HomeMy WebLinkAbout476 WALNUT PL - Building Permits(7i4) 75a-5273 • Fax (714) 754-a856 • wv+w.ci.costa-mesa.c�ILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
i
JobAddress: 476 WALNUT PL
Suite:
Vicinity: RESIDENCE AND ATTACHED GARAGE
Parcel Number: 42632312
Applicant: LEHMAN, JEFFREY
Address: 2415 MARGARET DR
NEWpORT BEACH, CA
Owner: HEAD, JON ROBERT TR
Adtlress 476 WALNUT PL
COSTA MESA, CA �
Convactor. J S L ROOFINC� INC
Address: 241$ MARGARET DR
NEWpORT BEACH, CA
Zip: 92663
Arch :
Address:
Zoning:
Phone: (949) 6463571
Zip: 92663
Phone:
Zip: 92627
Phone: (949) 6463571
License: 747706
Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: 10/02/2003
Issued: 10/02/2003
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING WOOD SHAKE ROOF. INSTALL SHEATHING AND COVER WITH 40 YEAR COMP. INCLUDES ATTACHED GARAGE.
Plan Check: $0.00
Permit: $19525
SMIP Res: $1.02
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: 5196.27
SETBACKS
MAIN STRUCTURE Fmnt 0- 0
ACCESSORY Fmnt 0-0
PARKING Exi_stinq: p
NOTES:
Rear 0-0
Rear 0- 0
Reauired: 0
FEE SUMMARY
PLANNING & ZONING
left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation
Right 0-0
Right 0- 0
$10,200.00
$10,200.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes antl related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRA710N: 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 tor ihe work authorized under this permit to be considered legal, such work must comDly with all applicable codes, end all
requlred inepectiona and tinel approval must be obtained. Failure to obtain inspections and final approval will resul� in ihe expiration of this permit.
FOR INSPEC710NS CALL: (714) 7545626
2446-46�6�00)
WORKERS'COMPENSAnON DECLARAPON: �
I hereby aMirtn under penalry of perjury one of the tollowing tleclarations:
❑ I �ave entl wlll maintain e certificate o( consent to selbinsure 1or workers' compensetion, es providetl for by section 3700 of the Labor Code, for the pertortnance of Ihe
wo fot which this permit is issued.
have and will maintein workers' compensation Insurance, es requiretl by section 3700 of the Lebor Cotla, tor tha pertormance oi the work for which this pertnit is issued.
My workars' compensation Insurente carner and policy number are:
Cerner: � � Policy NumGer:
(This section neetl naf be complefed ll fhe permif is veluetl e ne hundred dolle�s ($700) or less.)
❑ 1 certity Ihat In the performan o e work for whi this pertnit is issued, I shall not empioy any person in any menner so s to becoma subject Io Iha workers'
compensatian laws of Calii tl agree Ihal shoultl become subject to the workers' compensation provisions of Se ion 37 0 of the Labor Code, I shell forthwith
comply with the58 provlsi / �'/y//��[�'.� r1,
Applicant SignaWra: `� �� "` ' —Dele: � � �-/
WARNINGt FAILUflE TO SECUR 5' PEN 1 COVERAGE IS UNIAWFUL PND SMALL SIIBIECT AN EM�LOYER TO CRIMINAL �NAl.TIES AND CIVIL FlNES UP TO ONE HUNDRED
TMOUSANDOOLLARE(5100, AD I TOTNE OFCOMPENSATION,DAAIAGESASPROVIDEDFOFINSECTION39WOFTHEU00RCOOE,IMEREST,ANDATTORNEV'SFEES.
IICENSED CONTRACTORS DECLARATION:
I hereby eHirtn Ihat I em licensed under visions ol ter 8(wmmendng wit� Section 7000) of Division 3 of the Business and Professions Code, end my license is in tull
force end affecL Llc. p Class N
Conirador's Siqnawre: � Dete:
CONSTRUCTION LENDING A .
❑ I here6y eHirtn that there is e construction lentling egency for tha pedormance of Ihe work for which Ihis permit is issuetl. (Sec. 3097, Civil Code).
Lenders Name: Lentlers Atltlress:
Signature:
OWNEFi•BUILDER DECLARATIONS:
Date:
I hereEy eNirtn that untler penalry of perjury thai 1 em EXEMPT FROM TME CONTRAC70RS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Professions
Code: Any city Or county which requires e permit to construcl, elter, improve, tlemolish, or repair any structure, prior to its issuanCe, also reqWreS the eDDlicant for SUCh pertnit
to file a signetl statement that he or she is licensetl pursuant to the provisions of the Contractors License Law (Chepter 9(commencing with Section 7000) ot Division 3 of the
Business end Pmfessions Code) or thal he or she is exempt therefwm and fhe basis for the alleged exemption. Any violation of Section 7031.5 by any appliwnt for e pertnit
subjects the epplicent to a civil penalty of not more than tive huntlretl tlollare ($500).):
❑ I, as owner of the properry, or my employees wi�h wages as �heir sole compensation, WILL DO THE WORK, end the structure is not intended or otfered tor sale (Sec.
7044, eusiness and Professlons Cotle: The Contractore License Law Aoes not apply �o an owner of property who builds or improves ihereon, and who does suc� work
himseH or herself or through his or her own employees, provitletl that such impmvements are not intended or oflered for sale. It, however, the building or improvement is
soltl within one year ot wmpletion, the owner-6uilder will have the burden of proving that he or she did not builtl or impmve for purpose of sale.). �
❑ I, as owner Of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 704d, Business end Profes5ion5
Cotla: T�e contrectors License law tloes not apply to an owner of propeny who Duiltls or improves ihereon, and who contracis tor such project with e contracmr(s)
license pursuant to �he Contraciore License Laws.).
❑ I am exempt under sec. Business and Prolessions Code for this reason:
SignaWre: Date:
Owner ID verified by drivels license. ❑ Ve5 ❑ No Drivefs License No.
Verifica�ion ol OwnerShip by (type of daument, i.a. - properry ta¢ biil or deed):
Expires:
DIVISION OF INDUSTRIAL SAFETY PEqMiT CER7IFICATION:
❑ I hereby certify that no excavation live (5) or more teet in tlepth into which a person is raquired to descend, will be made in connection with work authorized by ihis
permit, and ihat no buildinq atructure, scaHolding, falsework, or demolition or dismantling �hereof, will be more Ihan thirty-siz (36) teet high. (Chap. 32, Gry 2, Art 2, Sec.
347, Title e, Calitomia Adminisiretive Code).
❑ As ownar-builder, I will nat employ anyone to do work which would require e permit Irom the Division ol Industnel Sefety, as noled ebove, unless such person has a
permit to do such work Irom ihe tlivision.
Signeture: Date:
Division at Industnal Satery Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 W III Ihe applicant or present or luwre building occupent need to lile end certify e Business Plen br emergency response to releese or threatenetl release of e herertlous
matedel7 ❑ Yes ❑ No
(Seciion 25505 of ihe Califomia Health en0 Salery Code requires, with some ezceptions, ihet e Business Plan be liled wlth Ihe Cosia Mesa Fire Depertment Dy every
business which has at any one time dunng e reponed yoer a quantiry of hazardous matenals equal to or groater than a weight o1500 pountls, or a volume of 55 gallons,
or 200 cu�ic feet of compressad gas at standard temperature antl pressure).
.................................................................................. _........................................................... _.................................................................................................................................................................. _............................. _..................... _............
2 Does or will t�e applicant or presem or fuWre buildinp occupani need to lila a registratlon lorm tor acutely hazertlous materials7 ❑ Ves ❑ No
(Section 25533 0l the Calltomia Heallh antl Salety Cotle, wilh some ezceptions, requires registratlon with the Costa Mese Fire Depenmont 6y eac� business wNch et eny
ane tima �as on hand a quentiry of ecutely haiardous meteriels equel co or greater Ihan a weight ot 500 pounds, or e volume ot 55 qellons, or 200 cubic feet o1
wmpressed ges e1 stentlard IempereNre entl preuure).
............._................................._.._._.........................................._................................._....._—................................�............................._....................................................................................._.__..................._......_........_...""._........
3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Pisk Management end Prevention Program br aately hazartlous matenals)7
an
t ot the Califomia Health and Safery Code provides tha� the Costa Mesa Fira Departmenl may require Ihe preparatioq cenification and filing with the Fire
an RMPP by businesses which are requiretl to reglster ecutely hazardous matenals wlth ihe Fire Depariment.
�� or will Ihe applicanl or presen� or fuNre building occupan� require br �he work whiCh is �he subjecl o� lhis e plicaiion a ermit lor such consiruction or
the Soulh Goa52 Air �ualiry ManegemeN Oistdct or Irom any omer eir polWtlon control tlistdct or egency7 � Yes � No
lion 658502 of the Celifornie Govemment Coda requires that the requested information be furnished on epplicailons tor nomresidentlal Ouiltling permits).
any part of the faciliry to 6e const�
ies", ihe faciliry must meet the req
............
pertnit irom Ihe South Coast Air
ication, have all of the disclosures
ier Ihis permlt be withln 1000 feet irom ine outer bountlatles ot a scnool'
ot Sec�ion5 25534 and 42303 of Iha Califomia Heal(h and Safery Cotle).
r other air
and Safe�y
or agency
an matle?
Qf yes", attach certificate ol compliance irom ihe appropnate air polWtion conirol otticer).
CERTIFICA7E OF COMPLIANCE: I certity tha� under penalry oi Derjury Ihe iniormation given above is correct. I a9ree to comply with all state laws and ciry ordinances
regartling Hazardous Materials and Emissions.
Signeture:
Date:
CERTIFlCATE OF COMPLIANCE AND ORVA710N OF ENTAV: I cenity untler penalty of perjury ihat I have reatl this epplication and state Iha� �he iniortnation given is
corract. I agree to co ply with all s laws entl city orCinances relating to building construction, antl authonze representatives of Ihe Ciry of Costa Mesa to enter upon the
above-descnbed pro rry tor inspe '�n purposes. I egree not to occupy or allow occupancy of any building authorized by this permit until tinal insDeqion.
ture Ot Legal Own r) I{� �] ('O��
e l) L� V
Or Auihonzetl Applicani
CODE �. Qaj[ 1(�II196$ �1 � INSVECTIONTYPE Qeg f[1�A1S
1616 Fixatl System Final Fire Prevention 206 Final Mechenical
1266 Paol Spa Final
200 Final Ro-Roof �� – g"� 3��
201 Finel BIocWRetaining Wall ,
202 Finel Fectory Fire Place
203 Final Sign
204 Final Demolition
208 Final Plumbing
210 Finel Elecirical
212 Finel Fire Preven�lon
220 Final Plenning Approval
222 Finel Site
250 Final Builtling/Occupancy
AOP���ant ta fill in all spaces
CiTY oF COSra�M/�E SA CONSTRUC/TyIO�N PE/R�MMIT
'ProjectAddress �'/!�o L!%.�C�/V! ri.i9C.� �+•�•/
ApplicanYs Mailing Address ��
Owner's nlame �� �.� Phone +s'y�'9�G
Address y%% ..y.�_/�h/� /D�ACC �5�01 /ilESA
Arch/Eng.{-s'MML� License No.
Address
Contracior'sNam« "sts1/L �'Q• �. Phone
Address ( mai I i ng)
City License No.
LICENSED CONTRACTOR DECLARATION
I he�eby affi�m [hat 1 am licensetl untle� provisions ot Charter 9(commencinq
wi[h section ]000) Of OiviSion 3 of the Business and Prote55ions Cotle, antl
my license is}p il orce antl eHect.
LJCE052 C d5
a igna u >
WORK R' COMPENSATIO EC ARATION
I hereby atfirm that I'have a rf ' te ot consent to seli-insure or a certiticate
Workers' COmpenSa[iOn rante, or a certifietl cOpy thereOf (Section
- 00, Lab. C.) � .
Yolicy No. Company
Certifietl copY is hereby�furnishetl.
Certified copy is filetl with the city Builtlin9 Division.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
�(TM1issection n¢etl nat be completetl if the permit is tor one huntlretl ($300) or
I ss).
I erlify that in the pe�(ormance of Ihe work tor whic his perm�t is issuetl, I
all not employ any perzon in any ner as ecome subject to the
orker nsation Laws of Calit
Date ��g Signature
NOTICE: If, afte� making this tle a� n, you shou tl become Subject t0 th¢
Wo�kers' Compensation provisi 5 the Labor Cotle, you mus[ forthwith
comply with such provision or this permit shall be tleemetl revoketl.
CONSTRUCTION LENDIN ENCV
1 herety a/firm that lhere is a construction lentling agency for the perfo�mance
of the work for whicM1 thls permit is issuetl (Section 309] Civ. C.)
Lentler's Name
Lentler's Atltl�ess
OWNER BUILDEH �ECLARATION
I hereby affirm that 1 am exempt trom the Contractor's License Law for tne
following reason (Section 7031.5 Business antl Professional Cotle: Any city or
county which requires a permit to construct, alter, improve, tlemolish or repair
any itructure, ptio� to ils issuance, also requires the applicant for Such pe�mit
to file a signetl statement that M1e/she is licensetl pursuant to the provisions of
tne Contractor's License Law (Chapter 9(commencinq with Section ]000) of
DiviSion'3 of the Business antl Professions Cotle) or that he/sM1e is exempt
K,j[�,�grefrom antl the basis for lhe allegetl exemption. Any violation of Section
31.5 by any applicant to� a permit subjects th¢ applicant to a civil
.� alty of not more [han tive nuntl�etl tlollars (E500).
��, a5 owner of the property or my amWe'92E�S�witM1 wages a5 their sole
pensation, will tlo tne work, antl the sVucture is not intentletl or ofteretl
for sale (Section ]044, Business antl Protessional Cotle: The ConGactor's
Lirense I.aw tloes not appty to an owner ot a property who builtls or improves
� the�eon, antl who tloes such work himself/herself or through M1is o� her own
employees, provitletl [ha[ sucM1 improvemen[s are not in[entletl or offeretl for
sale. If, however, the builtling or improvement is soltl within one year ot com-
D�etlon, the owner will have the burtlen Ot proving he/she tlitl not builtl or irm
p�ove for the purpose ot sale).
❑ 1, as owner of the O�operty, am exclusively contracting with IicenSeC con-
tractorsto construct the project (Section ]044, Buziness antl Professions Cotle:
The Contractor's License Law tloes mt apply to an owner of property who
builtls or improves thereon, antl who contracts Por such projects witM1 a com
traCtor(sl license pursuant to the Contractot's License Law). I am aware that
proof of their Worker's Compensation insurance shouttl be provitled to me.
❑ 1 am exempt untler Section B. & P. G. tor Ihis reason
s� .s,_ �a _ .—! _ . _
Date Owner
1 h¢reby ce� ity that I have �ea�
information is correct. I agree to
antl state laws relating to builtlir
Signature
.Drlver5' L
CMF 0865-4
�
Mat the above
mty ortlinances
mthorize repre-
t orooertv for
those within �eavy Do�tler lines anE sign all apPropriate Eeclarations.
E3 333"�� TF�GTNO. LO(N� UNITNU.
f IK]4 7 % 6
TVPE OF CONSTRUCTION NEW ADO ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHE
DESCFIPZION OF WORK/USE OF BLDG� �� _ �
TYPE OF PERMIT LJ GRADING CJ FOUNDATION L7 STRVCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ. FT. oCCUPANCv �
CONSTRVCTIONTYPE VALUATION$ 4fCOC
ZONE GRADINGCU.VDS. ACRES—
Remarks:
p�, z
Bar Sink
Backflow Preventer
Backflow Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavamries
P-Trap
Roof Drains
Showers
Service Sink
Sewef Cap
Sewer Connection
Solar Collecmrs
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closei
Water Heater
Water Service
A uto-W ash
Laundry Trays
FEES
Reinspectian Fee $15 Issue Fee $ 3
MECHANICAL FEES
Boiler
Duct- Under Ground
Duct � Strucmral
Duct - Ventilating
Exhaust System ❑ MWtiple ❑
FirepVFact. Blt. ICBO #
Heating System & Ducting
❑0.100,000 BTU 0100,000BT
Refnspection Fee � $75
30/84 White - Builtlinq; Canary - APplicant: Pink - Accounting; Goltlenrotl - ASSesSor
Hoodor Typel ❑
Canopy Type I I ❑
Refrigeration System
�0-100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee � $ 3
n.r. # L
S Main Buildi
E
T Front
B Rear
A
C Right
K
S Left
Ping. Ref. #
Planning Notes:
�.���
MAY -.4 s000
— 2 � �--
� � r•., rn� ;AccessQt.
� v �n r
"... ... . .. . . .�.
�' � Zone
Building:
Parking Req./Provided
ELEC7RICAL
Automatic Washer Transformer ❑ 15-50 KW
Construction Pole Sub. ❑ 50 + KW
Cooking Unit Meter ❑up to 100 amps
Dishwasher Meter ❑ove�100amps
Dryers ❑Gas ❑Electric Sub Panel
Fan - Momrs �0-1 HP �1'h - B
F.A.U. Inc. Solar �9-15 HP �76-15+
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0-5 KW �5-15 KW
Yole Light • -'
Ran9e � -
Sign
Standing Section:
Trash Compactor
FEES
Z
O
N
I
N
G
R
E
�
M
T
$
Reinspection Fee !$15 luue Fee $ 3
DEVELOPMENTSERVICESREQUIREMENTS:
2oning Approved By � Dat
Building Approved By Date
Application luued By Dat�
S MM Y OF FEES
BUILDING PERMIT $ � ��� SMIP $ ��Z^
PLANCHECK $ ��' L� PERMIT
PLUMBING $ �SSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTFICAL $ GRADING $
P�AN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTALFEE $ i18.g2
PLAN CHECK 25% $
,CONSTRUCTION AND PLANNING POOL & SPA
,APPROVALS Permit# � Date Inspector AppROVALS Permi # Date Inspector
i�. �Temporary Electrical Service or Pole 52. Pool & Equipment location�.:
2, Soil Pipe-Undrgrnd. �_� 53. Steel ReinforcemenY'�r'�;. 4''
3. Electrical Conduit Utiliiy-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ��•� '�'"
5. Steel Reinforcement '• . 'l °� . 56. Rough Plumbing & Pressure Test
6. Electrical UFER Gmd. ' 57. APPROVAL TO COVER-GUNITE,'�, � i `, �.
7. Footings 58. Electrical Conduit-Undrg�nd,
8. Foundation '' 59. Gas Pipe, � Undrgrnd., T�est'
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 67. APPROVAL TO DE K%;� '
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Fi�al
12. Sewer Cap 63. Heater & Vent-Final �
1� l
13. Roof Drains 64. Plumbing SYstem - Final�, �, �: - �
�
��-�. ,�.,:..
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
i6. Rough Electric Wiring 67. Fencing & Access Approval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOUSPA 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 O Gas ❑ Oil '
23. Gas Pipe-Rough & Test 72. Underground Flush •
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ 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 FINA�, �
29. Insulation 78. FIRE PREV. FINAL � � �
30. Drywall Nailing HEALTH DEPT: REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION � '
32. Electrical Power Meter�Flnal 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: • �
34. Final Heating & Air Conditioning �
35. Final Gas Pipe-7est • •'
36. Hood or Canopy
37; Final Factory Fireplace .. .
38. Final Plumbing � -
39. Water Service�Final ` �-
i
40. Gas Service-Final ' �
41. Solar pomestic-Final �
� � �
i . r
42. Backflow Preventer �'� �� '
; ,,
�,43. Backflow Irrigation , ,.1^ ,(
:44..'Lapdscape Irrigation System / ^� . 7. �
;' ,
,�5. Sound Attenuation � • � • � .
� i
�
r � � ._ , .
46.- Handicap Regulations ..
47. FINALSTRUCTURE&BUILDING °• ' '
- - 3os �Q L/�& JdC.p�' i• : i, .
_48.;SpecialRequirementsCompleted . :�� � ".
:.
,49. Electric Release to Edison ' ' ; ; •
.
50. Gas Release to $outhern California Gas Co '� � !� j
51. CERTIFICAT� OF OCCUPANCY , -
;.:
No. Date
�
�
�
GENERAL CONTRACTOR
AP No. L7,$_Q91}-Q3 IAT
INSPEC'PIONS
G
Wncer
k
TRACP
� Signature
G'3
FIRE ZONE
DATE GROUP
DATE 3-7-63
BUILDING PERMIT NO.
VALUE $ 14,E) .QQ
DESCRIPTION OF WORK i
TYPE V ZONE
SUBCONTRACTOR
R-1
[ 'L:�
� �� i 8s i i
>;i7STA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 91] COHTA M68A. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
eui�omc �
ADDRES9 T �.
COSTA MESA, CALIFORNIA
�—
!
6ETBACK lIN6 FROM r /
CENTEfl OF BTREET .J G O REAR YARD%]. � O
rSIDE YARD I LEFf S�� ��� I RIGHT �O �^ ���
1 DESCRIPTION OF WORK
BUILDIN6 f>'��ArF �
SIZE
EXTERIOR W LL�JeD
COVERING 7 {�LB
USE OF BUILDING AND V
�E RECEIUED
1963
� FI�H�I�E1DEPT.
APPLICA�j�W $�ft��lfij�ESA
BUILDING �
For Office Use Only
REC81P� NO. P6RM�T NO.
� DAl7l�'Y/' �i81/��
� I I NO. OP
rurve
NOTE: NO EAVE
YARDS MPROVED
MAIN BUIL�IN6
DISTANCE
MAIN BLDi
VAR. #
l�i
3/ � DATE /� '�
NINa —
UB80PN8W �
euaoma
?' 3
IG HAL�BELE95THAN
YARD3APPROVED
ACGESSORY BUILDR
DATE
' � � SO. PI'. �. _
I HENBBY AC1(NOWL8D08 TH/1T 1 XAVB READ TXIB APpLIGT�ON TX8 AMOIINT BHOWN UNOHP VALUATION IB p
ANG 8TAT8 THAT THH ABOVE 19 COAq[CT AND AOHEB TO COM� PlIRP088 OR BBTABLI8MIN0 A PERMIT P88
PLY WITH ALL CITY OqDINANC88 ANO BTATB LAWB q80YLATINO yqLUATION �
BUILDINacOrvsTauCiloN. PERMITFEE $
SIGNATUREOP �'�� S//� /0� _
PERMITTE j ;7 —
AUTHORIZED A6ENT G
a
0
�e F
Y' O
0
�— a
_ o
m
S'
s
_.� �