HomeMy WebLinkAbout785 SCOTT PL - Building Permits Applicant to fill In all spaces except those within heavy border lines anti sign all appropriate declarations.
PERMIT NO. TRACT NO. LOT NO. UNIT NO.
CIITY�OFF COSTA MESA C�OfNSTRUCTI�N PAR MI B Q/� R A.P.# Zone
!ItProject/;�[dress �f�'/'t --+G d .1 C e 37 / 4TBuilding: Accessory Building:
�� J S Main
AprJ.ic ailing Address TYPE OF CONSTRUCTION U NEW U ADD ❑ ALTERATION I�`REPAI R E Front Z
❑ CONVERSION ❑ DEMOLISH ❑ OTHE• 4 1 T o
Owner's Name v(TN�•'-a-0./L.O� Phone /W '
9 10, �_ L
,fir
„ C DESCRIPTIOfV OF WO K/U SE OF QLD^.7 - f B Rear N
Address AXI �7 5�l CR Ifl I,R y7sdJ6T.U/ V
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING III���111❑ FOUNDATION TRUCTU IL iK Right G
Address �}'/ /� ❑ TENANT ❑EL TRICAL 5 PPL�UMB�J;yGff❑ MECHANICAL $ Left• R
Contractor's Nam: .� =«0 • 'hone i1 /�'�5J ❑ 'OTHER eve F Ping. Ref.# Parking Req./Provided E
i 7� PROJECT DESCRIPTION SQ. FT. OCCUPANCY
Address(mailing) • C b t, �' 9��'y[ 5T / 3 Planning Notes: 0
9 9 9sj,�/ CON ST RUCTION TYPE �Y•—/t/ VALUATION$ ��Q Oe OQ T
City License No. ` 71� ZONE GRADING CU.YDS. ACRES S.
LICENSED CONTRACTOR DECLARATION �•
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: It Y �s- .'sem\f I - USW° �'� ciD CS
with section 7000) of Division 3 of the Business and Professions Code,and 1.--x•• s ` "M/r
my license is in full force an effect. /� �5 �/ /y p ,.s1I, .- (` .s 1 r ELECTRICAL FEES
License Class •� LISens ry Q 0Or g r W� ta r A.ft 5— C City+ .'Z Sec• 1240
Date Signature /Ic�t (-,•"! �X!ri PLUMBING 11 FEES Automatic Washer Transformer 0 15-50 KW
WORKERS'COMP NSATION DECLARATION Construction Pole Sub. •
0 50+ KW
I hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps
3800, Lab. C.)
Policy No. Company Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps
A
Certified copy is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection
Date ApplicantFan Motors 00-1 HP ❑1%-8
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors
(ens section need not be completed If the permit is for one hundred ($100)or Dishwasher Solar Piping F.A.U. Inc.Solar ❑9-15 HP ❑i6-15+
I certify that in the performance of the workyfor which this permit is issued, I Fixtures
shall not employ any persons in any mann r,reYas t become subject to the Drinking Fountains Solar Tank p Microwave
Workers'' n n Laws of Calitorrs+/i`//'Y/.' Device Boxes
Date Signature Floor Drains SwimmingPool w/Spa P Light
NOTICE: If,after making this declaration, you should become subject to the Outlets Range
'
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal 9
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Switches - Si n
Gas Service Outlets Water Closet 9
I hereby affirm that there I5 a construction lending agency for the performance
of the work for which this permit Is issued (Section 3097 Civ, C.) Intefceptors Water Heater Garbage Disposal Standing Sections
Lender's Name
Lender's Address Kitchen Sink Water Service - Generator 00-5 KW 05.15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash - "'
following reason (Section 7031.5 Business and Professional Code: Any city or - . .
county which requires a permit to construct,alter,Improve,demolish or repair P—Trap Laundry Trays - '•
any structure, prior to its Issuance, also requires the applicant for such permit
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains '
the Contractor's License Law (Chapter 9(commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee $ 3
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). 3 DEVELOPMENT SERVICES REQUIREMENTS:
Oi, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ Zoning Approved By Date
rcompensation, will do the work,and the stf oIsnot intended C or offerr's MECHANICAL ; 1 ti li
for salese (Section Business and f aProfessional Code: The Contractor'smproveFEES Building Approved By Date
License Law 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 Boiler Hood or Type I 0 APPlication:lssuad By Det i AA
employees, provided that such improvements are not intended or of offered for
sale. If, however, the building or improvement Is sold within one year of Com- Canopy Type II 0 .. SU RV O� FE_ '
pletion, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground Y006 —y�
prove for the purpose of sale). BUILDING PERMIT $ SMIP $ `"�
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System ..PLAN CHECK $ PERMIT
tractors to construct the project (Section 7044,BUSlnefs and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 06100,000 BTU 0100,000 BTU , P MBING $ ISSUANCE $
builds or improves thereon, and who contracts for such oroiects with a con- ENERGY P.C. $
tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple System Rtpair/Alteration I . P N CHECK 25% $
proof of their Worker's Compensation insurance should be provided to me. {3 "ELECTRICAL $ GRADING $
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire De ers
E X P I� E C 'PLAN CHECK 50% $ MICROFILM $
Date Owner Heating System& Ducting Registers r1iOIlI= MECHANICAL A- .,5�
I hereby certify that 1 have read this application and state that the above ❑0100,000 BTU ❑1wow BTI: 111C01111.I�te In:�O $ TOTAL FEE $
information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $
and state laws relating to bu'ding construction, and hereby authorize repre-
sentatives of this yyi o ter upon the above-mentioned property f �-r•• Sig• -
Inspection puropes/C, ,�/2(_ pate ___ / ^
Drivers' IA/ Date 11
Drivers' License or SS$ Reinspection Fee $15 Issue Fee $ 3 1ll( _ fo -
7/� of COO�sib3-c¢ozv , $
0865-46,rev.5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor D+TE' O3,' 4f89 7Itt 1 1;2u
CONSTRUCTION AND PLANNING POOL& SPA
Date Inspector Date Inspector
;.APlmROVALS Permit# APPROVALS Permit#
•
1;. "mporary Electrical Service or Poler 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
8 etlectricai Conduit Utility-Undrgind. ' 54. Forms
4:Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5) Steel Reinforcement . 56. Rough Plumbing & Pressure Test
6,lElectrical UF ER Grnd 57. APPROVAL TO COVER-GUNITE
7� Footings ; ..)a - 58. Electrical Conduit-Undrgrnd. -
8. Foundation • i 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, O 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 `
, „ 64. Plumbing System - Final i-
14. Rough Plumbing : ' 65. Electrical-Final
'
15. Rough Electrical-Conduit 66. Solar System-Final
16.E Rough Electric Wiring r 67. Fencing &Access Approval
17,. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18.,Rough Electrical-T Bar Ceiling a 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning, FIRE DEPT. REQUIREMENT
20. Rough Factory,Fireplace -•:•.- r APPROVALS Permit#
21. Ducts,in Structure - .-
-.. 70. Underground Hydro
22. Ducts, Ventilating ...,f71. Product Piping OGas ❑Oil /'
23. Gas Pipe-Rough;& Test t_� 72. Underground Flush
24. Roof Framing
.-• � . 73. Undergrnd.Storage Tank O Gas 0 Oil
25. Roof Sheathing_ •
j 442.4974. 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 4, - HEALTH DEPT. REQUIREMENT • .-
31. Plaster Brown Coat • 79. FINAL INSPECTION -
32. Electrical Power Met@r-Final" - 80. FOOD CERTIFICATE ISSUED -:
33. Final Electric Notes: 3 -Zs_3 ty0 L(-.c.42c s /Fa.„J
34. Final Heating & Air Conditioning S FtEECs R,10 PLAc_Cc- le _
35. Final Gas Pipe-Test BAC/2 /.0 /4"P7. NOON ✓•.-
36. Hood or Canopy TC U ic 3 •�t
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final - -
•
42. Backflow Preventer •
43. Backflow Irrigation '
44. Landscape Irrigation System
i
a
45. Sound Attenuation 1
46. Handicap Regulations EXPIRED
47. FINAL STRUCTURE & BUILDING Incomplete inspections
48. Special Requirements Completed Date ___7_/2-_/./Sig fit- -
49. Electric Release to Edison •!
-c
50. Gis Release to Southern California Gas Co 1 •
'�
51. CERTIFICATE OF OCCUPANCY -
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
PER NO. TRACT NO. LOT NO. UNIT NO.
CIT OF COSTA ME COOO�ISTR U�TION PERMIT A.P.# Zone
/ T ��9g8
Project Address ? C / 5 - S Main Building: Accessory Building:
- - �TVPE OF CONSTRUCTION U NEW LI ADD U ALTERATION 11`1 REPAIR E Z
Applicant's Mailing A.dress s • 's
�l w fl'� pe ❑ CONVERSION III DEMOLISH ❑ OTH T Front G
Owner's Name — O.� '� ��Y f✓- ane 1 j/1 r E�PLA GC 0 9 B N
p �1 7 DESCR PTION OF WORK/USE OF BLD � /v � A Rear I
Address /-QD� �tl''t5" N) S !/� �LO/F 7L •. A L P C Right N
Arch/Eng. 1�,t ,License/No. TYPE OF ' RMIT GRADING .FOUNDATION STRUCTURAL K - G
Address /bee JJJ C6 92 1 5 4 ❑ TENANT ❑ ELECTRICAL Q'PLUMBING ❑ MECHANICAL $ Left R
Contractor's Name 0 5 Phone ❑ OTHER- Ping. Ref.# Parking Req./Provided Q
PROJECT DESCRIPTION SQ. FT. OCCUPANCY Planning Notes: M
Address(mailing) CONSTRUCTION TYPE VALUATION$
City License No. ZONE__ GRADING CU.YDS. ACRES T
LICENSED CONTRACTOR DECLARATION S.
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks:
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect. ELECTRICAL FEES
License Class License No.
Date Signature PLUMBING FEES Automatic Washer Transformer 0 15-50 KW
WORKERS' COMPENSATION DECLARATIONBar Sink Showers Construction Pole Sub. ❑ 50+ KW
I hereby affirm that I have a certificate of consent to self-Insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter pup to 100 amps
3800, Lab. C.)
Policy No. Company Backflow Irrigation Sewer Cap Dishwasher Meter (Dover 100 amps
8 Certified copy is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection
Date Applicant Fan - Motors 00-1 HP ❑1 h-8
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors
(This section need not be completed if the permit is for one hundred ($100)or Dishwasher Solar Piping F.A.U.
less). Inc.Solar ❑B-i$HP 016-15+
I certify t .t in t - performance of the work for wh h this permit is Issued, I Fixtures
shall not . ploy :ny person in any man r as o become bject to the Drinking Fountains Solar Tank Microwave
Workers ••- n—
. i• Laws of Calif a
Date • a•O Signature e O Floor Drains Swimming Pool w/Spa Device Boxes Pole Light
NOTICE: f,afte ma.,ng this deciaratio sit Id become subject to the Outlets Range
Workers' •ompensati•n provisions of the Labor Code, you must forthwith Floor Sinks Urinal
comply th such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches Sign
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.) Garbage Disposal Standing Sections
Lender's Name Interceptors Water Heater `�
Lender's Address Kitchen Sink .(1 I Water Service V Generator 00-5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION ,J'
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays
any structure, prior to its issuance, also requires the applicant for such permit •
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee $ 3
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
'Aenalty of not more than five hundred dollars($500). $ 3 DEVELOPMENT SERVICES REQUIREMENTS:
DI, as owner of the property or •"^'- Reinspection Fee I $15 Issue Fee
on will do the work,and the structure is not intended or offeretl s Zoning Approved By Date
forfor sale ( c( ion 7044, Business and Professional Code: Tho Contractor's MECHANICAL FEES Building Approved By /Zalyt
License Law does not apply to an owner of a property who builds or improves ^ Date ar
thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I ❑ Application Issued By J(!^V\ Date
employees, provided that such improvements are not Intended or offered for
sale. If, however, the building or improvement Is sold within one year of com- Canopy Type I I 0 SUMMARY OF FEES
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground
prove for the purpose of sale). - BUILDING PERMIT $ SMIP $
o I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License taw does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU PLUMBING $ 5. 00 ISSUANCE $
builds or improves thereon.and who contracts for such oroiects with a con-
tractor )
s license pursuant to the contractor's License Law). I am aware that Exhaust System 0 Multiple 0 — __
System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $
proof oftheir Worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING $
❑ I am exempt un r Section & P.C.for this reason Firepl/Fact.BIL ICBG dk Fire Dampers
(' • / PLAN CHECK 50% $ MICROFI LM $
Date /7' Owner �'i ac Heating System&Ducting Registers 7�
�y / at / 4�ri�� o MECHANICAL $ TOTAL FEE $ S v DO
I hereby ertify at 1 have read this application and state that the above ❑0100,000 BTU 0100,000 BTL
informatio is cor act. agree to comply with all city and county ordinances PLAN CHECK 25% $
and state laws relating to building construction, and hereby authorize repre-
sentatives of this city 0 ant- pan the above-mentioned pro arty for
inspection pur•os s. .-' '
Signature i ',L�' Date •G /�/ _
Drivers' License or SS# _ Reins action Fee $15 Issue Fee 3 r �• '
p $ ei CCO3.32+-00035824 + a
0865-46,rev. 5/88 White - Building; Canary - Applicant; Ink - Accounting; Goldenrod - Assessor g`al4' 6/2ei S i 1111: ;.4:'1
•
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
3t 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-GUNITE ';
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9.-Water Pipe-Undrgrnd. - - 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10.•Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewpr Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Fin&
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval •
'-17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in-Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 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 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing 71/3/eye
LIP
39. Water Service-Final 01111 c-a°
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date if
PROJECT ADDRESS: 787 SCOTT PL ' --- - - UNIT: N/A • CITY OF COSTA MESA - BUILDING PERMIT PERM NO: P 045906
OWNER'S NAME: HElyk,RE1c1i SAKAMOTO
Amos: 9801 H T SPRINGS DR ' - PERMIT NO: P 045906 PLAN CHECK NO: N GOVT: N StIPP: N
HUNTINGTON BEACH •
CA 92646 •
CONSTRUCTION TYPE: 5-N ' PERMIT TYPE: PLUPURPOSE: REP
• ( 714 ) 962-3075 '
•
ARCNIENGINEER: ' • REG.NO.: - JOB DESCRIPTION : GAS RE--PIPE • SQ FT: '
I ADDRESS: ' ' UNIT:
CLAIM VALUE: • CALL-VALUE: ' GROUP OCC: R-1 /
PERMmEE: HERBERT SAKAMOTO ( 714 ) 962-3075 •
ADDRESS:. 9801 HOT 'SPRINGS.DR COMMENTS :
t HUNTINGTON BEACH CA 92646 ************************aFeFaFeaeryr*ager***sF**yEetaFiEaF*N-ieyrNaF**aF*** arx�r***#eta ****(E-x***i ***
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONI NG R E Q U T. RM E N T S .
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. S E 'T B A C• K S S •
CITY iC.: STATE LIC.: CUSS: MAIN BUILDING -----'- ---------- ACCESSORY BUILDING --
Date:. ' Signature: FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: - FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sett-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN. LEFT: FT IN RGHT: FT IN
Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C).
POLICY NO.: EXP.DATE: PARKING REQ: PROV: PARCEL: 42417203 ZNE: REF NO:• .
COMPANY: PLANNING NOTES>
❑ Certified copy is hereby furnished.' 0 Certified copy is filed with the city Building Division. > '
Date: Applicant DEVEIJOPMENT S E R V ,I•- C E S( REQUIREMENTS
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(Stool 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 ZONING APPROVED BY. . ,, - -i. DATE:subject to the Workers'Compensation Laws of California. • — —
•Date: ' • Signature: - BUILDING APPROVED BY : _ __ _ DATE:
ode,NOTICE:If,afterstmaking this declaration,wichu should become t i subjectemitthe Workers' revoked.
,ion provisions of the Labor •
1 - rj��
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICATION ISSUED B Y: — • DATE: dSffr/r/E//a' SF�F •
•
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for **.**-.********.***.*****.**.g g74- ** I .N. . * ITWWW �RW***a2ee**.**.* *,*,
which this permit is issued(Section 3097,Civ.C). *-**-*,**,*,*,**,**.*-*********.*******.************ *** ********************************
ADDRESS: - .LEGALIZATION:N ' FEE . S U M M A R. Y STRUCTURAL .SEGMENT:N .
OWNER BUILDER DECLARATION: I hereby affirm that lam exempt from the Coniractois'Stage License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or • 2 , 00
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is-licensed . ' • 25% SM I P/NON-RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business P LAN •
and Professions Codepor that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by • ISSUE FEE 3 . 00 '
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).' BUILDING-DIV-> PERMIT ISSUE . PLAN—CHECK • TOTAL PAID DUE
I, as owner of the property or my employees with wages as their sole compensation,'will do the work, and the TOTALS----> 2 . 00 3 . 00 0 . 00 5 .00 5 . 00 • 00
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law -
' does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through •
REVENUE DIVISION TOTALS--> COLLECTED: 5 . 00 OVER/SHORT: 00
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 ownerwill have the burden of proving he/she did not build or improve • BLDG PMT PLUMBING ELECTRIC MECHANIC, , FIRE SMIP/TOT GRADING PLAN-CHECK
for the purpose of sale). • 5 . 00
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business '
❑ 'and Professions Code: The Contractors'State License Law does not apply to anowner 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).I am aware I N D I V I D U A L F E E D R E A K D O W N
that proof of their Worker's Compensation insurance should be provided to me.
6 lam exempt under n:B P'7044 bc.•S P.C. '
for this re ra0 EMPLOYEE., TYPE QTY DESCRIPTIO N UNIT COST • TOTAL COST
Date: lillre, ownerh � J� vi PLO 1 GAS RE—PIPE 2 . 00 2 . 00
I do hereby mry that am aware of and understand the requirements of Califo a Health and Safety Code Sections 25505,25533,andEND OF FEES
•
•
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 • .
permit for construction or modification from the Air Duality Management District.Residential co struction applications are exempt from
these provisions '
Date: 3/ Applicant: `//%a p/4[�� •
I hereby certify that h ve re�ihis application and state that the above information is correct.I agree to comply with all city and county
•ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned . •
property for in/spection mitoses. ✓�
Date: // �/�W
•
•
I . DATE: 01/31/90 TIDE: 15:10 .
1841-48 White-Building:Green-Code Enforcement:Cenerv-Applicant:Pink-Revenue:Goldenrod-Assessor .
I
CONSTRUSTION 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 . E'- �--
c43.:Electrical Conduit-Utility-Undrgrnd. 54. Forms .. • ei
~4.'Eiectrical Conduit-Undrgrnd. 55. Electrical Bonding '
1,S.4Steel4Reinforcement - - 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 •
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Diens . 64. Plumbing System - Final I '
•
14. Rough Plumbing 65. Electrical-Final -
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval .
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning - - _ FIRE DEPT. REQUIREMENT _
20. Rough.Factory.Fireplace a APPROVALS _, Permit# :
21• Ducts Structure - -- 70.=Underground Hydro
22. Ducts, Ventilating - - - 'a, - 71. Product Piping 0 Gas 00il
21 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 '' ' ,. til: ;. _ _ HEALTH DEPT:REQUIREMENT
-
31. Plaster Brown Coat .. •t 79. FINAL INSPECTION
r
32. Electrical Power Meter_Final - -kik! 4, - 89. FOOD CERTIFICATE ISSUED
33. Final Electric • - % .• • Notes: - - . -. -
•- 34. Final Heating & Air Conditioning
35: Final Gas Pipe-Test - - 21/43/g0 Itfd ... - _
' 36. Hood or Canopy : ,� /.; ._
• 37.. Final Factory Fireplace 7.( .. • _ '
" 38. Final Plumbing - y iaht GO...; - - -
39. Water Service-Final - - 2 ' , _
• 40. Gas Service-Final -- ' - �1�'JJJ�143/qt)LFdJ, _ -
41. Solar Domestic-Final -' - - - - . .
42. Backflow Preventers - ' - +'
43. Backflow Irrigation .. - - - •
' 44. Landscape Irrigation System •_
45. Sound_Attenuation _ t = . _ - -
-
46: Handicap Regulations _ , '- •-• •• - _ ,
. 47. FINAL STRUCTURE & BUILDING • ' "'
48. FINAL PLANNING i,7 . - --
49. Electric Release to Edison ,'/9'' k, -
50. Gas Release to Southern California Gas Co ' t" . -
51. CERTIFICATE OF OCCUPANCY _ - --
No. Date
PROJECT ADDRESS: 785 SCOTT PL UNIT: N/A CITY OF COSTA MESA - BUILDING PERMIT PERM NO: P 045905
OWNER'S NAME: HERBERT SAKAMOTO i
•
ADDRESS: 9801 HOT SPRINGS DR PERMIT' NO: P 045905 PLAN CHECK NO: N GOVT: N SUPP : N
HUNTINGTON BEACH
�' CA 92646 CONSTRUCTION TYPE: 5 N PERMIT TYPE: PLU PURPOSE: REP
( 714 ) 962-3075
�
ARCH/ENGINEER: REO.NO.: JOB DESCRIPTION GAS RE-PIPE •
SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-1 /
PERMITTEE: HERBERT SAKAMOTO ( 714 ) 962-3075 •• .
ADDREss: 9801 F(UNTINGOT TONSPRINGS BEACH DR CA • 92646 COMMENTS :
•
***************************************ie***************************************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that)am licensed under provisions of Chapter 9(commencing with Section 'L ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in fun force and effect. S E .T B A C K S
CITY UC.: STATE UC.: CLASS:
MAIN BUILDING - ACCESSORY BUILDING
Date: Signature: FRNT: FT IN REAR: FT IN 'FRNT: FT IN REAR : FT IN
WORKERS'COMPENSATION DECLARATION: Ihereby affirm that I have a certificate ofconsent to self-insure or a certificate of Workers' LEFT : FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
Compensation insurance,or a certified copy thereof(Section 38W,Lab.C).
POUCY NO.: EXP.DATE; PARKING REQ• PROV: PARCEL : 42417203 ZNE: REF NO:
COMPANY: PLANNING NOTES>
❑ Certified copy is hereby furnished. 0 Certified copy is fried with the city Building Division. >
• **********************************************ee********************************
Date: Applicant: DEVELOPMENTSERVIS
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Oaeconeedt
sonnot be completed the permit S for one hundred WOO)DD or less). .. -
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 ZONING APPROVED BY . •
••••.:. DATE:
subject to the Workers'Compensation Laws of California. -- _ •--- - —
Date: • Signature: ' BUILDING APPROVED BY : ' -• 1 DATE:
NOTICE:If,after malting this declaration,you should become subject to the Workers'Compensation provisions of the Labor
Code,you must forthwith comply with such provisions or tNs permit shall be deemed revoked. c- t i . (�
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for AP PL'I CATION ISSUED BY: A — DATE; L
which this permit is issued(Section 3097.Civ.C).
LENDER:
•
ADDERESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the fonowbmg reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 2 . 00
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she Is licensed 2 5t SMIP/NON-RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)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 ISSUE FEE 3, 00
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred collars($503). •BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
I. as owner of the property or my employees with wages as their sole compensation, win do the work, and the TOTALS---- > 2 . 00 3 . 00 0 . 00 5 . 00 5 . 00 . 00
❑ structure is not Intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law
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: 5 .00. OVER/SHORT : ' .00
improvement is sold within one year of completion,the owner win have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
for the purpose of sale). • 5 ..00
I.as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
❑ and Professions Code: The Contractors'SIne LICBTSe Law does rotapplyto an"nu olproperty whobwfsnrimprovesthereen ******************************************************************************* h
and who contracts for such projects witha contractors)license pursuant to the Contractors'Solace License Law).I am aware
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E -BREAKDOWN
•
6 ham exempt under :DP7044 P.C.
Iorthis reason: EMPLOYEES
PC
S TYPE , QTY D E S C R I ' P T I O N UNIT COST TOTAL COST
•
Date: 0/ 7 f oan . �z e PLU 1 GAS RE-PIPE 2 . 00 2 . 00
I do hereby certify that I am aware of and understand the requirements of Califon'.Health and Safety Code Sections 25505,25533,and END OF FEES
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 •
permit for construction or modification from the Kir m ality Management District.Residential construction applications are exempt from - '
these provisions. .,�//' ///)/�/ /�
Date: 1/7/4,0 Applicant: 4:-7/ — •J� —�{—/ G '
I hereby ce i fy that I have read this appncation and state that the above information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby authorize aprresebntaties o city to enter upon the above.mentloned
property for ins on Pu
Date: /s/r�
1641-46 White-Building;Green-Code Enforcement;Canary-Applicant;Pink-Revenue;Goldenrod-Assessor • _ 01 00053077-00053077 TOT 5.00
DATE: 01/31/90 TIME: 15:10
CQeNSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location .-<- .7
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
_'3. Electrical Conduit Utility-Undrgrnd. 54. Forms .; :c
14. Electrical Conduit-Undrgrnd. 55. Electrical Bonding _
5r Steel Reinforcement 56. Rough Plumbing & Pressure Test
;6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
17.- 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 FloorSystem61. APPROVAL TO DECK .
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof brains 64. Plumbing System - Final .
14. Rough Plumbing 65. Electrical-Final •
15. Rough Electrieal-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL •
19. Rough Heating & Air Conditioning _ - _ FIRE.DEPT..REQUIREMENT
20. Rough Factory-Fireplace -- _ - - APPROVALS.. _ Permit # •
21-. Ducts,in Structurer , • 70. Underground Hydro '
22. Ducts, Ventilating - - -
_ 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe•Rough & Test - . .. 72. Underground Flush
24. Roof Framing , A 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing : ' - 74. Overhead Hydro .
•
26. T-Bar Ceiling(Structural) & Monocoat • r - 75. Dry Chemical - -
27. Frame and Flashing - ' ^ ' 76. Dry Standpipe - _
28. Lathing& Siding '• � . ' 77. FIXED SYSTEM-FINAL
29. Insulation % ' 78. FIRE PREV. FINAL
_i
30. Drywall Nailing _ .. HEALTH DEPT. REQUIREMENT
i 31. Plaster-Brown Coat • • ' .- 79. FINAL INSPECTION
•
• 32. Electrical Power Meter-Final ',• ' 80: FOOD CERTIFICATE ISSUED
•
33. Final Electric : _ - %? a; ; Notes: . -
34. Final Heating & Air Conditioning - • If ' - - '
35. Final Gas Pipe•Test -;2•6 a1 <-67 - . : -
- 36. Hpod or Canopy ; _ ;. �.� ' _.
- J
37. Final Factory Fireplace - -• - � � '
- 38. Final Plumbing - 41.3184 C ' -
39. Water Service-Final -- • t ,
40. Gas Service-Final ' - _ • - .21(3/gq C.IF/) ,
' 41. Solar Domestic-Final • '1 _
42. Backflow Preventer
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 r2,:-
50. Gas Release to Southern California Gas Co r I r
51. CERTIFICATE OF OCCUPANCY -
No. Date
OWNER COLLIER, LINTON DATE 6-4-59
JOB ADDRESS 785-787 Scott P1. BUILDING PERMIT NO. 9529
GENERAL CONTRACTOR Armitage Bldrs. VALUE $ 18,786.00
AP. No. LOT LOT TRACT FIRE ZONE DESCRIPTION OF WORK Dup.W�att.Gar,
INSPECTIONS 4 7/o-SP DATEI GROUP I & J TYPE V ZONE N' 2
Underground Soil mr U.G. Water kIsc 7-7-1 SUBCONTRACTOR PERMITS ISSUED
Underground Gas DATE NUMBER
Overhead Water and Gas
Rough Heating
Rough Plumbing - ? -1/ �3'�/f p ec 1n -Ci-2G-6't/ 7--9-71r . _
Miscellaneousfi�n,"/ _ .z_'/�che- .,•,1/T,_ e,. c '� -� 3 230, 3 --
Prop.
tifil_
Prop. SwriLinc Ho on. St. Swr, l(Y+W (rLt/ &-- ✓ ' (iIYi5it__1-1_3114 _ _G(�
Sprinkling System /
Heating, Final sKL
Plumbing Fixtures J - --ec
Final Gas Test //J' /i / be, ... ./.2
Construction Pole
Underground Power77 ) _
Rough Wiring t5.-//r..J? /7-o�ei 2- /R-s 7 VISR
Trenches 11157+-Forms Ohl-Steel '7-Q-y ...--
Floor
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam 4
yrs
ion PSheathingand and Flashing
Lathing, In R Out y11 �1aa�� ;;'71 , 51
-7- 4
Plaster, brown coat car`f iE /A 1 S ST
Plumbing Fixtures, Final ���,`.Y(.�'/�mi
Electric Fixtures, Final
Building, Final `!
OCCUPANCY 4F/
Form 210-3M-4-59 - 9529
1 •( 4 9529 'e EE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT a ' s Cl
P.O.BOX 317 COSTA MESA, CALIFORNIA FINANCE DEPT.
fOR APPLICANT TO FILL IN COMPLETELY APPLICATIOa�F l(PERMIT
TYPE OR PRINT BUILDING
BUILDING ADDRESS �l /7 R`— f7 Sc Cl2 �- j7J, A
7 d oj
COSTA MESA. CALIFORNIA FOR OFF/CE USE ONLY
eatetRECEIPT NO. PERMIT NOr//
OWNER A MAIL ^�% (�G/ '�[ I I ys
ADDRESS Q 07 / Ry..c4. \Y I T �CE S c. Ysus
CITY a- TEL.
N O. BUILDING �VC " 511: / f/
ADDRESS n ) 7
ARCHITECT . LIE. COSTA MESA. CALIFORNIA
OR ENGINEER NO.
FIRE V�F1p/�y,- ///^
ADDRESS ZONED < I 10 Group I-
STATE APPROVFn 6/y 5:7
CONTRALTO IC.NO. BY �'A L DATE 1 S 1
ADDRESS / 70 ? - iotd , ZONING
LEGAL I LOT S}/' 71 v LONE R NO. S USE OFDI NEW
DESCRIPTION NO. / BLOCK {� ITR C Ol T �I'PLAN9[//� �UILOING
A.P.NO. //G /0 `� ?- APBYPROVED'/// 'i ,/���DA/TE (; �y`�/
SIZE /r5 v I NO.OF BLOCS. YARDS b/ LeEVES 7
OF LOT (( /� S a NOW ON LOT REQUIRED ALLOWED
USE OF (CENTER LINE ST.)
EXISTING BLDG. FRONT �� �Fr. IN.
SETBACK LINE FROM ^x'
CENTER OF STREET 2/f• REAR YARD /� R.SIDE � . FT. IN.
N
Fey I .
de,. I 5—FT.
YARD I LEFT � IRIGHT (Th L.SIDE ✓ FT. IN.
DESCRIPTION OF WORK / '1
VR / REAR /4 `FT. IN.
NEW I ALTERATION I II ADDITION I
REPAIR I II MOVING I II DEMOLISH I
SIZE NGc f ( 3 5L NO.OF
SIZE rl ROOMS STORIES
EXTERIOR WALL ROOF
COVERING COVERING fill_ X t ? ..4 r a 3/
USE OF BUILDING AND WORK TO BE PERFORMEDy
d.../.1,172(.0
IZtt. 2(. �' ../4I /47' r' i ,,.) Id %tea ?C Z‘C.4" r-5/'
/
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.
DING ALL TY ORDINANCES AND STATE L G PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY
BUILDING Co T CTION. /_ - VALUATIONSIGNATUR SrPERMII TTE O� ...WWI 1LIFIAp� //,.I PERMIT FEE $ /�✓/4J[Ft\,
/I
sic -7g (J PLAN CHECK $
AUTHORIZED AGEN TOTAL FEE $ 5 /
OWNER EOVEE, MICHAEL
JOB ADDRESS
DATE y-z-O)
Scott Place BUILDING PERMIT NO. 2 711722
GENERAL CONTRACTOR785 Air Vent DESCRIPTION pF WORK Sunshade
Al' No. 116-702-3 LOT TRACT FIRE ZONE VALUE $ 252.00
INSPECTIONS Signature Date GROUP J TYPE IV ZONE R-3
Soil I PERMITS ISSUED
CGas SUBCONTRACTOR Date 1 Number I Signature
Water Plumbing
I Rough Plumbing
Prop. Swr. Line 0 House Con..0
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole
Underground 0 Power 0
Rough Wiring Heating and Vent.
Trenches 0 Forms 0 Steel Reinf. D
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing —In 0 Out-.0 .
Plaster, Brown Coat ---
Structural, Final e-mn (OA A ,s Electric
Heating, Vent., Refrig. and A.C., Final _
Plumbing, Final and Gas Test 0
Electric, Final
Building, Final G.mcsi- /O/e/&5
•
f 24672 CITY OF COSTA
r COSTA MESA BUILDING-SAFETY DEPARTMENT $E1965P.O.BOk 317 .COSTA MESA.CALIFORNIA •
For Applicant to Fill In Completely . t�}F�ICPERM
TYPE OR PRINT . �..JJ ��-For oly
BUILDING 7 ' r.-- Sco , 7- P / J
ADDRESS 7 J .C. RECEIPT NO. _ T o.
COSTA MESA, CALIFORNIA C/1 !J
///1/�.� � e RECE�� / Z R I I yH
OWNER (Irl 'lcl.neL /2 frr e/• ^ E/
BUILDING "7 r J DoT r PI.
AAIL r ADDRESS
ADDRESS �p �S �•e.�T r �2 .
FIRE
TEL. 1 ZONE TY AO GROUP/
CITY C. (Il. NG.61 z-zvR4 0
ARCHITECT // ✓ TEL
srrPROVHD �r DATE / rJ•-
OR ENGINEER �6!/[.�/ NO.
ADDRESS 7 t s--
/ r ZONING
ZOO/{ NO.OF US[OF NB Yw/LPL+a J/ICL.1�A
4 - I Ic .� _ (/� PLANS I BUILD!NO `A
CONTRACTOR
p / 6/!/Y+- fG. ,l
ADDRESS IO d7 �- n7Ay LEGAL �- f. /. Jo 2�a,Sf+
i1 gTect. DESCRIPTION !!!///LLL o r
� � � ((�� (, Tion - A.P.NO. IIID -Loa-a- 3
CITY (j&S'a�,
NOTE: NO SAVE OVERHANG SHALL BE LESS THAN
STATE TEL. @REAR P.L.
LIC.NO. �� 7J NO• -'' 3(>'� SO"TO SIDE_
EAVES
SIZE I NO.OF SLOGS. ALLOWED (U.B.C.REQUIREMENT)
OF LOT NOW ON LOT
(`�' �"' YARDS APPROVED YARDS APPROVED
USE OF
EXISTING BLDG. J � 2) MAIN BUILDING ACCESSORY BUILDING
SETBACK LINE FROM FRON tTT IZ44, �' FT.
CENTER OF STREET y�‘ S� REAR YARD
SIDE YARD LEFT - I RIGHT R.SIDE SBFT. FT.
DESCRIPTION OF WORK L.SIDE 5 /FT. FT.
I
NEW ALTERATION _ ADDITION X REAR I,S FT. FT.
DISTANCE BET. BET.MAIN&
REPAIR _MOVING _ _DEMOLISH MAIN BLOCS. ACCESS.SLOGS.
BUILDING NO.OF VAR•'# DATE
SIZE ROOMS STORIES C.U.P.# APPROVED
EXTERIOR WALLROOF APPR Vt4� /�/ 1
COVERING I QY7. DATE 9 COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
'ea+ _ v� R...
R
/6
BQ.Fr. R
r.
I HEREBY ACKNOWLEDGE THAT I HAVE REAb 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. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION.bVALUATION T PERMIT FEE $ ®O j
SIGNATURE OF� .` / `�� ��� /� S
PERMITTEE 1.€‘,...1-61410l
S
ra
°O'
AUTHORIZED AGENT 2 6
TOTAL FEE $ •7