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HomeMy WebLinkAbout166 ROCHESTER ST - Building Permits t, -" CITY OF COSTA MESA P r y �� BUILDING DIVISION �7 ^ (J� ' DEVELOPMENT SERVICES DEPARTMENT f PERMIT PERMIT NUMBER /V/ (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 166 ROCHESTER ST Status: ISSUED Suite No Applied: 09/24/1998 Issued: 09/24/1998 Vicinity: _ Parcel Nunmber: 42541505 Applicant NOCK, RON Address: Phone: . " Zip: Owner: HYCHE, ROBERT E TR Address #K SIERRA MADRE,CA Phone: 263 E SIERRA MADRE BLVD Zip: 91024 - Contractor NOCK PLUMBING Address: 11612 KNOTT ST _ . . Phone: 714 895-1246 GARDEN GROVE,CA . Zip: 92841 License: 707775 , Archl Eng: - Address: Phone: • Zip: License: SCO• PE OF PERMIT ' . INST DISHWASHER. FEE SUMMARY- - -- AMT QTY AMT QTY AMT QTY ISSUE FEE $22.00 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 It) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 - Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank • $0.00 0 Wash Basin $0.00 0 Dishwasher $8.75 1 Sewer Cap for Demo $0.00 - 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 . Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $30.75 COMMENTS/SPECIAL CONDITIONS • 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 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ e antl 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'comp/or/I/t/ion Innsuurranc rrier and policy number are: `' 21 Carrier: " 't /"�r ✓ Policy Number: AvW e VW,7 (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,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 Ll�� p� Applicant Signature: �1J�S �t —. Date: ✓VO lG1 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL11ES 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 un w- 'ov�'sions o f) t (commencing with Section 7000)of Division 3 of the Business and Professjons Code,and my license is in full force and effect.Lic.# /(J /- / Class# /i3 b Contractor's Signature: - - Date: !� - LS -%/ 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). Lenders 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 toe 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 completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 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.faisework,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? ❑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 end filing with the Fire Department of en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this apa�plication a2ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑Yes U No (Section 65850.2 of the Califomia Govemment 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 0 No (If 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? ❑Yes 0 No - 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws end 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. Si natureQf Legall Owner(s) _ 9 m And/Or du\•)dzed Applicant Date CODES IN$PECTQNTYPE DATE ILLS CGDE. INSPECIdNT1'PE DATE If ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing J0"30—9* 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 2446-06 r !4 y CITY OF COSTA MESA o 0 . � BUILDING DIVISION t ' ' DEVELOPMENT SERVICES DEPARTMENT O RQR-01937 • ; PERMIT PERMIT NUMBER w o i (714)754-5273 • Fax(714)754-4856 BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 296 'ROSE LN - ' Status: ISSUED Suite: Applied: 07/13/1998 Vicinity: Issued: 07/13/1998 Parcel Nunmber: 42615210 Zoning: Applicant: TROY, ALEXON ` - Address: Phone: ,Zip:_ _ Owner: KINDGREN, FRED'--A----< Address KINDGREN;'NANCY B RT>B NEWPOEACH,CA�', -'\ '• Phone:' ' ! '+ �1' \ 2056;TUSTIN AVE\ - ` 2 Zip: 92660 _ , Contractor LEE.ROOFING OF"COSTA MESA , Address: /01653 SUPERIOR AV r Y ` -. ' 7 ���- ` ; li i'� �sr• -/ i' `,`�\ � ��j /�� Phone: N . ( --A L'/ /'i COSTA MESA'CA Zip: 92627 .'',A �- , , ' 7 //ri 44%, License: 349686 - -A Arch'/Eng: j '/ 'isc. , •�,, 'Address -' /i i/ . . . ' � �, ., 1 1 Phone - ',?'�,.�7 - ' ‘','//,'*., t •1 <.j - 1• C . .,,ZIP: �- , : � �v _ i :� / i•:� SCOPE OF PERMIT , % ' i 't \• ' T/OFF AND REROOF 2600SF RESIDENCE&GARAGE W/COMP FOR RESIDENCE&BUILT-UP FOR GARAGE. / . � ' r.-.. '7 '-Y,:l'"' '" •`:‘ - • FEE SUMMARY , Plan Check: ' $0.00 - + Calc Valuation: $4,650.00 Permit: i; $99.75 %� Claimed Valuation: $4,650.00 SMIP, Res: ‘1. $0.50 , rte ,_-. „.,,�7;—'' C a -zF'ar /I�;t.,.; __ ••• , ,SMIP Com • $0.00 --- /r 4 Other '.1$0.00 Inspec`tion: , y$0.00 "-_ . , \Total:" $10025 �� - v', ' < , a ;/ v. '`7PLANNING &ZONING ' 2/1- SETBACKS;, �� - <; - r r ' ., / MAIN STRUCTURE Front 0-0 ,- Rear -0 0' � ,• Left , 0 0- Right 0-,0 ';'7' 7//V/ ,',ice � - -� 'L ,' >� - ✓. ;"l�� ACCESSORY Front 0-0'- '-" Rear :0-0 ' Left 0 0 1 Right -0-o %7 PARKING Existing: b,., - Required:-.-:, '0 • -. ,Proposed:. 0 "" NOTES: - - • 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 I§ECt3RATIONS WORKERS'COMPENSATION DECLARATION: - . . I hereby affirm under penalty of perjury one of the following declarations: •- ❑ I have and will maintain a certificate of consent to self-Insure for workers'.compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Caries C Policy Number. Mils section need not be completed If the permit is valued at one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,en gree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr visio Applicant Signature: � " Date: ,//r/7 WARNING:FAILURE TO SECUR ORIOERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100, ,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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.# /) • ` Class R vidirsPContractor's Signature: / `•.ice" Date: _ ( CONSTRUCTION LENDING •GENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued.(Sec.3097,CMI Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I 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 Ls licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Ls 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 properly,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 completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person is required to descend,wilt 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 Win 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 California 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 the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes ❑No (Section 65850.2 of the California 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 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE 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. lure Of/gal Owner(s) / Date Low.Or Authorized Applicant Date LORE L , .4 no... x' DATE MINS CRpS. WSPFCON TYPE DATE ROMS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool'Spa Final • - ' • -f a ' - 208 Final Plumbing - 200 Final Re-Roof 7-i7-91 91 ? '# 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 OWNER Macnab, Martha DATE 3_31_78 JOB ADDRESS 166 Rochester Street BUILDING PERMIT NO. 45748 �GENERAL CONTRACTOR Larry Warlamount DESCRIPTION of WORK Add Bedroom & bath AF LOT TRACT FIRE ZONE VALUES 4,500. -�Ih .CTIONS Si nature Date TYPE , V GROUP t ZONE A:AS ree •y �O 74€ SUBCONTRACTOR PE$MITS ISSUED rData Number Signature ATERU` _ 2.r y./b,71( Plumbin. • °UGH PLUMBI NAL// � / • S. � l9.. - '-'6") /� PROP. SWR. LINE E HOUSE CON. ❑ .� 4 - .i * �� '-a/-1. '1 /• SPRINKLING SYSTEM r / MISCELLANEOUS (� qN" ROUGH HEATING AND AIR CONDITIONING f 1..'ty7( TEMPORARY SERVICE OR POLE UNDERGROUND 0 POWER ❑ -/ ROUGH WIRING • • 7. 1-%X Heatin• and Vent. TRENCHES L•/ FORMS STEEL REINF. ,V - 2_) •i !_..._. _ •_AAAA . (. q FLOOR SYSTEM A BOND BEAM n STEEL REINFORCE f ,�n/� e/ SHEATHING A,9K G/r/n FRAME AND FLASHING $ LATHING - IN $ OUT I PLASTER, BROWN COAT ST 'URAL. FINAL ('� ,// Fl r riC 1-0,--,i4qILA,/ /. HE.U IN , FINAL AND G. AND A. FINAL PVC �-"A� N, Lo .2/7A tride�eter PLUMBING, FINAL AND GAS TEST V lJ� U J ELECTRIC, FINAL �/i /_ BUILDING. FINAL / _ r - / ..... 9 ,z . 45748 ` �uuST CI CGS,/q I Cii; COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 A': l A ION FOR STRUCTURAL PERM T For Applicant to Fill in Completely — Use Ink Only I REC: D • DATE RECEIVED D BUILDING ' //`` C%eS / /l 10 /� ADDRESS (Q (JL rt7 ,�J /" Mir ��! `r e. � e L L /7GJ A.P.NO. �- ��� .u OWNER �� �� ,// MAIL �/�,�e���/"L �vU��/-/f)O ADDRESS BUILDING /6t ' 7 oc,yti '/� V/. ADDRESS /' CITY aQ*'/4• C44.120/ NO. 30 Co rt TRACT ]7� LOT /I BLOCK CONSTRUCTION lA NEW ADQ ALTER REPAIR MOVING OFMO11SH LENDER / BRANCH OWNER „Nlel 00 88 ADDRESSARCHITECT �/', TEL. A'D'D ��ry VALUg��Jf OR ENGINEER NO. USS --JJ``!/UU ZONE / T PE t/i GROUP T-• FIRE ADDRESS 4 /// a��"' /,/'�/ b� ,,., APPROVE.° �, f CONTRACTOR/ail it L(/�.t/asaO�� BI Y e 1 I AA/ DATE S 3 • ADDRESS- �2 /90cc,90o ��/�/J �� /j� �7 . ZONE ' rf'1O OF USE OF NEW CITY a off,?o4/�,� NO..au i(j (1 .0 PLANS I BUILDING Y1 f. �s,. `- STATE '` CITY YARDS APPROVED I{ YARDS APPROVED LIC. NO. 474/2 IFROM 19 SIZE '3/,6` LIC.NO. MAINla BUILDING ACCESSORY BUILDING 3 OF LOT SOX t41U I NOWNO.DF ON LOOT / FRONT CGSOFT. FT. .2 USE OF N EXISTING BLDG,Z35J/)EIY/</#/ _R.SIDE C3i IGFT FT. CA i I-. Separate permits are required for L.SIDE C FT. FT. electric,plumbing and heating work. ^i W REAR el` / FT. FT. QUSE/O,FJ BUILDING AND WORK TO BE PE OORMED DISTANCE BET. BET.MAIN& Q �JY/'# 4P,e,4"AeC ' • "rap MAIN BLOCS. ACCESS.BLOCS. .d VAR.# -� DATE /�]Q 7 45n /-F- ef0C/�/ V tc //AA - C.V.P.# _� APPROVED /..3 /CJ APPROVE / -DATE 3/It, EC tri 00 I hereby acknowledge that I have read this application and state N r. X that the above Information is correct and agree to comply with CO" p+ all laws regulating building construction, and I shall not employ z: Z any person In violation of the workman's compensation laws of 2 the State of California. I hereby certify that I am properly licensed as a contractor under /1-4 SQ. FT. a the State of California Business and Professions Coda, 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:. om exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ �(2 (!`J' a and Professions Code,Dlvisi n Ch tar 9 / �i .../ h C�l�i / � f 4 PLAN CHECK $ / o Signature of L/ r� G LL Permittee "-�'"� S 51310 v TAX E q f �/ U Authorized Agent \ TOTAL PAID E 7( �)