HomeMy WebLinkAbout2770 SAN JUAN LN - Building Permits RENS NAME IF
2770 SAN JUAN LN Whir: -
C.1TY OF COSTA MESA - BUILDING . PERMIT 41
RS NAMEIP KNOWN: SAWtcA, WILLIAM PERM NV: M 85761
ADDRESS: 47.7V SAN JUAN LN C�
COSTA MESA,CA `J2b26 V PERMIT NO: M Vt35768 PLAN CHECK NO: IV GVV1 : N SUPP: N
AP PL.MAILING ADDRESS: CONSTRUCTION TYPE: V-IVPERMIT TYPE: NEC - PURPOSE: 0111
ARCHITECT OR ENGINEER: UC.ND.: JOB DESCRIPTION : REPLACE F .A. 0 SQ FT :
ARCH.OR ENG.'S ADDRESS: WIT: '
CLAIM VALUE; • CALC-VALUE: GROUP OCC: R-3 /
cONTRACTDRSNAIIE GRAHAM BRO HEATING AND Al ( 714 ) 546-1653
comommwsMuln(o '2952 CENTURY PL COMMENTS: X •
''ADDRESS: COSTA MESA CA =NO.: 248604 rt9t YPft'R'iYT'Ehler'RYtTT'itT'1tT'x'!t'!c 'R'T'R'F'Ryt*'R'R*Yt'Rit'R'fi'?YY'h1t'Y!'It R*1t.*,,e CJtR'lt'T'Itlthl***T'R'%c'T'/F1l•'a***T'f!'RF*X'R*
92b2b WMT: Z 0 N. I N G REQUIREMENTS
UCENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury That I am licensed under provisions of Cheptr 9 SETBACK S
(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my Scene a in full force and effect.
u NO.:U 3186 iter CLASS: C LU 1.1 O.: 248604 E Y ; V`i%y8 MAIN BUILDING ------------ ACCESSORY BUILDING ---------
//q y �'r /l/f 4reS ,, 1/LcL rRNI.: RE!!
IN REAR: tit IN tRNl rT 1N REAR: FT IN
Dme: /'// / // 7 Contredr: as/� / LEFT; tT 1N RIilYT: t 1 IN LEFT: 1•T 1N RGl-iT: Y 1 IN
OWNE BUILD R DECLAR/TION:I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the •
foowi reason(Section 7031.5 Business and Professions Code:Any c*y r county which requires a permit to canatrud,aver,improve.
PARKING H ES„J: YHO V : PARCEL : 14154229 L N E: REF NO:
h.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)d DNebn 3 d the P L ANN 1 NG 'N r.--
T E b> -
Business and Professions Code)or that he or she is exempt therMrum and the basis for the alleged exemption.My Notation of Section >
7031.5 by any applicant fora Permit subjects the applicant toe ova penalty of not more than five hundred dollars[55001). it it 7r ethicit
it it yr wrseit is itisititit i
ititittititititit it Wien-Knit iii w it it ititititititititbtititititititititii i ititititititititititdtirititiiitit it
,t 0 I.as owner of the propeny or my employeeswlh wages asthek sole compensation,MU do the work,and the structure is not intended DEVELOPMENT _S E H 1/4r.- I C E S R E U IR ENE N TS
• or offered for sale(Section 7044,Redness and Professions Code:The Contractors License Law does not apply to an owner d property u
who hoods or knproves thereon,end who does such work himself or herself or through ha or her own employees,provided that such '
improvements we not intended r offered for sale.If,however.the briding or inprovement is sod within ern year of completion,the ZONING APPROVED BY •
- • DATE:
owner-0uidr will have the burden d roving he or she did not build or improve for the purpose d sale). ,_
❑ I.as owner of the property,am exclusively contracteg with licensed contractors to construct the project(Section 7044,Business end -U-- - -NG A—--O V Ell B Y DATE:
Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon end who v'
contracts for such projects with a comm dors)licensed pursuant to the Contractors License Law). i -
, ❑ I em exempr under Seadn: B.B P.C.,for this reason: APPLICATION ISSUED BY : 'i DATE: Iliall? -1-
it itititit,...i....„.Yititit'itititRR'TTT'9t9 ,„„Jt-T'T!t'R'T'T)cftw,...st R-/c'T9. 'Rst N.Yrrsr*wwitit-A-NA-se Tit Yr XJt'!C YC'a ft it
Date: Owner:
LEGALIZATION:N F E E SUMMAY STRUCTURAL SEGMENT:N
I do hereby caitiff that I am aware of and understand the requirements of CaBrnpe Health and Safety Code Section 25505.Paxs,.end
25534,and that I r any future building occupant will/wilt rid(circle one)needle comply with said state codes and the requirements ler
a permit for modification from the AirTMFranagement Diatrid.Reddemal construction apPicetioneamnemrfran these BLDG PMI PLUMBING ELECTRIC MECHANIC FIRE SMIP%RES GRADING
provisions. PERMIT 13 . 25
Dale: Applicant _ 25t S M I P%NUN-RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby atoms under penally of perjury one of the following declarations: ISSUE FEE 22 . 00
❑ I have and MI maintaincenificate o consent losefineuro for workers compensation,asprovded for by Section 3700 of the Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code.for the performance d the wank for which Nps permit is oeued.
'P I have and*if indwell workers'compensation Neurones.as required370
by Section od the Labor Cede,for the performance of the TOTALS----> 13 . 25 LL• UU U , UU 37 . L7 35 . LJ UV
•
1C" work for which this permit S issued.My workers'compensation insurance carrier and policy number are:
Carver. MID CENTURY EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: - 35. 25 OVER/SHORT : 00
-Porky Number: NU1U90 / /8 08 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING' PLAN-CHECK
(This section need not be completed I the penal is for one hundred dollars/$100/or less) 35 , 25
❑ I nay Net n the performance of the work for whkh Nie•.. - a net •,I shag not em•., •• rson N any manner so as to
....-- wbjedto theworsers'conpeneation laws el 'afdrn': agree that if I -iiy • •. • wMedto theworkere' ie it it it it*ix'ire ii itititit it it it it it it ii it Si it it it ititititititit sir it it it it it it it it sr sr sc it it it iv ii it rt Itch it sc Se sr sr inr-7r it it itis ii ii ii it rms.'it 4Y 4,..,i,***
•
/roNsnnss Bodin 37004 the Labor.....Ishinf• :hcomply t• ' •:, _ . ......
Api
Da it 17/#7 Appl am: 97 r ,i I N L 1 V 1 U U A L
Mee Failure to mac workers'conpscompensationun 1,and still subject an employer torIMrW penalties and TYPE jT Y D t SlH I Y 1 1 V NF EE BREAKDOWNUNIT COST1
TOTAL AL COST
G 11 fines up to one hundred thousand dollen($100,000),In tion to the cost of compensation,damages as provided for In .
S. don 370dolthe Labor Code,Interest,end ettomsy'stem MEC 1 INST FORC-AIR/GRAV FURN <= 1000K BTU 13 . 25 13 . 25 of 5. 2penally there isry
a consteton lending agency forthe n END OF FEES
performance of the work for which Ilia permit is issued(Section 3097,Cb.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read Nis applkmion and state that the above intimation is cones.I agree to mnpty with all city and county ordinances
and state Laws relating to bddig construction and hereby authorize representatives of this city to enter upon the above-mentioned property
incite�...
PETER INT" —ERT / • 11-17-1997109:25 A')135.2;,
N y RCFT0:01-F15499
�efiT.i Ii _ td%sa( Dme: /f / / PEkI'lIT:085?6Fy
_ Signature`e •rl.,. W••• - , • t.•or
(5151-40.WP) White-Building&Safety;Green-Rle:Canary-Appicent Pink-Revenue;Goldenrod-Assessor
CONSTRUCTION AND PLANNING • :. POOL & SPA
•
APPROVALS Permit # Date : Inspector APPROVALS Permit # •
Date Inspector
1. Temporary Electrical Service or"Pr, 52. Pool & Equipment Locaiioni
e
2. Soil Pipe-Undrgrnd. --- 53. Steel Reinforcement - ,r-
•
.. 3. Electrical Conduit Utility-Undrgind:' , 54. Forms - - -
"' 4. Electrical Conduit•Undrgrnd. , 55. Electrical Bonding - -
S.�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, Oa Undrgrnd.;Test ti `1 -
I
9. Water Pipe-Undrgrnd. •- 4 60. Backwash Lines,P-Trap-L-Undrgrnd. -
10. Structural Floor System . 61. APPROVAL TO DECK ' M
11. Property Sewer Line.,& House Connection 62. Backwash & Receptor-Final ; '
12. Sewer Cap - Y
63. Heater& Vent-Final •
13. Roof Drains . 64. Plumbing System - Final •
14. Rough Plumbing - - _' - . 65. Electrical-Final
-ft'
• 15. Rough Electrical-Conduit - - - _ 66. Solar System-Final , '
16. Rough Electric Wiring - " 67. Fencing & Access Approval r - ,
17. Rough Wiring Sign :68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
-
19. Rough Heating & Air Conditioning - FIRE7DEPT:REQUIREMENT
20. Rough Factory Fireplace APPROVAL& . Permit #
21.. Duct's, in,Struaure t. '_ - . , 70.-Underground Hydro '
22. Ducts, Ventilating; - . 71. Product Piping OGas ❑Oil .
23. Gas:Pipe Rough & Test ` ' t 72. Underground FIuFh t .,
24. Roof Framing - 73. Undergrhd.Storage Tank 0 Gas 0 Oil
25. ,Roof Sheathing . 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frathe and Flashing' - - ; -� , ' 76. Dry Standpipe; , ;
28. Lathing& Siding . - 77. FIXED SYSTEM FINAL -
29. Insulation78. FIRE PREY. FINAL 4.
30. Drywall Nailing • HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat' - • ' 79. FINALINSPECTION `
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: - '!
34. Final Heating& Air ConditioningZ Q.�
hi: • ,
•
35. Final Gas Pipe-Test .. •
;
' 36. Hood or Canopy . - .. . . ;,
,
37.-Final Factory Fireplace -
38. Final Plumbing - -
39. Water Service-Final . f
•
40. Gas Service-Final ` .
41. Solar Domestic-Final -
42. Backflow Preventer., ,t '
43. Backflow Irrigation, i • -
,44. Landscape Irrigation System' ,; - -
45. Sound Attenuation - -
46.'Handicap Regulations ' •
47. FINAL STRUCTURE & BUILDING -- .. •
48. F INAL PLANNING
49. Electric Release to Edison .
.50.-Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
C PROJECT ADDRESS: 2770 SAN JUAN LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 053262
1 YAMEWSNAME:SAWKA, WILLIAM
ADDRESS:
2770 SAN JUAN LN PERMIT NO: B 063262 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA, CA 92626
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
979-9097
ARCMIENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF RESHT, REROOF W/COMP SQFT: 5,700
ADDRESS: UNIT:
CLAIM VALUE: 5, 700 . 00 CALC—VALUE: 5, 700 . 00 GROUP OCC : R-3 /
PERMITTEE:NORLAND ROOFING (714 ) 855-0544
ADDRESS: 24272 ENCORVADO COMMENTS• SMOKE DETECTOR REQUIRED PRIOR TO FINAL
MISSION VIEJO CA 92691. %+6******4%******#*#BELE**#***iF%****#*****aE**********#sF**###**aLa6******************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIR EMEN TS
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS
CITY LIC.:0�a I1 4695 STATE LIC.:5 62 8 5 T CLASS:(i....3 9
�/—q��'' /! ?oC9 Signature' Ci....----1.A. — MAIN BUILDING ACCESSORY BUILDING
— WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to selt-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT: 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 ND.:116 7112 EXP.DATE: I 1/01 /9 3
COMPANY:STATE FUND PARKING REQ• PROV: PARCEL: 14164229 ZNE: REF NO:
❑ Certifiedfopy is hereby furnished. Q Certified copy is ith the city Building Division. PLANNING NOTES>
ate' 6���
. ,,/3I_ Applicant: _//✓� �. ***%%*#*******;****34******#*******%*********%-#**-***14 *1414*%14%14**•#1414**IE*BriE*********
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). D E V E"L O P M E N T SERVICES REQUIREMENTS
I certify that in the performance of the work far which this permit is issued,I shall not employ any person in any manner so as to become /I- 2
subject to the Workers'Compensation Laws of California. ZONING APPROVED 'BYDATE;
•
Date: Signature:
NOTICE:It,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: /.1
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; - DATE: 73 a-�-3
which this permit is issued(Section 3097,Civ.C). ***************t*********1414 ****#uu #'14.14 * * w***********3e***********-, ***iris•****
LENDER: ******************************************** ' **********************(%.****$*% *
ADDRESS: LEGALIZATION: N F E E SUMMARY ST'RUCTURAL'''/SEGMENT:Y
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,Q GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish.or PERMIT 8 1 • 0 0
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed . 571
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 70001 of Division 3 of the Business SMIP/ ON?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 live hundred dollars($500). ISSUE FEE
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�,
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS——--> 81 . 57 0 , 00 0.0 0 81 . 57 81 . 57 . 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• 81 . 57 OVER/SHORT• it 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADINGi) LAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 81 , 00 • 57
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon 2\--
andwho contracts for such projects with acontractor(s)license pursuant to the Contractors'State License Law).l am aware *********************************************************-**********3P*14^34***44****
that proof of their Worker's Compensation insurance should be provided to me, INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST 'TOTAL COST
Date:
do hereby certify that I am aware of and understand the requirementsofrCalirornia Health and Safety Code Sections 25505.25533.and SFR 5700 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00
�1. 5, 700 , 00
I
25534 and that I or any luture 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 Ouality Management District.Residential construction applications are exempt from
these provisions. �+
Dale: Applicant: ',1
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county 01 00143910-00143911,,nT CE T 81.57
ordinances and state laws relating to building construction and hereb . 'adze representatives of this city to enter upon the above-mentioned DATE: 07/30/93 TI!E'} 11:36
properly for inspection urposes i
vain, 7,,, Signature .F 5,
Driver's License or Social Security+:
164146 While—Building:Green—Code Enrorcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
I
p,. / 1
f I
,r CONSTRUCTION AND PLANNING / POOL & SPA I. I
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 UF ER Grnd. 57. APPROVAL TO COVER-GUN ITE
7. Footings - - 58. Electrical Conduit-Undrgrnd.
8. FoundatiOn Ti 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd, 60. Backwash Lines,P-Trap, 0 Undrgrnd . .
10. Structural Floor System C 61. APPROVAL TO DECK '
11. Property Sewer Line & House Connection , 62. Backwash & Receptor-Final
12. Sewer Cap •- 63. Heater & Vent-Final •
13. Roof Drains T 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-I 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 OOil
23. Gas Pipe-Rough & Test ]o ' - 72. Underground Flush
v7
24. Roof Fram'.ng . 73. Undergrnd.Storage Tank O Gas Oil
25. Roof Sheathing D'y_q y �u.4f 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing - • 76. Dry Standpipe
28. Lathing& Siding 1 I
77. FIXED SYSTEM FINAL
29. Insulation i., 78. FIRE PREY. FINAL
30. Drywall Nailing - i --,- HEALTH DEPT. REQUIREMENT
•
31. Plaster Brown Coat- `:-----I 79. FINAL INSPECTION h
32. Electrical Power Meter-Final l -�� -,f 80. FOOD CERTIFICATE ISSUED {
33. Final Electric _ Notes:
34. Final Heating & Air Conditioning IL I`-,t-1
I +
•
L I
35. Final Gas Pipe-Test - f ,
36. Hood or Canopy r _
37. Final Factory Fireplace 11
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final i
41. Solar Domestic-Final 1
i
42. Backflow Preventer i I
43. Backflow Irrigation
1 44. Landscape Irrigation System
45. Sound Attenuation
I
46. Handicap Regulations / • - 1
F 47. FINAL STRUCTURE & BUILDING ,47--6.I' (OG'v''�)•-d 6,.. �" K c��, of - 6
48. FINAL PLANNING - '':
49. Electric Release to Edison { -
50. Gas Release to Southern California Gas Co , -
51. CERTIFICATE OF OCCUPANCY -
No. Date
18899 '14R-g.r^?11-,r0',o7x. ****8530*$530
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 317 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING
ADDRESS 2770 San Juan Ln. .
COSTA MESA. CALIFORNIA For Office Use Only
RECEIPT NO. I PERMIT NO.
OWNER Mesa Del Mar Development Co. 18899
MAIL RECEIV�E�¢ p�rr DATE RECEIVE DATE ISSUED.
ADDRESS 3800 E. Coast Hwy. iD ai tet, -/o3 ISR B t 4
BUILDING
CITY CoronaCT Del Mar NO.Un la220 ADDRESS
ARCHITOR ENGINEER MaC CO Realty CO. NO.TEL.OR 3Lt220 - COSTA MESA. CALIFORNIA (///� /)
ADDRESS 3800 E. Coast Hwy. FIRE"ZONE ' TYPE Z GROUP /�1. �/-
CONTRACTOR Macco Realty Co. APPROVED
BY DATE
ADDRESS 3800 E. Coast Hwy. ZONING - I-
ZOri) NO.OF. USE OF N {J `q�
cln Corona� Del Mar K� "1. PLANS
7� •
-Bu1LDut� I /6 {E i �%uV'
STALIC.TNO.207343-A-SB-1 NO. OR 34220 DESCRIPTIONLEGAL
Lot 37 Tract 1180181 `
SIZE - NO. OP BLDGB,. .a
OF LOT 6324 S.F: NOW ON LOT 1'Tone A.P.NO. -
USE OF None YARDS EVES
"'
EXISTING BLDG. APPROVED ALLOWED
SETBACK LINE FROM (CENTER LINE ST.) /`F-
CENTEROFSTREET 50' REAR YARD 221 FRONT ' .fJ//O FT. IN.
SIDE YARD I LEFT 91 I RIGHT 101 R.SIDE / 1 / FT. IN.
DESCRIPTION OF WORK
L.SIDE ((�� FT. IN.
NEW X I II ALTERATION I II ADDITION I REAR r� /, (9-2 -ET. ` IN.
II MOVING I II DEMOLISH BYPROVEp�,` /u-LV1�1 DATE S -1:13
REPAIRI 't"t`.�' .
BUILDING. NO. OF
SIZE 001Xg0I ROOMS 5 STORIES 1
EXTERIOR WAItS. 00 0102.co I Rookiood shake & Rock
COVERING COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
Single family res. w/atter ear. Living Area: 1585 S.F.
Plan # 300-A Garage Area: 440 S.F.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION �"�7
PERMSIGNIITTEF TURE OF Mesa Del "ar Development Co, PERMIT FEE $ J //fo
s17,060.00 PLAN CHECK $ �O j.3-0 4
AUTHORIZED AGENT / sd.t^i / O
TOTAL FEE . - 0