I RIGHT -- R.SIDE Q FT. FT.
DESCRIPTION OF WORK L.SIDE 0 FT. FT.
NEW X ALTERATION _ ADDITION REAR b FT. FT.
DISTANCE BET. BET.MAIN a
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS.
VBUILDING NO OF
SIZE 33x53 .50 ROOMS 6 STORIES 2 CAU.P.jl�(/ APPROVED ^ (� f
EXTERIOR WALL I ROOF SI/INC�-r APPRO ed--9' 775
COVERING Stu rWO COVERING 440441.0. BYu.
DATE 1 FI,]Y-�/ VV
USE OF BUILDING AND WORK TO BE PERFORMED
Residence w/attached garage et l
Model 32G
155864.FT .1
4'tc' Q '
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT S O N UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ABLIBHING A PERMIT FEE ONLY. p
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION -
BUILDING CONST UCTION. ( ^ ,,,(((��T (b
(� 'n� • ....7.„
PERMIT FEE $
SIGNATURE O Tt �/ i/-.(L� ,,``'. B
PERM ITTEF = • '/ (J' P -L Oa E
j/^(,,�/ S/47!4 PLAN CHECK $ ,1Pn- / m
AUTHORIZED AGENT / ` I /1 .1u1a. TOTAL FEE $ (. / at A