HomeMy WebLinkAbout2409 RICHMOND WAY - Building Permits r&DORE55S*BUILDING: '2409 RICHMOND WY LMT: CITY OF COSTA MESA — BUILDING PERMIT
OWNERSNAMEIP IDKIWN: BAINES MARY F PERM NO: B '073608
ADDREss: 2409 RICHMOND WAY
COSTA MESA,CA 92626 PERMIT NO: B 073608 PLAN CHECK NO: N GOVT: N SUPP: N
APPL.MAIUNG ADDRESS: CONSTRUCTION TYPE: VN PERMIT TYPE: SIR PURPOSE: OTH
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : T/OFF, SHEATH & REROOF W/COMP SHINGLES SQ FT: 2, 999
ARCH.OR ENG.'S ADDRESS: LINT:
CLAIM VALUE: 2, 999 .00 CALC—VALUE: 2, 999 . 00 GROUP OCC : R-3 /
CONTRACTOR'SNAME: STOUT ROOFING INC ( 310 ) 923-6775
CCNTIIACTORSMNUNG P 0 BOX 4309 COMMENTS : SMOKE DETECTORS REQUIRED PER 91 UBC
ADDRESS: DOWNEY CA mm.: 402536 +E+E#iE1f1E****iEit1E1E1EiE1E1FiE1E1EiE1EaEiEitiE+EiFiE1(•iEiElkiEiEn-lE1E****#IEiF1E1E+rdEx-iElEffiE#iEfE#1f1E#iE1EiEifiE+tlEiEifiE#iE71'*K'*'*
90241 WIT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penaE rjury that I am licensed under• • • x of Chapter 9 SETBACKS
(commencing with Section 7000)01 Division 3 d the Busi and Profs a ode,and my- use is in lull force effect.
cm uc.NO.: 05, 77 ^c.cuss.: 39 uC. .: 4025 6 E 10/: 5 MAIN BUILDING ACCESSORY BUILDING
� /I_/ / / RNT: FT
IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dale: Contractor: rkrele LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under peraly of perjury that I am exempt from the Contractors 1.... -. w for the
following reason(Section 7031.5 Business and Professions Code:Any city or county which requires a permit to construct,eller,improve, PARKING REQ: PROV: PARCEL: 41916557 ZNE: REF NO:
demolish.or repel any structure,prior to he issuance,also requires the applicant for such permit to fib a signed statement that he or she
is licensed pursuant 1°the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)ci Division 3 of the PLANNING NOTES>'
'
Business end Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation ci Section a
7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more thanfve hundred dollars(195001). *,*,*,*,**,*,*,*,**,***.)E*,**,***,*,*,*,*,*,.x,*,*,#.M,*,*,*,il,.**,.M.##*,*,**,*,*,*.*ff.K.*.N.*.*,#*,i(,1f*,9F,K.**,1h*.*.M,*.#'i[ih,l!*.*****1h
❑ I,s re
°wn dike property of my anPoyees with wages as thee soleo compensation,will do the work.and the structure notintended D E V Ev L OPMENT SERVICES R E U I R E M E N T S
or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply to an owner of property - Q
who bolds or improves thereon,and who does such work hmsetf or herself or through his or her own employees,provided that such
improvements are std intended or offered for sale.If,however,the building orimprovementis sold within one year of completion,the ZONING APPROVED' BY • DATE: t'
owner-builder will have the burden of proving he or she del not build or improve for the purpose of sale). •
❑ I.as owner of the property,ant exclusively contracting with licensed contractors to construct the project(Section 7044.Business and
Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon and who BUILDING APPROVED BY : DATE: -
• contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law).
❑ Iamexempt under Section: B.APc..for this reason: APPLICATION ISSUED BY: DATE:
Date: Owner: *
LEGALIZATION:N F E E UMMARY STRUCTURAL SE MENT:Y
I do hereby certify that I am aware of and understand the requirements of Cddanu Health and Safety Code Sections 25505,25533,and
au rmitffa4.andconst cti«i«�i�ionffr ntheAiwinlWal ng(dmfs°na)naedladnpfywith said anepplatins reeemptfinenala BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
per Y onepame ovine. to comply
wondrudisnapcoces an to requirements
provisions. PERMIT 54 . 00 . 50
•
Dalt Applicant: SMIP/NON—RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally ci perjury one of the following declarations: ISSUE FEE
❑ I have and will maintain a cenificate 01 consent to selkinsure for workers'compensation.as provided for by Section 3700 of the Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Code,for the performance of the work i«winpn this poem*uissued. TOTALS----> 54 . 50 0 . 00 0 .00 54 . 50 54 . 50 .00
RI I have and will maintain workers'compensation insurance,as required by Section 3700 d the Labor Code,for the performance of the
]� work for which this permit is issued.My workers'compensation insurance carver end policy number are:
Carder: STATE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 54 . 50 OVER/SHORT: 00
Polity Number: 044940000468 / 10/19/95 • BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
. (This section need not be completed t the permit is for one hundred dollars($100(or les) 54 .00 . 50
❑ I certify that in the performance of the work for which this permit is'd.,I shall not employ any person mannersos to
become subject the workers'compensation laws of California .s Net d I should become . to the • . . 1E1EiE1Eif1E1E1E1EjEJE#***************************************************************K RE it 9r
compensaia(t$M s a vfong7ao of Code, - -• tit comply . n Neve p• 's.
OOyY (l777� INDIVIDUAL•
F E E BREAKDOWN
Dale: Applicsc . Li/ / ae.� - / ,
Warning:Failure to secure workers compensationcoverage la unlawful,and shall subject an employer to atm!;/penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines up to one hundred thousand dollars($100,000),In addition to the cost of compensation,damsps provided for in
Section 3705olLabore Lor colds,Interest antlatromey'e lase. SFR 2999 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 2 , 99
9 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which this pert is issued(Section 3097,Civ.C). .
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and state that the above information is correct.l agree to comply with at city and county ordinances
and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above mentioned protect,/
for inspection pun
DARL NE BURFOFyD www
Pum Nanta /(J/ f� )!�9S-........'
7L'' I
Dae: /`J V` tri 00137540-00187691 Ts_tT 54,50
pp canucrlrador DATE: 03/04. S5 TIME:Signature of OvmerlAgenVA / C: I 09:'3
(5151.46.WP) While-Building A Safety:Green-file:Canary-Applicant:Pink-Revenue;Goldenrod-Assessor
. iCONSTRUCTION AND PLANNING POOL & SPA
• APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
7i
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe•Undrgrnd. . - 53. Steel Reinforcement '
, _
.,, ,,3,;, lectrical Conduit Utility-Unargrnd. 54. Forms
49Electrical Conduif-Undrgrnd. 55. Electrical Bonding, -
T. ,c F-•
_t
rcet eel Reinforcer ntm 56. Rough Plumbing& Pressure Test ,
,
- oB«ElectricalUFER_Gihd. ' 57. APPROVAL TO COVER-GUNITE •
�].•',_E&otings 50 - 58: Electrical Concleu Undrgrnd.C. =r
3 n87 Foundation a. - e- 59. Gas Pipe, 0 Unclrgrnd.,Test _ ^ •
s, - - m A. .• r
.
r
Water Pipe-Undr>'rrd. :-; 60: Backwash Lines,€Trap,0 Uridrgrnd.
10. Structural Floor System - 61. APPROVAL TO DECK. .-',/a •
11. Property Sewer Line& House"Connection 62. Backwash & Receptor-Final
12. Sewer Cap `" ru 63. Heater &.Vent-Final •
,
13. Roof grains 64. Plumbing System - Final
14. Rough Plumbing. „
- 65. Electrical-Final ��
15. Rough Electrical-Coriduit c' 66. Solar System-Finals %' • . r
• 16. Rough Electric Wiri f 67. Fencing & Access.Approval : 2 .
17. Rough Wiring Sign l 68. APPROVED FOiePLASTERING •
18. Rough Eiectricalr7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditionirit FIRE DEPT. REQUIREMENT
, - r: rrr_c * T. d* - c' _ .1� _ ..
20. traugfi Fetor Fi ace i ' � k S E m fAPPfYOV�,YLSE,� Pert.ttit# ' }
fr
l} - _ � ' a- -.._.E
21. E}uctjintStrueturen tr -• •. `-�.�" = C _.; i 70. •pnderij?&u0d Hydro *
22. Ducts; Vegtiiaing fc j. r_. -c • , 4< C 71. Product F9ping 8c4as l3 Oil
23. Gas Pipe ougtj & TBstZS ,r ri - < O* I- 72. Undergrddrid Fttis-ti''- +
24. RoofiFra Ing' u].] tr ;; J * ,y I.7 Undergrri0ae.Sto ank ❑Gas ❑Oil
25. RooEShesthing _ :-.•x.. C r/7--n 4:2441,: 74)-verhead Hydrin,-, - ° • -
26. T BaFCeilring (Strutktral) & Mob_otoat * .',_1 x - 21* 75';Ary CheLrsical F� : -
27. gjante arid,Flashing:; '�x " >' h ' 76 Dry StarWPlpe ;IL; 't ' C
- - •-:7 - - -s . . err t • , r
-128. Lathing 8!'Sidyfng O* t' .� ,. ` '• •' - t-, 7x. FIXED'A TE r5INAINAI -.
L ;r1 :s. CLQ: _. r•. .. ". •: :-, . is •✓ 4* '• .ti -
29. Insulation- • t • t- _ " •• ` 78; FIRE PREY. FINIAL
- C - -• • .. i.
30. Drywall N3'ling 's•' ,•, > _• 1 _ r�1EALTH.DEPt.'FfEaUlRfiMENT
- 31. Plaster B own;Coaz* i -••*'I a i- t''''79.E FINAL INSPECTION a =
Y ` • ( - ` r ^. •- 41
32. ElectricaPPowrr Met2r$inaI : x o' I • [4, '8O FOOD CERTIFS. ATE ISSdED,
* 7 •a. rt. .;1 C ."- J.5.
33. Fina1rElectric � - -, , _ ,.yx Nines: •-3 '1t'7 .-1O
34. Fina Heating& Ai 3Cditionin
nntg ,'rri Y Y 1 f• •'iw S - -
35. Flna�Gas`AipE Tes x "or i• .C.0 E3 -
rt'
E_-,-r
` Cr . A -
1136. Hood_or Canopy " ^2 . h--... 'i * n '• • i to * Ctr
Zn n i C,r, --• ; 'rt +r co 'K m "t::
r r Zr G. ..
37. F.inal.Factory Fireplace y; ' t -� *' c s N
-3- 38. Final?Plumbing * ft" r 1 r* S c.-. * w
39. Water Sertaice4Final }. s " , ;.c " ' ""• a- •-
•
i 40. Gas ServicetFinal -t o: 4:4-0.--i _ ri
-
41. Solar DOmestit}Finaii =' C t` .• � i :, -yo • r -
1 x
42. Ba ckflow.Preventer + "`_ * y yl-, ' * t_l --
'+ _ x r ml ill --, :.
• •
43. Backflow Irrigationa ->. S r c. .r .; �"✓ x. ,;
44. t,-andscapV IrrigationrSystem 'zi�; .r a F7 C E a* % T. ^ -:a r it c
• T.
R. 0..: _
45. Sound Attenttbtion* - .. ` m nt rt r rj.“. t .Cr. r - e
46. Handicap•Regulations -i t" �� '`" `^ •
47. FiN ^ STRUCTURY& BUILDING ' } S °
48. E1NA4 PLANNING* 1 4' 71-i -4, ft r•1 ' < y ".--0 -
sc •r t1 - �J r r r
49. Eleci?1c Release to E6ison i 1t. • t
50. Gas Release to Southern California Gas Co r I! �' C m * m
n
51. CERTIFICATE OF OCCUPANCY 3 "`.; `-
No. Date
-",...„,,;%
PROJECT ADDRESS: 2409 RICHMOND WY UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; E0516a't
OWNER'S NAME: BAl1VE5. MARY F ���^'d
ADDRESS: ,MONTEZ MARIA PERMIT NO: E 051608 PLAN CHECK NO: •N GOVT: N SUPP: N
2409 RICHMOND WAY •
COSTA MESA CA 92626 CONSTRUCTION TYPE: V.—N PERMIT TYPE: ELE . PURPOSE: OTH
ARCH/ENGINEER: 714 641-8114 REGAO.:
JOB DESCRIPTION : INSTALL 2 CEILING FANS SQFT:
ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
PERMITTEE: MONZEZ, MARIA - - ( 714 ) 641-8114 •
ADDRESS: 2409 RICHMOND WAY , • COMMENTS; INSTALL 2 CEILING FANS
• COSTA MESA . CA 92626 c**>f***x**x**xK**tE>E>F, >Ex*tl*****xx**** a****aExxx ** x.x>Fix-rF**** * xx*><*>EI6x*rn;6*kiF>s
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
70001 of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACK. S
CITY LIC.: STATE LIC.: CLASS: .
Date: Signature: ------- MAIN BUILDING ---- ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: 1 hereby affirm that I have a cenificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR : FT IN FRN T: FT IN REAR: FT IN
Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C). LEFT; FT IN RGHT: FT IN LEFT: FT IN HGH T: FT IN
POLICY NO.: EXP.DATE: '
COMPANY: PARKING REQ• PROV: PARCEL : 41916557 ZNE: REF NO; •
❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Budding Division. PLANNING NOTES>
•
Date: Applicant: x-********************** *'
******* *i4'IF**)f•k.3f.*x..)t**1f1f****N**is3P**is•,x3i-**lf*aF*iix**•*K*****
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT S E'r`R V I C E S R. E Q U I R E 'M E N T S
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. ZONING APPROVED• BY DATE;
•
Date: Signature: __ • ' r
NOTICE:If.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE:
.
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. . +
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: .s DATE: LJ OI
. which this permit is issued(Section 31197.Civ.Cl. **.**x.%*.*.*.X.*X-*};**Iir0*7t i*******iv k***?t-**S.: -- 3F'3b*i�--o.- 3F3,iT:it T•• iF.2 )(.3(.**#8 VC-0'*#3F f' **' - xr**.
• LENDER: .*.}F******* ****k*?i'**** **K*****it*}'.**#*x******ii jEk******k*.**-**k*ik 3E**-hr*3F?E* *****3e**
ADDRESS: LEGALIZATION:N F E E S U M M A R YSTRUCTURAL 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 ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of 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/she is licensed PERMIT .' 3 , 00
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 70001 of Division 3 of the Business 50% SMIP/NON—RES .
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15 . 00
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—>• PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE O structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 3. 00 15 . 00 • 0 . 00 1 8 . 00 18 . 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 offered for sale.If,however the building or
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS—.—> COLLECTED • • 18, 00 OVER/SHORT: 00
for the purpose ofsale): BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
•
I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 18 . 00
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).l am aware ****************}F**********k*t**7f.*********s:*'.i****1rY-***********#`-x-**********r:**4(,*.x.
that proof of their Worker's Compensation insurance should be provided to me. . I 'N D I V I D U A L F E E BREAKDOWN
o I am exempt under Section: B. 8 P.C.
mrm 9/ • TYPE QTY D E S C R II P T I O N UNIT COST TOTAL COST
Date: reap: [ I Owner: +�� ELEt+ 2 FIXTURES LIGHTING 1 ST 20 FA. , 75 1 . 50
I do hereby certify that I am aware of and understand the requirements of California Health and Safety -. Sections 25505.25533,and L E 2 . REC.EP T/SW l 1 Cal 1 ST 420 EA. . 75 5 150
25534 and that I or any future building occupant will/will not(circle one)need to comply with s and the requirements for a -
permit for construction or modification from the Air Duality Management District.Reside '. dications are exempt from END OF FEES
these prOv Ions
�L/JJ --��^1_
Date'. it- / 9/ Applicant: —irk-- t
I hereby certify that I have read this application and state that the above information is correc. r •• o comply with all city and county ,
ordinances and state laws relating to building construction and hereby authorize representan^: ...the above-mentioned
properly fffi�msp ongoys. —y�� - '
Date: 7 Signature: 711. 01 000844'51-00034451 TOT 18.ui}
DATE: 04/09/91 TIME: 10:30
Driver's License or Social Security h: •
1641-46 White—Building:Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor •
x
CONSTRUCTION AND PLANNING POOL & SPA
u - Date Inspector Date Inspector
APPROVALS Permit# - APPROVALS Permit#
1;Temporary Electrical Service or Pole 52. Pool & Equipment Location - ,i -
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms -.
, , ir., ��
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.
8. Foundation 59. Gas-Pipe, El Undrgrnd., Test i
J
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK l
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final .' r 'i. r,.,'.)
12. Sewer Cap 63. Heater & Vent-Final 'I R
13. Roof Drains 64. Plumbing System • Final - (' N
i - r�'. / 1
14. Rough Plumbing 65. Electrical-Final ''r N. ; I /
15. Rough Electrical-Conduit 66. Solar System-Final i
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 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structuratl & 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 'S/ (,1 WC.
34. Final Heating & Air Conditioning ������."'''' ```"`jjjjjj__//
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace ,
38. Final Plumbing -
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
J
43. Backflow Irrigation -
44. Landscape Irrigation System '
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING -
L49. Electric Release to Edison
50. Gas Release to Southern California Gas CO. ,
51. CERTIFICATE OF OCCUPANCY
No. Date
PR0.1E HESS: 2409 RICHMOND WY UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERK! NO: M 055981
A
NEWSDDRESS: BAINES MARY F
DDflESS: 2409 RICHMOND WAY PERMIT NO: M •055481 PLAN CHECK NO: N GOVT: N 'SUPP; N
COSTA MESA, CA 92626
CONSTRUCTION TYPE: V—N PERMIT TYPE: MEC PURPOSE: 0TH
ARCH/ENGINEER: 641-8114 • REG.NO.:
' ADDRESS: UNIT: JOB DESCRIPTION : CHANGE OUT FAU SQ FT:
•
PERMITTEE: • CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / •
ADDRESS: MARY F, BAINES ( 714 ) 641-8114
�^(2�40p9 RICHMOND WAY COMMENTS: SMOKE DETECTOR REQUIRED IN THE• HOME '
rneTAT IMRcA Ci 92V6 *********************K***** ***********************- *****+ ****** -xv** **** k*
LICENSED CONTRACTORC(AR IO ereby affirm that I am licensed under pr visions o sister 9(commencing with Section
7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect. Z U NI N G REQUIREMENTS
CITY LIC.: STATE LIC.: CLASS: SETBACKS
•
Date: Signature: MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION; I hereby affirm that I have a certificate of consent to self-insure ora certificate of Workers' FRNT: FT IN REAR: FT IN FRN T: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). • LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN •
POLICY NO.: EXP.DATE: '
•
COMPANY: PARKING RE(Q PROV: PARCEL: 41916557 ZNE: REF NO:
❑ Certified copy is hereby furnished. 0 Certified copy is filed with.the city Building Division. PLANNING NOTES>
>
Date: Applicant: *****************3E**7e*****7E*X********!*********-7r************i(***********3E )f#*'***
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). D E V E L O- P M E N T S E R '-V ICES 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 — ,
subject to the workers'Compensation Laws of Calilprnia. • ZONING APPROVED BY . ' DATE
Date- Signature:
NOTICE;II.alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILD ING APPROVED BY : DATE:
•
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: DATE: a— I �,_(
which this perms is issued(Section 3097.Civ.C). ********************** • , ********** FY-/r Ti-*
LENDER:
ADDRESS:' *************************KK********* ***************************K**************
LEGALIZATION:N F E E S u M M A R Y STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE $MIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of 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/she is licensed PERMIT - .- 9 00
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 25% $M 1 P/NUN—RE$
and Professions Code)or That he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN ..•
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE - .t...• 15 . 00
I. as owner of the property or my employees with wages as their sole compensation. will do the work, and the BUILDING—DIV—> PERMIT ISSUE ZZ.AN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTAL S----> 9 00 15. 00 0 . 00 24 . 00 24 , 00 . 00
does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through P
his or her own employees,provided that such improvements are not intended or offered for sale. If,however the building or .
improvementissoldwithinone year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COL-LECTED• 24 , 00 OVER/SHORT: 00
for purpose of sale)_ BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business h24 . 00
and Professions Code- The Contractors'State License Law does not apply to an owner of property who builds or improves thereon 49/
and who contracts for such projects with acontractor(s)license pursuant to the ContractorsSlate License Law). l am aware ****,**,*,*,#*X*********************,144*****4*,*X***1(XY,*********X******* ,**KK*K3(.****
that proof of their Worker's Compensation insurance should be provided to me.
rt I am exempt under Section:$P,70 a 4 B.8 P.C. e IND I V I D U A ,i, F E E BREAKDOWN
X for this reason: c 'v
• ALL WORK BY OWNER TYPE QTY DESCRIPTI .6 N UNIT COST TOTAL COS"t
l4 /.,�1j • C44,?gAtga)
Jlroa herebycemty:hallamawareofandunderslanemerequiremeNsofrCaliforniat(eayl 'andSafetyCodeSections25505,25533,antl NEC 1 INST FORC—AIR/GRAV•�FURN <= 100 K BTU 9 , 00 9 . 00
25534 and that I or any future building occupant will/will not(circle one)need to comp with said state codes and the requirements for a' END OF FEES
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from'
these provisions. • 4p
4'
' Date: Applicant: ' •r •
I hereby certify that I have read this application and state that the above formatmn is correct. gree I. •. ply with all city and county .-' '
ordinances and state laws relating to building construction and hereby in representatives .ci 0' er upon the above-mentioned Lt 02. Q01043 —20104358 TU.)-1 -24.0 .
erly
propor inspection purposes. �; DOE; 12 /13/91 Tllils 10:46
Signature: /
Driver's License or Social Security a:
;A
.
4
1641;46 White—Budding;Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor •
•
i
CONSTRUCTION AND PLANNING'
POOL & SPA
/, APPROVALS Permit# Date Inspector r Date I Spector
t APPROVALS Permit #
1. Temporary Electrical Service or Pole 52. -Pool & Equipment Location vj
r
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement :,:� '„�!
3. Electrical Conduit Utility-Undrgrnd. 54. Forms • -
4 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.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test '�
iii
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. "j�l
10. Structural Floor System 61. APPROVAL TO DECK 'i �''
11. Property Sewer Line Ti 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 ' I -
y. i•
15. Rough Electrical-Conduit 66. Solar System-Final
:7
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 0 Oil
25. Roof Sheathing 74. Overhead Hydro -
26. T-Bar Ceiling (Structural) & Monocoat - 75. Dry Chemical .
27. Frame and Flashing - - 1 . 76. Dry Standpipe - • -
28. Lathing &Siding - 77. -FIXED SYSTEM,FINAL
29. Insulation 7..-. ' 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT '
31. Plaster Brown Coat - - ,79. FINAL INSPECTION -
32. Electrical Power Meter-Final • IC_`, 4. . .80. FOOD CERTIFICATE ISSUED
i
33.-Final Electric , `Notestab71/
� NO ethe4fppye_ e - G,_ p
34..Final Heating& Air Conditioning- l�n /u /pi, t" c - -
35. Final Gas Pipe-Test r(� !� t •
•
36. Hood or Canopy _ `
37. Final Factory Fireplace '
38. Final Plumbing . - -
39. Water Service-Final • - - .
40. Gas Service-Final : I ` :
41. Solar Domestic-Final • '
42. Backflow Preventer i ' '
•
43. Backflow Irrigation
1
44. Landscape Irrigation System, - - - '
45. Sound Attenuation• - -
46. Handicap.Regulations - , •
47. FINAL STRUCTURE & BUILDING I
a8 FINAL PLANNING,
.
f^-' .
.49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co '
51. CERTIFICATE OF OCCUPANCY' , . _ ..
No. Date
I
PROJECTADORESS: 2409 RICHMOND WY UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E O3tt2Ut
OWNER'S NAME: BAINES, MARY F —
ADDRESS: MONTEZ MARIA PERMIT NO: E 058206 PLAN CHECK NO: N GOVT: N SUPP: N
2409 RICHMOND WY
C.M. CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: PTH
6418114
ARCH/ENGINEER: REG,NO.: JOB DESCRIPTION : ADDING A FIXTURE & ONE OUTLET SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE; GROUP OCC: R-3 /
nmmm MARIA MONTEZ ( 714) b41—8114
ADDRESS: 2409 RICHMOND WY 7 `----" COMMENTS: SMOKE DET, REO
Lx-
C.M. CA 92626 ****X*x*-x ********'x** .Z4***************-M************-******.*****-+E*** **-********
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect. / SETBACKS
CITY LIC.: STATE LIC.: CLASS: I /
•
Dale: signature: _ MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that haves certificate of consent to serf um oracertificate of Workers' (,EFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
Compensation Insurance,or a certified copy thereof(Section 3800, Lab,CI.
POLICY NO.: EXP.DATE:
COMPANY: PARKING RE(Q7��• PROV: PARCEL : 41916557 7.NE: REF NO:
0 Certified copy is hereby furnished, 0 Certified copy is filed with the city Buildin ivision. PLANNING NI)TES>
/ >
Dale: Applicant:
***ififiE****iii'**3flE1EAf-****(Fie li**** ***xif" 1ciEkif*****x-*********3fi(1t***************{E3FlEiF3F*
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Thissection need not be completed if .• u' ' • one hundred woo)or less). D V E L O P M E N T S•�E+,1R V I C E S R E ,Q U I R E M E N T S
�-�
I certify that in the performance of the work for which this permit is issued,I shall not emplo a en N�a� . i . to become
subjecuq.yeWork/rCamPe? awsmCatfornia. �e ZONING APPROVED BY r3 DATE:
.........--1Qate: f Signature: BUILDING APPROVED BY : DATE:
NOTICE:If.after making this declaration,you should beco esu ec:to the workers' . ovisions of the Labor
Code,you must forthwith comply with such provisions or this permit shall be deemed revoke.. nn u�i aa /
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for Ay'1'L I CATION ISSUED B Y: _ . .'�l' DATE: �r/n -��/
which this permit is issued(Section 3097.Civ.C). 484)44(•*4F?e:1F*! 4FhFYe?e*IFi+:)<};.Y%;ey%j;l&?)4%i" ' 104(8Z tYzic?^Y#:?k'1FB !s ie3e#'**is******************1rie#*'A`*****-'x'
LENDER: ************************** **' **i 1F7eie*********M***************iF**#3e*******iF***'r.
ADDRESS: I.hGA1. 1 /.!\'t'! _ +' F EtS [J M M A R Y STRUCTURAL SEGMENT :N
LEGALIZATI'
•
OWNER BUILDER DECLARATION: thereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 1 50
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed J 0 t SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 70001 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(S500). ISSUE FEE 15 . 00
I, as owner of the property or my employees with wages as their sole compensation, wit do the work, ane the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 1 . 50 i S, 00 0. 00 16 , 50 16 . 50 0 0
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 offered for sale. If,however the building or REVENUE DIVISION TOTALS--> ' COLLECTED• 16 . 50 OVER/SHORT• 00
improvement is sold within one year of completion,the owner wit have the burden of proving he/she did not build or improve
Apror the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
the
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 16. 50
❑ 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 acontractorfs)license pursuant to theContractors'State License Law).I am aware ******"1('***** ('***iF****1e******i('**********(Fie*i('*iE**i('**'lE*********'*****iE'ir************
iF
that proof of their Worker's Compensation insurance should be provided to me, I N D I V IDUAL F E E BREAKDOWN
m I am exempt under Section: B P 70 4 4 8.8 P-0.
for this reason��LL WORK BY OWNER TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: 7--A -- owner:- �r ELE 1 FIXTURES LIGHTING 1 ST 20 EA. . 75 '
. 75
I do hereby certify that lam aware of and understand the requirements of California Health and Safety Code ' 25505,25533,and ELE 1 RECEP T/OtJTL ET 1 ST 20 EA. . 75 . 75
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 END OF FEES
permit for construction or modification from the Air Duality Management District,Residential construction applications are exempt from
these provisions.
Date: Applicant:
I hereby certify that I have read this application and stale that the above information is c. • agree to comply with all city and county ('.ry //
ordinances and state laws relating to building construction and hereby authorize representati 's of th.city to enter upon the above-mentioned C1 GC11`c 7tt'CJ.111 nCY': 3:-..!'-
1' -,
Wong):inyectio;yurposes i ,fv i
�C[/ •(Lsi �j. � file �7rli/9i T'; . r:;R:'
Dale: Signature: k
Driver's License or Social Security to:
1641,46 White—Buitdinq: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
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 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 I
12. Sewer Cap • ' •
(.�• y 63. Heater & Vent-Final ,
13. Roof Drains I 64. Plumbing System - Final I
14. Rough Plumbing i • ;` 65. Electrical-Final
15. Rough Electrical-Conduit t` - 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 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 i 79. FINAL INSPECTION
32. Electrical Power Meter-Final0.2*
- 80.• FOOD CERTIFICATE ISSUED
33. Final Electric i Notes:
34. Final Heating & Air Conditioning I"
35. Final Gas Pipe•Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer I i
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation .
• 46. Handicap Regulations
-
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING •
`
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51'. CERTIFICATE OF OCCUPANCY
Date
OWNER SAN VISTA BUILDING COMPANY DATE 6-1-64
JOB ADDRESS 2409 Richmond Way BUILDING PERMIT NO. 22276
GENERAL CONTRACTOR same VALUE $ 12,635.00
AP No. LOT 226 TRACT 5160 FIRE ZONE DESCRIPTION OF WORK res w/att gar
INSPECTIONS Signature DATE GROUP I&J TYPE V ZONE R3
Soil 4 Y7 SUBCONTRACTORPERMITS ISSUED
Gas ���111DATE NUMBER
Water
Rough Com. Refrig. 0 Air Cond. ❑
Rough Heating IWASSrail IEr Q /
� � % 3- �G tiJ� .�S ati
Rough Plumbing 0 r • OA ! f 3 6_/—"/ SG i)C- 7
Miscellaneous A"
Prop. Swr. Line ❑ House Con. d: St. Swr. ❑D . //illilVdeirt (!..c.-,-..4.-- '✓,_ 0•7-•C 9 1963 4 0 7
Sprinkling System
Construction Pole 1� l i I t�
Underground Power
Rough Wiring z y- / - ->, - „_ StP 1 7 19b6 2'4 6 4 —
Trenches' Forms Steel Reinf. 0
�/ w/ Fitr,ns Dept.
Floor System �/ / Spec.Rep'Says°`�
Bond Beam 0 Steel Reinforce 0 ~ / - '
Sheathing 1 ', sG �npls
Frame and Flashing _ jr: 1,- 54
Lathing — In ,�/ Out!Y.-- eL /n /3�6
Plaster, brown coat e. /l/C/(G w.
Refrig. ❑ Air Con. 0 Final
Heating, Final - e. ?
Plumbing Fixtures, Final ait
?Plumbing `Wi�
Final Gas Test J % ' nf] / atr
Electric Fixtures, Final i Jr
Building, Final i,4 .A(/
OCCUPANCY • ,
Form 3U4-5M-3-63-5-BP T-[nT.n FOR SPECIAL REOUIREMEN1S
222 to FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT NPAYEEI1 s 1984
P.O.BOX 317 COSTA MESA.CALIFORNIA •
FINANCE DEPT.
For Applicant to Fill In Completely • APPLIE T(AC4f ,1 RME6A '
•
TYPE OR PRINT - BUILDING
• For Office Use Only
BUILDING .2 (] �( �N/I vial .
ADDRESS D t fLMh Y
RECEIPT NO. PERMIT NO.
COSTA MESA, CALIFORNIA 2227
C_ /11 RHCXI 0 B DATE, RECEI ED/ DATE ISSUEDS
OWNER` XL,t.. UA tva � .�J `7/ V� JUN 1 1964
1 (��. BUILDING
ADDRESS k b�» 8 .S� Sir- ADDRESS �.• FIRE
J
CITY e /7i. 1/ NO���. ` ZONE . TYPE. V iGROUP ler-.
APPROVED
ARCHITECT , TEL / ' BY DATE
ORENGINEE'/� s I_ N•. O J
{(/� •
• ING / ,.
ADDRESS ' ('?2_ .+OS-
-• ��(�� /� __ 1
CONTRACTOR �:�-LivL �J•�(.�XC� �1L� lj'� rices " ,ii ni-- '� .
j /�` (t si ('C {-� LEGAL ( e
ADDRESS '/1 !C/t� G �/ r LEGALIPT1DN ' S7 0 . A �t��
�/ ^3(/.2
CITY T fr. -
�I /J ''')y/Q.•�/y ' NOTE: NO EAVE OVERHANG SHALL BE SS THAN
LIC.TNO/yJ 7/2 — • NO.4DJ !/O / 30"TO SIDE B REAR P.L.
SIZE qq //77 J� `•I EAVES
OF LOT r/-U Al / o I NOW ON LOTS (/ ALLOWED (U.B.C.REQUIREMENT)
•
YARDS APPROVED YARDS APPROVED
USE OF ;/11 ,� - A . MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. 1 I fA.'7`^'"'- -
(FROMC L TREET)
SETBACK LINE FROM / C FRONT t.- FT. FT.
CENTER OF STREETREAR D
SIDE YARDI LEFT ,
O RIGHTYAR� R.SIDE 0 FT. FT.'
- l
DESCRIPTION OF WORK L.SIDED FT. Fr.• (
NEW ALTERATION ADDITION REAR' \J FT. Er. �1,
DISTANCE BET. BET.MAIN&
IL/`J ) 1
X
REPAIR MOVING DEMOLISH
MAIN BLDGS. ACCESS.BLOCS.
BUILDING�Ap t/ n NO.OP PAA !7. Zn ^^ VAR.# DATE
SIZE 0 0 J Z / ROOMS ,� STORIES J--. C.U.P.JC •S APPROVED
EXTERIOR WALICY'�-' _I ROOp �p ,.yn. APPRO D)({/((I1`��,( � n •""-.."'"1. L_ a
COVERING J COVERING BY 11{'�/�VV vs.\ DATE y-__- -
US UILDIN AND WORK TO BE PERPORMfi �-1 gyp]
DI a
> 1-
L'e / � .
- // BQ.FT. /,leo
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN ANDER VALUATION IS FOR THE F
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
FLY WITH ALL C TY ORDINANCES AND STATE LAWS REGULATING - VALUATION - �� �� m
BUILDING CONST'. CTION. Cl
SIGNATURE OF / �/ PERMIT FEE $ j
co
PERMITTEE ` $ /C143-" °'� A HECK S I�/I re/ ¢ •p4�
AUTHORIZED A-+ / .0 > i
TOTAL FEE' $ / 0. 0-0 ii