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Home My WebLink About2265 REPUBLIC AVE - Building Permits r c. J CITY OF COSTA MESA °`y �� BUILDING DIVISIONit F ,.-,_, � ,, J DEVELOPMENT SERVICES DEPARTMENT. PER T NUMBER �; PERMIT 00-00729 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2265 REPUBLIC AV Status: ISSUED Suite: Applied: 05/22/2000 Vicinity: HOUSE&GARAGE Issued: 05/22/2000 Parcel Number: 42235124 Zoning: _„^ ISSUED BY: Applicant: ANDERSON, GEORGE CARL III Address: 2265 REPUBLIC AVE Phone: (949)548-8735 COSTA MESA,CA Zip: 92627 Owner ANDERSON, GEORGE CARL III Address 2265 REPUBLIC AVE Phone: COSTA MESA,CA - Zip: 92627 . Contractor: OWNER-BUILDER Address: Phone: Zip: , License: 0 • Arch : Eng: ' Address: - Address: ' Phone: Phone: • Zip: License: License: • SCOPE OF PERMIT REROOF-DO, USE EXISTING SHTG, INSTALL 1 LAYER OF 30#FELT AND 25 YEAR COMPOSITION SHINGLES. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,500.00 • Permit: ' $83.25 Claim Valuation: $2,500.00 SMIP Res: $0.50 -SMIP Com: $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 notcommenced within 180 days,or if work is suspended or abandoned Lfor 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 •• fl WORKERS'COMPENSATION DECLARATION: r' 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,es 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'compensation Insurance carrier and policy number are: . Carrier: _ • Policy Number: (This section need not be completed it 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 Califomia,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION 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 Class it Contractor's Signature: Date: 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).): 0 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 en 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 purs•=nt to the Contractor 'cense Laws.). D 1:1I am exam`. under sec. ! Business and Professions Code for this reason: 131 Signature: L LH % r- i.,, , Date: Owner ID verified by .river's icense. ■ 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,Califomia 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 Califomia 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 ❑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 ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 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? ❑Yes ❑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 or this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No e (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 ree to comply with all st e laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-d ribed prop inspe on purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final' spection. gnature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE INSPECTION TYPE LAZE INTMALS CODEk INSPECTION TYPE PAM INTITIAIE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final �! 208 Final Plumbing 200 Final Re-Roof ? O[d-OP 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 2446-46 / ___ _ _ _ _ _ _ _ • f 1 Applicant to till in all spaces except those within heavy border lines and sign all appropriate declarations. _ _ _ CIY,OF COSTA MESA CONSTRUCTION PERMIT 'PERM O r��r TRACT NO. LOT NO. UNIT NO.' • •ProjeceAddress : 2265 Republic �� / /� 1 9916 "88/87 ! • • . 5¢00 D. Applicant's Mailing Address ' • 2265 Republic. TYPE OF CONSTRUCTION ❑ N•EW U ADD U'ALTERATION Li REPAIR 1 ' Schumacher 650-8561 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER E_R_ A p •# — - 1 _ _ 'I bone Owner's Name Phone DESCRIPTION OF WORK/USE OF BLDG. Address 2765 Repo blir - S Main Building: ' Accessory Building:. 1 • El . 2 Arch/Eng.' License No. ,TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION U STRUCTURAL E Front I ' I , o Address • ' • ,,' ❑ TENANT ❑ ELECTRICAL ® PLUMBING ❑ MECHANICAL B• Rear ( N Contractors Name Vat Taylor & Sons u118h- R7R-0` 5 ❑ OTHER - .-' - - . A - -- . . - , -. -- ' " , . I 8402 'Katella• AVe . Stanton 906EO OJECT DESCRIPTION SQ. FT. • OCCUPANCY K Right ss22 N Address(Mailing) , t I.L. J�I�I Y iJ87 G 3882.L, , CONSTRUCTION TYPE • - ,VALUATION$ s Left ��V L• ti ,• ' City License No. • ZONE - GRADING CU.YDS.' ACRES • E LICENSED CONTRACTOR DECLARATION. Ping. Ref.# - Parking Req./Provided • ' I hereby affirm,that I am:licensed under provisions of Charter 9 - encing Remarks: I _ ' Planning Notes: - , N) with section 7000) of Division 3 of the Business and Prtle,and • - _ ]� my license is in lull forte and f c . • - T ` Licen,e Ip Sf � - Li -nse • •s • ' - 4 S 15-•:(3:', O Date IL I L g-/Rb Signature I <� . r ' ' - _ PLUMBING - FEES • I - .- .� wORKERS'COMPENSATION DEC • - • �� .. Bar Sink • Showers , - • q - hereby affirm that I have a certificat- of cons¢ t o self ure • a certificate ELECTRICAL •FEES 2. Workers' Compensation Insuran•-, or a ter (fled y there. (Section � - ... 400, Lab. C Backflow Preventer Service-Sink _ Automatic Washer Transformer ❑ 15-50 KW 1 •• i ' ` Policy No. 00291090 Company 1 S _' Backflow Irrigation Sewer Cap, - - • • • 0 50+,KW •_ Certified copy is hereby furnished. _ _ - _ COnStfucti0 n'P.o l2 Sub.; %� Cert_r_ copy sof fled with the cin. •i •n. Bathtubs 'Sewer Connection - Cooking-Unit Meter ❑up to 100.amps ' •• -- , Date�4/ 7711µ6 Applicant S, / �/' - - - - _ EXEMPTION FROM WORKERS'CO /'SAT •N •EC RATION Clarifiers: - Solar Collectors •: _ ' y y - Dishwasher ! I .Meter,❑Overton amps (This section need not be completed if he permit is or o'- untlred ($100) or - - - _ . . less).• �• I Dishwasher - . Solar Piping Dryers ❑Gas ❑Electric' , .Sub Panel I certify that in the'performance of, he work for whic • Is permit is issued, 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 ❑1'G-8: - Workers' Compensation Laws of California- I - Date 'Signature Floor Drains • ,Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP ❑16-15+ 'NOTICE lf,after making this declaration,you should become subject to the- • - - -- - .. - ' - Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal ' Fixtures comply with such (provisions or 'this permit shall be deemed revoked. I Microwave ' CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes - I hereby affirm that there is a construction lending agency for the performance - Pole Light of the work for which this permit is issued (Section 3097 Civ. C:) ' • Lenders Name li Interceptors 1 Water Heater -f 2 00 Outlets Range Lentler's'Atltlress' - Kitchen Sink Water Service ' Switches Sign OWNER BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash • - Garbage Disposal ' Standing Sections 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 • ' I Laundry Trays ' I ( Generator 1:0-5,KW 05-15 KW Trash Compactor any structure, prior to its issuance,. requires the applicant ch permit 1 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(commencing with Section 7000)of 4 '"Division 3 of the Business and Professions Code) or that he/she is exempt '- ' 31.5'm and the basis for the alleged exemption. Any violation of Section ' • - 31,5- by any applicant for a permit subjects the, applicant to a civil • I i : •_ - I - I natty of not more than five hundred dollars($500). , I I - 3 ' 11 ' 0 I,'as owner of the property or my employees with wages as their sole Reinspection Fee . 1 $15 , Issue Fee' _$ • ' - • ' compensation, will do the work,and the structure is not intended or offered Reinspection Fee _, ;I,$15. Issue Fee 1 I . -•.$ 3 ' for sale (Section-7044, Business and Professional Code: The Contractor's MECHANICAL I I . • FEES — - - I I License-Law does not apply to an owner'of a property who builds"or improves _ , , - _ , thereon, and who does such work.himself/herself'othrough his or her own - DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler _ Hood or 'Type I ❑ ` p _ - sale. If;however, the building Or improvement is sold within one year of com- _ Canopy Type II ❑ Zoning Approved By _ Date • 7- . pletion, the owner will have the burden of proving he/She did not build or im- Duct-Under Ground Building Approved By • ' Data. • prove for the purpose of s•ale). • - e--_ C]�L�7 �7 . ❑_Lai owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System. ' Application Issued By ' ' Det 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 ' ❑0-100.000 BTU ❑100,000 BTU - I ' _* SUMMARY OF FEES ' '" • builds or Improves thereon,and who-contracts for such projects with a con- - - _ - , tractor(s) Ilcense pursuant to the Contractor's License Law). I am aware that' Exhaust System ❑. Multiple'❑ - System Repair/Alteration, • ' . BUILDING PERMIT $ _ . 'SMTP , I $ proof of their Worker's Compensation insurance should be provided t0 me. _ - PLA N.CHECK $ - •PERM6T ❑ 'lam exempt under Section' B.& P.C.for this reason Firepl/Fact.;Bit. ICBG# • Fire Dampers - , - _ PLUMBING $ Ct'_t7a! �'�O_ISSUANCE $ '3 , 00 ,Date - ' - 1 Owner- • ' • • .. Heating System& Ducting I - Registers . - ' : PI AN,CHECK '25%. $' ;ENERGY P.C: $ - • •. I hereby certify 'that rI have read this ap. :cation nd state that the above 0o-100,000 BTU 0100,0008TL - ' _ - ELECTRICAL $ - -GRADING $ • • " 'information is correct.-I agree to comply .' • . • ty and county ordinances -- . - 'antl•state laws relating to bui ding - y coon .nd hereby authorize repre- .. - - PLAN CHECK 50%, $ :MICR OFILM $ - •sentatives of this-city . - to upo• the •ove-mentioned property for . ' • .. ' .. _ - ;inspectionpurpos �: - Date12/28/86. 'Signature ,ice/// MECHANICAL $ I - .TOTAL FEE $ 5 00 • •Drriivers' License or .AW -Applicant; Pink -Accounting; Goldenrod - Assessor 1) .111111111rWr War 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 • r : 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd.. - 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. 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 ` • • 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. 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 0 Oil 23. Gas Pipe-Rough &Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas l7 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: 1q-4. i LorrCerza, 34. Final Heating & Air Conditioning ' /177.-40/ 7 r 35. Final Gas Pipe-Test • KYAtv 4 Pr 36. Hood or Canopy • 37. Final-Factory Fireplace 38. Final Plumbing 39. Water Service-Final - a i• i - ' i 40. Gas Service-Final " - ' 41. Solar Domestic-Final -" �- 42. Backflow Preventer _ _ ..' 1 43! Backflow Irrigation �� 44•.':Landscape Irrigation System . r 45. Sound Attenuation •46. Handicap Regulations • - 47t.'FINA L STRUCTURE & BUILDING 48.1 Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ) 51. CERTIFICATE OF OCCUPANCY - •'� No: Date OWNER Eristol Estates - - DATE (1-18-56 - JOB ADDRESS 2265 Republic Avenue' BUILDING PERMIT.NO. 28814 GENERAL CONTRACTOR S.V.Hunsaker VALUE $ 8,856.00 LOT 168 BLOCK TRACT 28731Single nes. w.att gar GROUP I & J TYPE V ZONE +w FIRE DISTRICT 2910 PERMITS ISSUED INSPECTIONS D. E SUBCONTRACTOR SS�� qq DATE NUMBER Footing Trench !� may, Foundation Forms and Grade to Garage Rough Framin / Plumbing,Roug to Sla~4,� (AJ- f-I L Plumbing,Rough Complete )'LL./f - 6_ aD$' ,c1 ie /ola tt.#0.t/ -//4'-C , /7 fj 7 - Temporary Pole �f / Wiring, Rough ,(4 C a-6 t' d4'2fyAVc-e_ =-/33-6 Z�y- 5 Heating,Rough Heating, Final 6 5 / � �4 E/ 5—/6 --.2-. 449179Sewer„Housed Sewer,St.� ' 7&--e-:i q��ti n• 6 -s"-6 -S G . •S'7S0 — Septic Tank or Cesspool did r 77 S' i, ,, ,i /-,-a‘--a `c ?Cd — Lathing, In "----- Out • 7-.I. 6'-4 Plastering - -,.(c Plumbing,Final,Fixtures Complete`Y1 CS /2/1-4 _ Plumbing,Final GasTest/C h'Las - /2/fl - or fJr Wiring,Final 22a _ Occupancy /� �'i 7-/ 'Ca c FORM 210 3M 10.03 ti Costa Mesa Bui ding Department APPLICATION FOR PERMIT P. O. LI 2910 -r , D NG 1 COSTA MESALIFORNIA FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN ea-pi/Tali � �7 /� � Receipt No. ermit N5'�o! AddBuilress ZZG ea-pi/Tali(✓ 4 . �a I/ Costa Mesa, California Receive by Date Rec'd. Date Issued Nearest ( -7c' 7i—/?-U a Cross St. //(/,G Soo) S � . Building Address Owner1/57-Cl‘.. . --1.-7--/g7.4'.5. Costa Mesa, California Mail / .-�S Address 4z� � T,1.4--s- )/Z. Nearest -�-^ Tel. ///777 / City !2-7)-7//`0 e4 C/le Noi7 7//2-J% Zone Sa No.of I Type / Group y e Architect or / tic. r'� Plans (Yy Engineer No. Approved !/) by Date / Address CORRECTIONS Contractor S• yemiogrAtE Z Noy Li,'«4'/ Address 477 )1/4— Legal I Lot / p 12 73 I i l• u�/, y\ 1 fi " ;-- Description No. /v p I Block I Tract j 1(, ' ^lam d,..;I 'ki 4 ,I (Attach Metes and Bounds) ----%• _h! No.of Bldgs. 8 Size of Lot-&X) )t/0 o I Now on Lot ° ,' 1 igr;c; 0 Ilse ofNo.of No.of a Existing Bldg. — I Families I Rooms Iii Setback Line from t Rear Yard 2s--/- city of r,,,,_ Z Center of Street co Side Yard $4 C' "i tn.;C,I i;,77 C1 D DESCRIPTION� OF WORK , 1 r New I '1- Alteration I I Addition I Repair I I Moving I I Demolish I Size i0// No.of Size / RoomsofStories Exterior Wall'- I Roof $ 'C 'C — Covering G CCs. Covering APPROVALS Use of New Foundation Location Inspector Date Building. -_;/.1.4., rr ,zy ,q;///y ,ile//,rf/ p 4,A-ern:aC/P d (7to,.0 GC. / Forms, nals, %% ,MatUnder-Pinning Frame: Fire Stops, �Y Bracing,Bolts I hereby acknowledge that I have read this Application and state that the above is correct and agree to comply Lath. Int with all City Ordinances and State Laws regulating building construction. Lath.Ext. Signature of ,.-� �,�//�) Permittee –' Plaster,Int Authorized Agt 2releaC) Plaster,Ext. Valuation terma Fee $ 2 2/ /0 Masonry Reinforced inae lan Check$ //• 00$ Bond Beam , ee I $ 33 ' el FINAL FORM 204 1055 0. P.&5. Lie _Z4 .j ,t - - J � r a o a 0 a. s -- ."R 17,-56,11.11.-EA 6092 f `• . .. .. ir•. ,�. . .V _ 0CS\ Street - PLOT PLAN Show location and distances from property line and between buildings. 1 • • •N