HomeMy WebLinkAbout2209 REPUBLIC AVE - Building Permits ed5-53/ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. .
-- PERMIT In TRACT NO. LOT NO. •• UNIT NO.
CITY OF COSTA M An CONSTRUCTION PERMIT �'I/A' - o 2 //�� A.P.# .� 1 Zone
•Project Address 2 a 9 U A L7-c- ' ` `21 "� II
c"f5TYPE OF CONSTRUCTION H NEW U ADD LI ALTERATION H REPAIR S Main Building: Accessory Building: Z
Applicant's Mailing Address -a6s' E
Owner's Name /71401.-0 i G— "Ay - Phone 4 /'N Di CONVERSION ❑ DEMOLISH DI OTHER - B Front N
DESCR IPTIOrtt K/USE OF B G. Rear
Address rcii so//ri. ( /R�, �,Qe eL4 Q, Gat.✓j1 A I
IArch/Eng. License No. TYPE OF PERMIT DI GR ING FOUNDATION ST UCTURAL C Right G
Address (y e❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ' $• Left R
Contractor's Name ‘,...),5,7x-/-_,/ CariC,s"C Phone > �t`1//6. ❑ OTHER •
�1, 3 Ping. Ref. # Parking Req./Provided - • E
PROJECT DESCRIPTION SQ. FT. OCCUPANCY R Q
Address(mailing) L^ -�. �lr1.S1— -Sim i{,f/R/rfi.:.[ C'i}L yam. Planning Notes: M
"�)"c,-; CONSTRUCTION TYPE VALUATION$ T
City License No. y �� 439 ZONE GRADING CU.YDS. ACRES S.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks:
with section 7000) of Division 3 of the Business and Professions Code, and T
my license is in ful,jforce and effect. _ ,(�' ELECTRICAL • FEES
License C ss —.2 C. -^ L))'cense No. .. L Sbj
bate Signature i� �J�'T-�. PLUMBING FEES Automatic Washer Transformer 0 15-50 KW
WORKERS' sAnoN DEC LARAjP10N Construction Pole Sub. ❑ 50+ KW
I hereby affirm that I have a certi mate of consent to self-insure or a certificate Bar Sink Showers
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps
3800, Lab. C.) - '
Policy No. CompanyBackflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps
Certified copy is hereby furnished. Dryers DGas ❑ElectricSub Panel .
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection
Date Applicant Fan Motors❑0-1HP ❑1%-B
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors __
(This section need not be completed if the permit is for one hundred ($100) or F.A.U. Inc.Solar 09-15 HP 016-15+
less). - Dishwasher Solar Piping
I certify that-in the performance of the wo r whl55 is permit is Issued, I . - Fixtures Microwave
shall not employ any person in any ma er o avCo b ome subject to the Drinking Fountains Solar Tank
War kers,,Cer ton Laws of Califorpia. _ - Device Boxes
Date ( -1 m-1 j Signature / / A-sem---. Floor Drains Swimming Pool w/Spa Pole t -
NOTICE If,a siert
this declarat n,you ould become subject to the / Outlets doge
Workers' Compensation provisions the - r Code, you must forthwith Floor Sinks Urinal - .
comply with such provisions or his permit. shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Cl t Switches Sign
I hereby affirm that there is a construction lending agency for the performance -
of the -work for which this permit is issued (Section 3097 Civ. C.) Interceptors W r Heater
Lender's NameGarbage Disposal Standing Sections Lender's Address Kitchen Sink Water'Service Generator 00-5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION .
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or
' county which requires a permit to construct,alter,improve,demolish or repair P—Trap ' Laundry Trays '
any structure, prior to its issuance, also requires the applicant for such permit -
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee ! $15 Issue Fee $ 3
•
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). DEVELOPMENT SERVICES REQUIREMENTS:
LI I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3
compensation, will do the work, and the structure is not intended or-offered Zoning Approved By Date
for sale (Section 7044, Business and Professional Code: The Contractor's ' ' MECHANICAL FEES Building Approved By 4 — a - Date
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own Application Issued By 4-+ - -_�-�� r — - . Dat: /='�Y
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0
sale. If, however, the building or improvement is sold within one year of corn- Canopy Type II 0 SUMMARY OF F ES df
pletlon, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground
prove for the purpose of sale). BUILDING PERMIT $ SMIP $
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural ' Refrigeration System PLAN CHECK $ PERMIT •
tractors to construct the project (Section 7044,Business and Professions Code: •
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $ —
builds or improves thereon.and who contracts for such oroiects with a con- ENERGY P.C. $
tractor(s) license pursuant to tne Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 • System Repair/Alteration I PLAN CHECK 25% $
proof of their Worker's Compensation insurance should be provided to me. - ELECTRICAL $ GRADING $ _
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers PLAN CHECK 50% $ MICROFILM $ _
Date OwnerHeating System& Ducting Registers MECHANICAL $ -2-4, `do TOTAL FEE $ _2-y.C/0
I hereby certify that I have read this application and state that the above / .00-100,000 BTU ❑100,000 BTL - OO PLAN CHECK 25% $
information is correct. I agree to comply with all city and county ordinances
and state laws_feltiting to building construction, and hereby authorize repre- LL U/�/V�t -
sentatives of/thiss cit enter upon the above-mentioned property for �/3 /"
inspection purp s s c� 7 IC
Signature /�i w�/�.._ Date / i ri VOr
Drivers' Ljlense QV qt Reinspection Fee $15 Issue Fee $—' Di 000432.25 D0343 TOT 2a,00
• .DATE:. 09/25/-N ?MET 14.33
0865-46,rev.5/88 White - Building; Canary -Applicant; Pink -Accounting; 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
2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement
• 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 I 58. Electrical Conduit-Undrgrnd. .
8. Foundation - ,r, 59. Gas Pipe, 0 Undrgrnd.,Test
'L9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
,
10. Structural Floor System . - r 61. APPROVAL TO DECK
r 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. Rough Electrical-Conduit 66. Solar System-Final - -
/
16-Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING
18., Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19! Rough1Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20,E Rough Factory Fireplace APPROVALS Permit#
2V Ducts, in Structure 70. Underground Hydro ,
22. Ducts, Veritilating ',I 71. Product-Piping 0 Gas 0 Oil •
23. Gas Pipe-Rough & Tesit 72. Underground Flush
24. Roof,Framing 73. Undergrnd.Storage Tank D Gas O Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation- 78. FIRE PREV. FINAL
30. DrywakNailing HEALTH DEPT. REQUIREMENT
31. Plaster k-own Coat . 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED ,.�, W
33. Final Electric Notes: e' IL"1
34. Final Heating & Air Conditioning (0-`1-4A LOO
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final /..(1
41. Solar Domestic-Final 7 2.,
f r .
42. Backflow Preventer 7I /
_
.=_
43. Backflow Irrigation i /i C
44. Landscape Irrigation System i 7'
45. Sound Attenuation
Lyf -
I 46. Handicap Regulations '. :I"
I - rz
• 47. FINAL STRUCTURE & BUI LDING
48. Special Requirements Completed
49. Electric Release to Edison V/
ti
50. Gas Release to Southern California Gas Co ' f
51. CERTIFICATE OF OCCUPANCY /�/ r•No. Date !/ '0
__ _ ,Applicant to fill in all spaces except those within heavy border lines and.sign,all.appropriatetdeclarations. . _
�� - - -- -•• •- _ - f PER NO: TRACT NO. :LOT.NO.I UNIT NO.' - •I , i X 3441 9/19/86 ` •
-
CITV OF COSTA N11E5�1o�CO r•T�UC N PER IT I • as ���� i _ : 5.00 + TL
• Applicant's
Project Address OO�r prL J,^9fi( -U gEPAIR f
I 0 L;• / •
/ I/ TYPE OF CONSTRUCTION LI NEW L ADD LI ALTERATION '
Mailin• 'ddress ❑ CONVERSION ❑ DEMOLISH ❑ OTHER , •
' I )
��- /} A• .P.#- .- - � - .- Zone._.
Owner's Name , L / ' Phone mit//L v DE• SCRIPTION OF WORK/USE OF BLDG.
•
( Address ! �) I , S Main Building: I I 'Accessory Building:,
Arch/Eng"I • License No. ' TYPE OF PERMIT '❑ E z
GRADING [ OUNDATION L STRUCTURAL T Front , : 0
•
Address - •. - ❑ TENANT ❑ ELECTRICAL_ ' PLUMBING ❑ MECHANICAL • B Rear ( N
'1"
,/lr/ �/ r .!L •hone ''C,�"VC ❑ OTHER'S__ ' __- _.- --. .-. ._ _..__ _A ,
Contractor's Nam i C Right i I : • I N
"•r I i / PROJECT DESCRIPTION SQ. FT. OCCUPANCY
Address lrtiailing) •_) / . ; • CONSTRUCTION TYPE 1 VALUATION$ I K Left I , . . R
City License No. S ,ZONE - GRADING CU.YDS. ' ACRES .Ping. Ref.# ,:, Parking Req./Provided E
LICENSED CONTRACTOR DECLARATION ' - - ' ' Q
I hereby affirm;that;I am licensed under provisions of Charter 9 (commencing Remarks: i ' Planning Notes: I ' M
' with section 7000) of Division 3 of the Business and Professions Code, and • - • ' - - ' ^I 1
' my license'ls in ful •, - and effect. I (�/�Ja, - _ ` ' . 1
Licen .s a s "c_ se ND^I . �� • , - _ RECEIVED -`r . t J i98G T
y _ S.
Date • ft - MPJ, Signature fSIfLU 'd1 it 4/ s ( PLUMBING ' I FEES I - I - �' ' •.
f -
WORKE-S•C•MPENSATION thatIhveaceDELLARATION . Bar Sink - - Showers ; _ ELECTRICAL . FEES
1 hereby affirm that I have a Insurance,
of consent to self-insure or'a certificate
of Workers' Compensation Insurance, or a certified copy t ereof (Section Backflow Preventer Service Sink' r -
3800, Lab:Ng-419,5c v ; I - .. - _ - - Automatic Washer _ • Transformer 015-50 KW
11 Policy No: I company i Backflow Irrigation - .Sewer Cap 1 '❑'50 1-,KW ' ••
[ Certified copy is hereby furnished. I ! - i l i — Construction,Pole Sub. - ". •'
ALJ C¢5�s['i iedro 7y�./�5�filed with the city js(/�p`�Itli/np'�D�yi orA //, Bathtubs Sewer Connection Cooking Unit' • • Meter ❑up to 100 amps : •
Date V��Fv�'�rs Applicant b"t•_'//(G( r � ,� 'L - I _ -
Clarifiers
(This
ROM WORKERS'COMPENSATION DECLARATION ' Solar Collectors• . ' 'Dishwasher t Meter.Dover 100:amps - r
' (This section need not be completed'if the permit is for one hundred ($100) or - '
less). Dishwasher l • Solar Piping I :• Dryers ❑Gar ❑Electric: Sub Panel -•
I certify that in the performance of.the work for which this permit is i55ued;I I
shall not employ any person in any manner'so as to become subject-to the Drinking Fountains ,Solar Tank-., Fan .Motors❑0-1 HP, ❑i'h-8,
Workers' Compensation Laws of California. •• • 1 _ • - - I -
Date r • Signature Floor Drains - Swimming Pool w/Spa F,A,U. 1
• NOTICE:`It;after making this declaration;you should become-subject to the - - - _ - '- -' - - - - - - Inc.Solar_❑9-15 HP_016-15+ . _ _
Workers' Compensation provisions:of the Labor Code; you must forthwith ^Floor Sinks 1 ,Urinal Fixtures ' •
-
, comply with such (provisions or this permit shall be deemed revoked. - ' Microwave -
CONSTRUCTION LENDING AGENCY, Gas Service 'Outlets ' Water Closet Device Boxes
, I hereby affirm that there is a construction lending agency for the performance I I Pole Light I ''
of the work ,for which this permit is issued (Section' 3097',Civ. 0.) Interceptors ./. lWater Heater Outlets i Range
Lender's Name ,
• Lender's Address - • - - - - - - -' - • - Kitchen Sink- • - Water Service - SwitchesSign ' ."
' OWNER BUILDER DECLARATION -
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories . Auto-Wash Garbage Disposal '
following reason (Section 7031.5 Business and Professional Code: Any city or 9 P Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator ❑Q5 KW ❑5-15 KW
any structure, prior to its issuane/s also requires the applicant for such permit Trash Compactor I ,
to file a signed statement that he/she is licensed pursuant to the provisions of ROOF Drains I
the Contractor's License"Law(Chapter 9 ons Co ncin9,witt Section 7000) of _., I '-" ,• _l, _ ' _
I Division 3 of the Business and Professions Code) or that he/she is exempt . i
!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 ot'noi more than five hundred dollars ($500). II • - .• , I •
' ❑ I, as owner of the:property or my employees with wages as their sole Reinspection Fee 1'' $15 , ' , ' 'Issue Fee' 1 $ 3 - ` ' - -
:compensation, will do the work,and the structure is not intended.or offered III - •Reinspection Fee -1 $15, Issue Fee -; I __$ 3
for sale"(Section 7044, Business and Professional Code: The Contractor's - . I MECHANICAL • ' FEES - -
' License Law does not apply to an owner;of a property who builds or improves
'thereon; and who does-such work himself/herself or through his or her own - - DEVELOPMENT SERVICES REQUIREMENTS: ' ' _ ,
employees, provided thatsuch improvements are not intended or offered for Boiler i Hood or Type I ❑ • _ I --
:sale:If, however, the building or improvement is sold within one year of com- - .- Canopy 'Type II ❑ Zoning Approved By, ' • _ • _ Date ' •
pletion, the owner will-have the burden of proving.he/she did not build or im- Duct-Under,Ground - ' - •
- - •
I prove for the•purpose of sale)., - i - Building Approved By Date rte- n
D 1; as owner'of tire property, am exclusively contracting with licensed con- Duct-Structural • Refrigeration System Application Issued By - ' - Oil' I c Date 7'44 6'
tractors to,construct the project (Section 7044,Business and Professions Code: • " - -
' The-Contractor's"License Law does not apply to an owner of property'who E10-100,000Duct-Ventilating _ 0-100,000 BTU ❑100,000 BTU . r,-SUMMARY OF FEES '. i •
• builds or improves thereon, and who contracts for such projects with aeon-- - ' - _
tractor(s) license pursuant to the Contractor's License Law). I am aware [Hat e BUILDING PERMIT $; • SMIP _ $
Exhaust System Multiple ❑ , System Repair/Alteration -
proof of their Worker's Compensation insurance'should be provided to me.- - PLAN CHECK $ c -PERMIT -
❑ I am exempt under Section' B.'& P.C.for this treason : Firepl/Fact.Blt. ICBG# • •
Fire Dampers ' _ ' ' PLUMBING • t $ , a� .ISSUANCE $
Date • ..Owner • - - Heating System& Ducting r . Registers - T " PLAN CHECK 25%' $' - .•ENERGY P.C. $
• •
I hereby certify that I have read this application and state that the-above t 00"100,000 BTU ❑100,000BT ,
$ GRADING $ -
information is correct. I agree to comply with all city and county ordinances - ELECTRICAL -. -
•
'and state laws relating to building construction,-and,hereby authorize repre- - - - MICROFILM $ -
sentatives 'o --this city to enter:upon:the above-mentioned property for - • . I - i. ' PLAN CHECK 5G%
;inspection repo r t g/ I - -. i MECHANICAL; $ I ' �•-__��I
Signature s.` � t- _ �� Date• { r '3/ • _, - $. -TOTAL•
FEE r:$ =�L
Drivers'License or SS# / ' • Reinspection Fee $15 Issue Fee• r ' $ 3 ' PLAN CHECK -25% $ • I
�_`'-wigs40/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
• 1
CONSTRUCTION AND PLANNING POOL&SPA --
Date Inspector Date Inspector
APPROVALS Permit# - APPROVALS Permit#
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement .
3. Electrical Conduit Utility-Undrgrnd. , 54. Forms
4. Electrical Conduit-Undrgrnd. • 55. Electrical Bonding en
5. Steel Reinforcement ,, 56. Rough Plumbing & Pressuc5TTest • rt
ii
6. Electrical UFER Grnd. 57. APPROVAL TO COVER:G,UNITE -
7. Footings 58. Electrical ConddittUndrgr`rid. rn
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Ties]
9. Water Pipe-UndrgrnU. _ 60. Backwash Lines, P-Trap, 0 Undrgrnd. •
44
10. Structural Floor System 61. APPROVAL TO DECK '
11. Property Sewer Line & House Connection 62. •Backwash & Receptor-Fin-al--
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains • 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. -
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. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro -
22. Ducts, Ventilating 71. Product Piping 0 Gas D Oil
23. Gas Pipe-Rough & Test 72. Underground Flush -
24. Roof Framing - - 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing . 74. Overhead Hydro
26. T-Bar Ceiling (Structural)-& Monocoat 75. Dry Chemical
27. Frame and Flashing- - - _ 76. Dry Standpipe _
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation - ' 78. FIRE PREV. FINAL .
30. Drywall Nailing ' ' - HEALTH DEPT. REQUIREMENT
31'. Plaster Brown Coat 79. FINAL INSPECTION • - .
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric ' Notes: .
- 34. Final Heating & Air Conditioning - -
•
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace '
38. Final Plumbing +f,6-YO (ea •
39. Water Service-Final
40. Gas Service-Final . . ,
41. Solar Domestic-Final I
• 42. Backflow Preventer
43. Backflow Irrigation : --
44. .Landscape Irrigation System
45. Sound Attenuation '
•
46. Handicap Regulations . •
47. FINAL STRUCTURE & BUILDING '
48. Special Requirements Completed '
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCYr
No. Date -
JOB ADDRESS 99(10 Pennhl in. AvP - BUILDING PERMIT NO. 5299
GENERAL CONTRACTOR r-P {•{-..r-tt$S42e-ry, S ChnS VALUE $ 9,90h;.00 `T• 3f-7 7
AP. No. LOT 67 TRACT 3185 FIRE ZONE DESCRIPTION OF WORK Res, t/2tt. •ar
GROUP I & J TYPE V ZONE R)1 PLAN NO. 0111
INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Trenche Forms Steel C - 7-
Floor Sy m
Steel Reinforce Chimney Re-Rod .
Be.,d D.nm A,,,,,,..„ /?A/]7
Frame and Pias ing / titrfj//.� 7
Lathing, In Out 'JL/•1�
Plaster, brown coat /0-7,411
Underground soil
Top Out L9 9-S=S7
Furnace pa, w,.e-5 -$-r,7 At!e_4_//Dn/t=i2C/ ,QY 'I 1 ]45] /O d/ 7 !e
Gas Vents
Rough Plumbing --A/,/,L,L1-4>1/4.!-2LG IIA W q t ,n r-. /0 (J lt' 7 IV
Cesspool Septic Tank
Prop. Swr. Line House Con/ / St./+Si ,S 9/D-.S'] ' I" 6 - - • 8e_,..,o-¢,Pk42-_.
Sprinkling System - _. [...'were '- . 9-,o-5 /D 7.17
Heating Final MA/LC /, 2Z'O r / /
Plumbing Fixtures, Final M/LC 'd-Ln.-t7 - 7/ r 1 .� i/f_
-Final Gas Test /,r M H- c to-12-57 — -r�K e-C}/1w _/ ;4-- c / ✓l ---2
Construction Pole
Underground Power
Rough Wiring .l 1 1 q + __,+ I a..,,
ft'6. -� 7 �S-- n ••
Fixtures, Final `y7)- l / r/ !
.nrrrtnawrry
�. _.-..
•
5214 . FEE UCEfV D
COSTA MESA BUILDING DEPARTMENT MAY 21I
P.O. BOX 317
FINANCE DEPT.
• COSTA MESA. CAL
IFORNIA rr yy ��FF ��TTp pppp SS
FOR APPLICANT TO FILL IN APPCIIC�TI�IVAFOERA PERMIT
BUILDING !!�� n 4 ����7f�,, � �� 1^7� ' /� � BUILDING
ADDRESS q. 0.� / V U/V'e. ,
COSTA/ MESA. CALIFORNIA FOR OFFICE USE ONLY
,(y� -1r /I�/I I ' �, 1{p�, .) RECEIPT NO. P EIAeti]+(Y.f�^
OWNER �Fl // 6A-L,I/jL¢��ir/�++�'� � �lam.\fJ�5l'�./��J4' I
MAIL IS ��Jp�� ,// r/1�� RECEIVED_ BY/ DATE RECEIVED-'JIIIHI yl �JJ/
ADDRESS 2D L E l O b�.l LQJ Ani 6=4)7/-5-7
111 1
/jT TEL. /��-/y_ I BUILDING
CITY ( 1 f. NO. ctJ /'�`J I ADDRESS
ARCHITECT LIC
ENGINEER ENTINEER NO.
. COSTA MESA. CALIFORNIA
FIRE
ADDRESS ZONE
ZONER, TYPE GROU
CITY LIC ,J PLANS '/
CONTRACTOR NO.
'Y' �O R"� �/ �p�
D ��5� TEL. APPROVED
ADDRESS ����" - NO. BY DATE (/
LEGAL LOT /1 /] Of CORRECTIONS
DESCRIPTION NO. �D / BLOCK TRACT` Q
A.P.NO.
SIZE ry/� X 9 NO. OF BLOBS. a
OF LOT / O a NOW ON LOT
USE OF
EXISTING BLDG. �;
CO
SETBACK LINE FROM n I I
CENTER OF STREET NO 1l REAR YARD Vi
SIDE YARD RIGHT a LEFT S
DESSCRIPTION OF WORK
NEW I ALTERATION ADDITION
REPAIR MOVING DEMOLISH
BUILDINGI NO.OF
SIZE /� y,1 Cr ROOMS b STORIES
EXTERIOR WALLL Ftp ROOF
COVERING fjQ COVERING1
-
USE OF N� I'/ • I/
BUILDING r. .f-(- - AI n
41-411
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL •
CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC.
TION. VALUATION
SIGNATURE OF,J71-
(222n," d ( Q/)
PERMIT
�
PER
MITUjiDT/rPLANCHECK S. ---
S
?
AUTHORIZED AGENT TOTAL FEE $ ✓ O _I VPMF
I...