Loading...
HomeMy WebLinkAbout1102 RIDGECREST CIR - Building Permits ,'�' - CITY OF COSTA MESA ' a J/ BUILDING DIVISION F . Ir.. . DEVELOPMENT SERVICES DEPARTMENT PERMITpNUMBER 359 R I .n...%" PERMIT %wimple,'It (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1102 RIDGECREST CI Status: ISSUED Suite No Applied: 05/11/2005 Issued: 05/18/2005 Vicinity: ' / a�� Parcel Nunmber: 42203122 J, , 4 - - " --� ,- ISSUED BY: %,i Applicant: KEVIN SZABOa•` • L C : r -1 I. 4 `z▪• ;'x•„ Address: 17390 MT bL'IFFWOOD ' }fit M, ) t '/ �\',. �,6yr`tic: �� gI-Phone"714-241 1414 . . r/• / ('`,-2.1�-.,_---,;:.-S-",„ \\\ FOUNTAIN VALLEY,CAS r":Zip 92• 627- - ( / �T.-C\.\ Owner RILEY JAMS SCOTT � � i' - '/fol cer Address 1102 RIDGECREST CIR ti`tt '`ti ° •('� ,ti, \ h ,,\,:%,,./ 7 r. ' 32 Phone: 949.722.7641 v S„sk / COSTA,MESA,CA Zip 1.'92627-3977 S��•. (`/' 'y\�\ i 'rte �, �, \ r t . 1 1 DAA '\` �`. ' -' \ *y Contractor 1/COAST-ROOTER PLUMBING.HTO,&NC / - `";� U,- V '... - ) tAddress A 7390 MT CLIFFWOOD ° : =- - • ) ��:,A' �� � r �� "� ; Phone: (714)2411414 -� ��\� AV ' i)\�' i.__ i \\:...1 r FOUNTAIN VALLEY.-. Zip: 92708 tc":_:- kk7 1 )�\ t License: 529127 V \ 1` � I U i t / '"". _Y !s-J tI/' /g /9/K /1�` t7T17 L' , ?) //A� - ': Ir.1,;'�� � �� k! M rt ; SCOPE OF'PERMIT �_` , i -.y 'k' k. 1 ;-i ' SWATER HEATER CHANGE OUT , f 1 V/ __ o:J 11 , 'i 1- J./ .---..0. t ',y A,\Vb 1. ' " i :FEE°SUMMARY ,%r; --71 . 'Jut -._. r4: �C, 1-"'• 11\`\` ' AMT QTY ""AMT ;QTY ' . . - t < AMT r,QTY ISSUE,FEE_- \\. $23.50 Laundry Tub/Washer .50:00,/ 0 ,Sump Pump TJ/ / r---".:::-.50.024 - 0 F Backflow irrigation-+. •••.;4.;;$0700..... ; 0 � Landscape Irrigation �$0 00/.-�0 Swimming Pools•� $0.001€1'0 BackFlow Pre�v•enter'\ $0.00 : -. 0' P-Trap -$0:8"07-:- 0' Trap Primer/.'5' t�"--"$0.001./ 0 Bathtuti.'4 \,„i.i\ „,$0:00 ' 0 , Pressure Regulator, $0.00 0 Urinal," '4J r}(lb /$00o, 0 Clarifier%/stemf„�.,- ' $0.00:°, 0 ' Process Piping'(per,10 ftj'�x.$0.00 0 Vacuum;Brkr-Bkflow(1 4) $0.00' 0 Connect(Ice,Soda,etc) $6,00V- 0 I Receptors'ls r $0.60 -0 Vacuum Brkr Bkflow(5+) -$0.00 0 Dental Units 1, $000;x'\ 0 Septic Tank '� „Gp c $0 00 0 Wash Basin c 7 ',$0.00 0 Dishwasher`' y t $0 00 N\0 u r.-n4SewerFCap`for Demo:,r,- (?`$9.00;2;/.-0;',.:'. `,. c,Z /J I yWash.Basin Set"r �' $0.00 0 Drain, Floor :), , $000 \`0 Z " :_.:Sewer,Connectk7 r t, .$000 0 _ Waste and Vent System/1/$0.00'$0.00 0 Drain,Rainwater.-:,;& 4/;$0.00 0"'",;‘.‹.\\:N.1.. Sewer Pnvate Line`s . $0.00)"0'0 ,Water Closee.(Toilet)//) $0.00 0 Drain,Roof 1 \‘`,$0.06:7,...,0 Shower j2 , a il$0 00 4. 0°'" i 2 Water Heater/vent{jr'/ $12.30 1 Drinking Fountain t%"'.,;..; $0`00 "0) `^.�-Sink bar n l "0:7'50-00 "e---0-;.:.C.1.2" Water'Piping(Instor�Rep.) $0.00 0 Expansion.Tank w $000c, 0 -. Sink corn e`rcial�L $0]00,..,-S-70,--- \\1 Water Re=pipefi%f $0.00 0 Gas Earthquake Valve '` $0 00 9/ 4/ „ Sink Floor=-"2:-.==:.:$0700-70-� \. Water Service% $0.00 0 Gas(1-4 outlets) $000N. 0‘-..,./ z?SiM kitchen $0 00 7'0 �, \Water S9fterier $0.00 0 Gas(Over 4 outlets) $0 00t- 00.` /� sink;-service%mop-J r�, $0:00���0�)J OTHER-V $0.00 Gas Repipe $0.00-'1/2"--:.c.0:2--......; Spa(private) ; , 11 '--' ($000`" _0.-- VIOLATION $0.00 Gas Service $0.00 0.‹.'-:7)--•":";-,Spa(public) -'1J\�.i, "L.156.00` 0 , -26 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 �-C '- -- -- _ - - . 4-''/' REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 _ ___- TOTAL CALCULATED FEES: $35.80 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 l I •`: - WORKERS'COMPENSATION DECLARATION: t' . 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 lot which this permit Is issued. - ' 'l4 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: '( A'AJ -'A f GO• Policy Number: /'764-1-- o- ZOO / • (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ 1 certify that in the performance of the work for hibh this permit is issued,I she'll-rot employ any person in any manner so as to become subject to the workers' . ' compensation laws of California,a d gree I t if I should become subject to the workers'compensation provisions of Secti9n 3700 o(L the Labor Code,I shall forthwith comply with these provisions. / Applicant Signature: / Date: / /0 WARNING:FAILURE TO SECURE WORKER 'COMPEN ATION 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 TH T 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 nd Professions Code,and my license is in full force and effect.Lic.# TZQ(7...77 Class# Cc-3 G Contractor's Signature: Date: //6'/(Ys' CONSTRUCTION LENDING AGENCY: n- r ❑ 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). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of'cdmpletion,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. - el 77 — Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires:. Verification of Ownership by(type of document.i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation 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 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 Califomia 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 0 No 5 Does or will theapplicant or present or future building occupant require for the work which is the subject of this application a,aernit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? lYes LJ No (Section 65850.2 of the Califomia Govemment Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (It yes-,the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 ...i.t...i. .l ... .. . .................. 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 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. Sig . ure Of Legal Owner(s) // Date 411, ''"' sir - i onzed Applicant �G � D to c CODES INSPECTIONTYPE ' - " "t16IE' '-' ILLS ' ' CODES- MSPECTIONTYPE ' •• -' PATE. j( $ 1616 • Fixed System Final Fire Prevention' 206 Final Mechanical -Oct (� IJ ' 1266 Pool Spa Final 208 Final Plumbing • "i'-e, n( 200 Final Re-Roof - • 210 Final Electrical - • 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Fire Place ' ' 220 Final Planning'Approval - 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy _ CITY OF COSTA MESA REQUEST FOR OCCUPANCY TRACT NO. S VS" DATE 3-16 - 77 LOT NO.. _ /- ADDRESS Oen •4/i/ -Catcrr C//1ccE The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The undersigned, by executing this agreement, acknowledges that vL (he-she-they) (was or were) t[/ tadvised that this tract has not been given final inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the City at the time the final tract map was approved. The City assumes no liability for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. The undersigned agrees to indemnify and hold the City harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted condition. BY 470 S...- Purchaser RECEIVED BY / / CITY OF COSTA MESA Developer . •d/o authorized "Pit^I^ cr?i repress v MAR1111111 16 1977 BY /h 7-4107-410IIM PM CAL'Lenddr�"F i}_SA.L . '.y�r:G5 c: LOAN i.JS 30. 7 8 9 ID ll ]212 3 O , NGELES, CALIFOR.N:A 90054 WILSH :.E IIOULEaAiip A OWNER COLE, WAYNE DATE 7_11_77 JOB ADDRESS 1102 Ridge Crest Drive BUILDING PERMIT NO. 44295 GENERAL CONTRACTOR g Lozzi Masonry DESCRIPTION of WORK Fireplace AP No. 115-661-22 LOT TRACT FIRE ZONE VALUES 1.000.00 INSPECTIONS Signature Date TYPE ITT GROUP ,T ZONE R-1 SOIL • PERMITS ISSUED GAS SUBCONTRACTOR I I . Dore Number Signature ATER Plumbl ww • ROUGH PLUMBING D .ySO7� /I7 ;120 .j • PROP. SWR. LINE Q HOUSE CON. 0 SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE IL UNDERGROUND n POWER El • ROUGH WIRING�JIu J cep, Heating and Vent. TRENCHES Le FORMS STEEL REINF. o- cep, 7-/2-?? FLOOR SYSTEM BOND BEAM Ei STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING =IH n OUT n PLASTER, BROWN COAT STRUCTURAL, FINAL Electric HEATING, VENT., REFRIG. AND A.C., FINAL ,., • PLUMBING. FINAL AND GAS TEST n ' CZ,p 7-L , 1 (- ELECTRIC, FINAL 111 ^. BUILDING, FINAL P"41 1-11 17 GC PatU 44�I. : J JIB 11-77,.1,,,.(}Q1114•' 'int*)$ie.sc COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely —Use Ink Only RECEIV DATE RECEIVED DATE 1 UED BUILDING //6?J t jO6rc ' `J , 7� 7-2 ADDRESS Y,/ ..// F9 U //' �//� PERMIT NO. OWNER G-9 /�✓e Ce9,2 C A.P.NO. jOtf -�� / 'ift BUILDINGMAIL ^� • ADDRESS s - .4'. ADDRESS #0.2. �ciesr CITY C, 579- 13 .CZr,Q NOL C JfS'' TRACT O LIS LOT 7 BLOCK CONSTRUCTION . NEW I ADD ALTER REPAIR MOVING DEMOLISH LENDER /Y// BRANCH - OWNER ttei dit/e— a Cr • ADDRESS LL / r� ARCHITECT TEL. USE r/te fore e�ALU$ OR ENGINEER NO. . . FIRE - • ///�/( ADDRESS ZONE TYPE I L..ROOUUP• `/�///7 r�/t APPROVED DATE/ I( // CONTRACTOR ,�O Z�/)�.SO,1^��7/�/ BY ADDRESS /Q 87/ c5T�aVn)„, rjb 20NED NO.OF USE OF NEW / CITY���92/./6��/e- NOTE, 5..-0-a 7 (� PLANS -BUILDING ��C�/ rl^. STATE CITY YARDS APPROVED YARDS APPROVED LIC.NO. 3�o)/0 q LIC. NO.?/QB/ MAIN.BUILDING ACCESSORY BUILDING ly 512E NO.OF BLDr:S, (FROM C/L STREET) 6. OF LOT I NOW ON LOT FRONT FT. ••••101,01.- --e\FT. Q USE OF Jam' yt��J C `� 1/4,5"% C Ca EXISTING BLDG. it . ��.!O4t C. y4 R SIDE FT. �>z) h �^ FSeparate permits are required for L.SIDE FT. T. C:P. electric,plumbing and heating work. Cc' Ca - REAR FT. FT. I.W. USE OFILID LINGA D WORK -BE PERFORMED DISTANCE BET. BET. MAIN Si Qr�jet« C MAIN BLDGS. ACCESS.BLDGS. VAR.+ DATE MC.U.P.#q/_'�-p APPROVED D Q BY �"'/C DATE / /�- ' APPROVE Ce oG • W — Q I hereby acknowledge that I have read this application and state n p{, that the above information is correct and agree to comply with O. all laws regulating building construction, and I shall not employ co Z any person in violation of the workman's compensation laws of _ m 5W the State of California. SO. FT. co I hereby certify that I am properly licensed as a contractor under N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ ig, ov e and Professions Code, Division 3,Chapter 9. . G o a m /DOO i PLAN CHECK $ +- o Signature of LL Permittee �� �/� $ TAX $ • . 1 U Authorized Agent .. TOTAL PAID $/0t o cY "O T 407J.4 • PAID'', 'M 0 860* :£***R7.57 COSTA MESA BUILDING-SAFETY DEPARTMENT ' P.O.BOX 1200. COSTA MESA,CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only AP LIGATION FOR STRUCTURAL PERMIT /� AEIIV BY DATE RECEIVED DATE ISSUED ADDRESSI BUILDING 1 VC/ RIIr&Er�r_�r- cue. °c,W ./QCiol //, /' / / �s �r.� -• 'J • OWNER 'W DEU�GO�/`•E'��T.� A.P. NO1ISt44I�..CI,22 PERMI4V./J. . ©MAIL BUILDING ADDRESS/SU C I77W` ST ADDRESS 110P--- eiD .6��E5T f CITY asTo;! I 4 NObg2-fat> TRACTIiq I l LOT 7 BLOCK CONSTRUCTION - NEW ADD ALTER REPAIR MOVING DEMOLISH LENDER BRANCH _ It 1 ' OWNER l� , • //li ADDRESS • UE dy ARCHITECT D(^•'[/ i A TElr�y i/ SE L�r r y �i $ '�(I OR ENGINEER f'{ NO,J�7 T�+ "'"' "' -' FIRE . • ADDRESS ZONE TYPE (1_ GROUP_' rar / AYPROVED CONTRACTOR) (�)((��- / „ BY DATE ADDRESS/ gj ST (77.2545)-, TEL O E NO.OF USE OF NEW CITY rS-.I NO4 -yzio , _ 1 PLANS ' BUILDIN-[`s LV/ , , r rr. --i STATE `'I CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING I (FROM C/L �Tpj',EETT}}tr:{{:II���� C. OF LOT •L.L1 SIZE I NOW ON LOS FRONT 1./FT.'s. FT. Q USE OF o �,jI EXISTING BLDG. R,SIDE [FT.L/0--f_ FT, .'E S • eparate permits are required for L.SIDE 7FTbj. FT. Ci electric,plumbing and heating work. REAR /2�T. FT. 117USE OF BUILDING AND WORK TO BE PERFORMED• DISTANCEBET. BET.MAIN& Q MAINBLD BLDGS. ACCESS. BLOC'S. DATE Q is tLiG/2•15//9.WoaF.� z '2 Ca C.URP# APPROVED//S•�f�_J RAPPROVjeD 1 Q DATE '/a -7 CL . . . • OLD( FOR SPECIAL REQUIREMENTS . C I heresy acknowledge that I have read this application and state In N g that the above information is correct and agree to comply with — co CB all laws regulating building construction, and I shall not employ - . Z any person in violation of the workman's compensation laws of m the State of California. / 717 sTin ./ g! m 3 I hereby certify that I am properly licensed as a contractor under 1 SQ. FT. Q!1 !TL L7lY/� w the State of California Business and Professions Code, Division 3, THE MOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: " am exempt from the provisions of the State of California Business 'a it and Professions Code, Division 3, Chapter 9 VALUATION PERMIT FEE S LP n Signature of �j�c'A'q ���/// /� PLAN CHECK $ /!' 0d mo Permittee .C.etGVYEU $4.,i sti/1� TAX $4,,e, T ^ �J u Authorized Agent ��"" [lTl% TOTAL PAID $ IV�/ 2 • 07 10E 003279 d*** 169.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely—Use Ink Only RECEIVED BY DATE RECEIVED DATE ISSUED BUILDING ID ADDRESS 8 ilk_ Cr_ t ..._ - . . . PERMIT NO. OWNER A.P. NO.BUILDING !�/� Imo/ r� /�• MAIL ADDRESS no z. /\I DCIECR EST P. ADDRESS TEL. CITY NO. TRACT LOT BLOCK CONSTRUCTION NEW ADD ALTER]REPAIR I MOVING DFMOLISH LENDER BRANCH OWNER ADDRESS VALUE ARCHITECT TEL. USE $ OR ENGINEER NO. FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR BY DATE • ADDRESS TEL. ZONE NO.OF USE OF NEW PLANS BUILDING CITY NO. F.. STATE CITY YARDS APPROVED YARDS APPROVED gLIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING W SIZE 1NO.OF BUMS. (FROM C/L STREET) Ci. OF LOT NOW ON LOT FRONT FT. • FT. a USE OF EXISTING BLDG. _&§IDE FT. FT. to H Separate permits are required for L.SIDE FT. FT. W electric,plumbing and heating work. REAR FT. FT. ).. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& QMAIN BLOCS. ACCESS. BLOCS. 71 VAR.# DATE C.U.P.# APPROVED APPROVED . } _BY DATE ..1 IX L I hereby acknowledge that I have read this application and state to n 12 that the above information is correct and agree to comply with a• all laws regulating building construction, and I shall not employ w Z any person in violation of the workman's compensation laws of WS' ' the State of California. .. I hereby certify that I am properly licensed as a contractor under SQ. FT. N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ro Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business /I io VALUATION PERMIT FEE $ /v 9 60 d and Professions Code, Division 3,Chapter 9. W/ .1 In PLAN CHECK $ cn Signature of O Permittee $ TAX $ • _ 2 • J' . U Authorized Agent TOTAL PAID $ /6.9 l[rrC'