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HomeMy WebLinkAbout1317 STONEFIELD ST - Building Permits ADDRESS aBUILDING: 1317 STONEFIELD ST anti: • CITY OF COSTA MESA - BUILDING PERMIT MCI g -000a3 MIENSNAIIE IF KNOWN CARL CARLSON • FLOOD : X 46 PERM NO: M 086542 ADORES& 2745 STARBIRD DR COSTA MESA, CA • 92626 �2'� PERMIT NO: M 086542 PLAN CHECK NO: N GOVT: N SUPP : N APPL.IMAMS A00RESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: MEC PURPOSE : OTH • ARCHITECT OR ENGNER: sac.No.: JOB DESCRIPTION : F.A.U . & A/CSQ FT: AIM OR ENG.'S ADDRESS: WIT: CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 / coNmACTOfrsMAIt PACIFIC AIR COMFORT (714 ) 937-1333 - CONTRACTORSMMImo 1327 S LEWIS COMMENTS : X AoDREss:ANAHEIM CA ucIlo.: 500236 *********************+Eat*itrt*ttac-*rtiEittESyatNrEatr('* -*r('** Eat&-SEiE -N****3t*+E+t*****+tx-it******x'*rE* 92807 uwT: ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 SETBACKS (co. _ •with Section 7000)d Division 3 of the Business and Professions Code,end my license bin full face end effect. C' sac. 0.:042281 uc.cuss: C20 LIC.NO.: 500236 EXP : 03/98 MAIN BUILDING ACCESSORY BUILDING -- FRIT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN tale: 3 d' a Contractof' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN WNER .UILDER DECLARATION:I hereby affirm under pent of tory!hall am exempt from the COMradore License Lew for the �.- 7,; .reason(Section 7031.5 Bus=es and Professions Code:Any city or county whidi requires a penult to construct,eher.improve, PARKING REQ: PROVV: PARCEL: 14102403 Z N E: REF NO: •..modish,or repo prior W any structure, kth s issuance.also requires e applicant for such penal to file that « a signed statementhe she PLANNING NOTES> K 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 there'll=end the basis for the alleged exemption.My violation of Section > - ,.a' •., 7031.5 byanyepplicanl for aperme subjects the applicant to a cad penalty of no.more than five hundred dollare(S5oo1). ************************************aE* *************************************cif** ❑ I,as owner of the property or my employees with wages as their sole compensafion,will do the work,and the structure is not intended DEVELOPMENT SERV-ICES. REQUIREMENTS or offered for sale(Section 7044,Business end Professions Code;The Contractors License Law does not apply to en owner of property _�f who buids or improves thereon,and who does such work himself or herself or through he that or her own employees,provided t such - improvements erenaintended or offered faesle.l,however,the building orinprovemenle sal within one year d completion.the ZONING APPROVED BY `•`� DATE: owner-builder will have the burden of proving he or she do not build or improve for the purpose of sale), • o Prof aas rtoes:rn°r°eContraeae chnively O0°ialwddooees Warmediro with w trownera°propen=mina ywinpbuild°d« proves Irk Business BUILDING APPROVED BY : . ../' DATE: contracts for such Buprotects witha contractor(s)licensed pursuant to the Contractors license Law). A'''; AmurI o lamexempt under Section: B.AP.C..for this reason: APPLICATION ISSUED BY: 44's DATE: * Date' (2,.... LEGALIZATION:N F E E SUMMARY STRUCTUR • EG ENT:N I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sedions 25505,25533,and 25534,and that I or any future building occupant will I ell not(circle one)need to comply with said male codes and the requirements ler a permit for construction ormodification from the Air Duality Management District.Realdedilcondnidonepptmre tionaaexempt from theBLDG PMT PLUMBING ELECTRIC MECHANIC -FIRE SMIP/RES GRADING provisions, PERMIT 32 . 00 Date: Applicant: 25% SMIP/NON-RES PLAN WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following declarations: ISSUE FEE 22 . 00 ❑ Ihave and will maintain acertificate of consent toself-insure for workers'canpenanice,aspred provided d n3700meLabr BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE Cede,for the penama emmew«kf«wNhmpermit is Bpa ,Baee. TOTALS----> 32 . 00 22 . 00 0 . 00 54 . 00 54 . 00 . 00 cI have and wit mainlan workers'compensation insurance.es required by Section 3703 of the Labor Code,for the performance of the work for which this permit is issued.My workers'compensation insurance caner end policy number we Carrier GOLDEN EAGLE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 54 . 00 OVER/SHORT: . 00 Policy Number. NWC.ii /399-04 11 /25/98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK /., l'This section need not be completed I the pemsk is for one hundred dollars(5100]or less.) 54 . 00 1,,.//❑ I cert performance in the perfownce of the work for which the permit is issued,I that min l employ any personany manner so as to ' subject to the workers'compensation laws d Cad M.end agree that l I should become subject to the workers' ******************************************************************************4 * penavion provisions ofof `I Section 3700' ,,,,,,,sit the Labor Code,I hheathwnh those provisions. INDIVIDUAL• F E E BREAKDOWN ` ,,,,,,,sit • rW/Nun to secure waren:compensation coverage Is unlawful,and shall subject an employer to criminalpenalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST �ll�fines up to one hundred thousand dollars(s100000),In addldon to the cost of compensation,damages as provided ler In Section 3706 of IM Labor Code,Interest andatmmey's Mee MEC 1 INST FORC-AIR/GRAV FURN <= 100 K BTU 13 . 25 13 . 25 CONSTRUCTION LENDING AGENCY:I hereby affirm under pelt o parlay that there is a ndnstnwnn lending agency fa the MEC 1 REFRIGERATION SYSTEM <= 100 K BTU/H 13 . 25 13 . 25 performance of the work for whist the permit is issued(Section 3097.Ca C). MEC 1 GAS PIPING SYS 1 - 4 OUTLETS 5 . 50 5 . 50 LENDER'S NAME: LENDER'S ADDRESS: END OF FEES I certify that I have read this application end state that the above idamalion is correct.I agree to comply with all t and county ordinances and state laws relating to building construction end hereby authorize representatives of this city to enter upon the ebove'mentioned property • for inspection purposes. LYLE COOTER01-13-1398(11:53 NIns4.Z1 Point Name _ ) ` V. �J�/,�}L/��S� �/2/ 9g :.ain•21-[2180.6 Date PERMIT:085642 Signature • . �vl�Appficat/C°Ire a I r/ i (5151.4e.WP) White-Building&Safely;Green-Rle;Canary-Appicent;Pink-Revenue:Goldenrod-Assessor C . CONSTRUCTION AND PLANNING hi' - POt,__ . SPA r 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 . '6."$teel Reinforcement • 56. Rough Plumbing & Pressure Test 1, 6'. 'Electrical UF ER drnd. 57. APPROVAL TO COVER-GUNITE , • 7. Footings 58. Electrical Conduit-Undrgrnd. 8, Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. ' • 1 . 60. Backwash Lines, P-Trap, 0 Undrgrnd. -. Y 10. Structural Floor System - 61. APPROVAL TO•DECK , 11. _Property Sewer Line & House Connection 62. Backwash & Receptor-Final -1 r 12. Sewer Cap _ . . - 63. Heater & Vent-Final 13. Roof Drains 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-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL . 19. .Rough Heating & Air Conditioning - .-,.. • • FIREDEPT.'REQUIREMENT - 20.-Rough Factory Fireplace 1.-1:: - •- - ,i APFROVAES'.' Permit#' 21. Ducts, in Structure:. - - 70. Underground Hydro 22. Ducts, Ventilating` „ - - _ ' L; 71. Product Piping.D Gas ;O Oil 23. Gas Pipe-Rough & Test - ' - 72. Underground Flush _. C, 24. Roof Framing _� ' �tj.;; 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing I .' ,.r 74. Overhead Hydro: 26. T-Bar Ceiling (Structural) & Monocoat D __ - 75. Dry Chernical .r 27. Frame and Flashing . - 76. Dry Standpipe, ., : • , - 28. Lathing &Siding - -. 77. FIXED SYSTEM'FINAL - 29. Insulation . • 18. FIRE PREY. FINAL 30. Drywall Nailing - + ' ' 'HEALTH DEPT. REQUIREMENT 31. Plaster Brown,Coat ' - 79. FINAL INSPECTION [ -32. Electrical Power Meter-Final - _ 80. FOOD CERTIFICATE ISSUED w i : 1 i -1 ....i 33. Final Electrie. - . ' . _ _/ Notes: ,_, 34. Final Heating& AirrConditionirig - 1i _ p' Mas ,-- •' - 35. Final Gas Pipe-Test, V '; ' ,. -, 36.. Hood or Canopy - . 37. Final Factory Fireplace • , . - •* - . - , 38. Finan Plumbing - - ` 39. Water Service•Final • _ I. , 40. Gas Service-Final L ' 41. Solar Domestic-Final • • , a - 42. Backflow Preventer , - -. - 43. Backf low Irrigation ,• - • 44. Landscape Irrigation System -. - " 45. Sound Attenuation , , 46. Handicap Regulations - - - - 47. FINAL STRUCTURE & BUILDING . , 48. FINAL PLANNING • - - . 49. Electric Release to Edison - • 50. Gas Release to Southern California Gas Co • . - 51. CERTIFICATE OF OCCUPANCY No. - Date ADDRESS OF BUILDING: 1317 STONEFIELD ST UfaCITY OF COSTA MESA - BUILDING PERMIT Egg - Do oa7 OWNERS NAME IF KNOWN: CARL CARLSON FLOOD ; X 46 PERM NO: E 0865431 ADS: 2745 STARBIRD DR • COSTA MESA,CA 92626 PERMIT NO: E 086543 PLAN CHECK NO: N GOVT: N SUPP : N APPL.MAILING ADDRESS CONSTRUCTION TYPE: V-N PERMIT TYPE: ELE PURPOSE: OTN ARCNRECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : F.A.U. & A/C SQ FT: ARCH.OR ENG.'S ADDRESS: UNIT: CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 / CONIRACTORSNAn: PACIFIC AIR COMFORT (714 ) 937-1333 CONTRACTORS MARINO 1327 S LEWIS COMMENTS: REF:M-86542 ADDRESS ANAHEIM CA uC.ND.: 500236 ******+E***-x**RERERr*RERE*****-x****IE*****K-**+EIe*R(-*At*-x-IraE*****at**N***-x-**RE*-It***K-aERt******* 92807 um ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 SETBACKS (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect. CITY LIC.NO.:042281 LIC.CLASS: C20 uC�NO.: 500236 EXP : 03/98 MAIN BUILDING ACCESSORY BUILDING / 7 c Contractor. lFO FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN / ' / LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN Os BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt hone the Contractors License Law for the reason(Seeion7031.5 Business and Professions Code:Any city or county which esquires a permit to construct,alter,improve, PARKING REQ: PROV: PARCEL: 14102403 ZNE: REF NO: •-morepairh,or repany structure,prior to its issuance,also require•the applicant for such permit to fib a signed elaatement thet he or ahe h S licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING NOTES> Business end Professions Code]or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section > .. 7031.5 by any applicant for a permnot s subjects the applicant to a civil penalty of more than live hundred dollars[$5DOD. ************1k**************1F**1f*****itt**********1E********************1E********** El I.as ovmer of the propeny or my employees wah wages as their sole compensation,will do the work.and the structure is not intended DEVELOPMENT V E L O P M E N T S E:R V I C E S R E !1 U I R E M E N T S Businessor offered for sale(Section 7044, and Professions Code:The Contractors License Law does not apply to an owner d property yd who builds or improves thereon. such and who does work Itself or herself or through his or her own employees,provided that such • improvements are nota sale,If,however,the building or bnprovemeM is oned completion, ZONING APPROVED BY sold within year comn,the • ,r intended or offered lDATE: owner-builder will have the burden d proving he or she did ltd build or improve f«the purpose d sle). • ❑ I.as owner of the propeM,am exclusive&contracting with licensed contractors to co crud the prded(Section 7044,Business end Professions Code The Contractors License Law does not apply los owner of property who builds or improves thereon end who BUILDING APPROVED BY : DATE: rif contracts dor such projects with a mmredor(s)licensed pursuant to the Contractors License lew). 1:1 �, �, ,{r I am exempt under Section: B.AP.C.,Iorthis reason: APPLICATION ISSUED BY: DATE: �1/E/7 Date: Owner: LEGALIZATION:N F E E SUMMAR STRUCTUR• EG ENT:N I do hereby certify that I am aware of and understand the requirements e)CaliforniaSectionsHealth and Safely Code 25505, end 25534,and that I or any future building occupant will/will not to(circle one)need to comply with said date codes end the requirements for apermit for conatmotionormodification from the Aitiry ananagen«gDidrid.ResideMdcondrudionawlcationsan(senddmmMeseBLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RE'• GRADING provisions PERMIT1 1 . 00 Dale: Applicant: 50% SMIP/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby am under penally el perjury one of the following declarations: PLAN Iarum ❑ I have and ail maintain a certificate d consent to self insure for workers compensation,as provided for by Section 3700 d B the Labor U IL E •N G E L 2 • -0 Code.(ortheperformanceofthewokforwhichthispermitisissued. BUILDING DIV > PERMIT ISSUE PLAN CHECK TOTAL PAID DUE _Cl Ihave and witmaintanw'orkers'cmpesationinsurance,srequired bySection 3700ofteLabor Code,for the performance ofthe TOTALS----> 11 . 00 22 :00 0 . 00 33 . 00 33 . 00 . 00 1� work for which this permit is issued.My workers'compensation insurance carder and policy number are: Carder: GOLPEU EAGLE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 33 . 00 OVER/SHORT: . 00 C' "1 Policy Number: NW9-04 11 /25/98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN- HECK This section need not be completed I the perm's is for one hundred dollars/51001 or less) 33 . 00 3 I certify that in the petomance of the work for which this permit is issued,I shall not employ arty person in any manner so as to •. oma suublect to the wotera'ccnpensation dews d Cedernu, nd eagree Mat H I ehaub came ct besubjeto the worken' ***************************************************$*************************** na ••mpaation provisions&Section n3 3700 of the labor Cob,I shall/onhwth comply with Thos provisions. INDIVIDUAL F E E BREAKDOWN ,w, / ! L Applicant: A- ' 'amino:Failure to secure woMan'compensation coverage Is unlawful,and shall subject an employer to criminalpenalties and TYPE QTY DESCRIPTIO N • UNIT COST TOTAL COST civil lines up to one hundred thousand dollars(5100000).In addition to coat ct of compensation,damages as Provided for In Section 3705 of me Labor Cow,Interest.and attorney'•lees. ELE 1 MOTOR/POWR APPARATUS 1 . 1 - 10 .0 HP 11 . 00 11 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for dee END OF FEES performance of the work for which the permit is issued(Section 3097,Cy.C). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and date that the above information is cowed.I agree to comply with all ply end county ordinances and stale laws relating to building construction and hereby authorize representatives of this dry to enter upon the above-mentioned property for inspection purposes.LYLE COOTER 01-13-1958/11:52 G' T `1/,733032 Print Name Ern :01-3,71E1037 4- :01-tiG18U3/ • Signature • Acis`or . (5151-46.WP) White-Buidig. Safety:Green-Fle:Canary-Applmnt:Pink-Revenue:Goldenrod-Assessor • I ' CONSTRUCTION AND PLANNING POOL & rA 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 . r1 . '.5,: Steel Reinforcement' . 56. Rough Plumbing & Pressure Test 6.1 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 Si House Connection • 62. Backwash & Receptor-Final • 12. Sewer Cap - - 63. Heater & Vent-Final . 1'3. Roof Drains - - , ' . . 64. Plumbing System - Final 14. Rough Plumbing ' , _ • 65. Electrical-Final 15. Rough Electrical-Conduit, •• • t-- . - • 66. Solar System-Filial 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: .- ._J , a1, FIRE'DEPT:REQUIREMENT 20. Rough Factory Fireplace - '; APPROVALS-' : Permit # - - -I J 7 21. Ducts, in,Strudture' ^+. 70.'Underground Hydro • 22. Ducts, Ventilating - r ' -" yi. 1 ' 71. Product Piping.°Gas ❑Oil -, 23. GasPipe:Rough &,Test - -• - 72. Underground Flush 24. Roof Framing -*-' • - -'. ' 73i Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof;Sheathin '- ' - 9 74. Overhead Hydro- 26. T-Bar Ceiling (Structural) & Monocoat _ 1 75: Dry Cheinical - 27. Frame and Flashing'. - ' t ' - „ 76. Dry Standpipe - ., r - 28. Lathing& Siding • . , h 77: FIXED SYSTEM-FINAL 29. Insulation 78: FIRE PREY. FINAL • 30. Drywall Nailing • -• - ' HEALTH DEBT.,REQUIREMENT 31. Plaster Brown-Coat ' 79. FINAL INSPECTION 11 32. Electrical Power Meter-Final 1 - 80; FOOD CERTIFICATE ISSUED 33. Final Electric, - I-Z1-18 f,,rNotes: - • 34. Final.Heating& Air Conditioning- . r . -_ - 35.Final Gas Pipe=Test ' 36. Hood or Canopy . - ' 37. Final•Factory Fireplace. ' -. ; . - . 38. Final-Plumbing • - I i - . 39. Water Service-Final -- • - 40. Gas Service-Final . • - ••-' . .. - - 41. Solar Domestic-Final n c •�. . - I 42. Backflow Preventer , - - 43. Backflow Irrigation . . , - ' - + 44. Landscape Irrigation System r a .. ._ - -. 45. Sound Attenuation .. 41-4 46. Handicap-Regulations • .. . _ -: , 47. FINAL STRUCTURE & BUILDING - " 48. FINAL PLANNING - 49. Electric Release to Edison =''• 50. Gas Release to Southern California Gas Co ' ' - 51. CERTIFICATE OF OCCUPANCY No. Date ADDRESS OF BUILDING: 1317 STONEFIELD ST WIT: CITY OF COSTA MESA — BUILDING PERMIT OWNERS NAME IF KNOWN: CARLSON, CARL H FLOOD : X 46 PERM NO: B 07508 ADDREu' 1317 STONEFIELD ST COSTA MESA,CA 92626 PERMIT NO: B 075084 PLAN CHECK NO: N GOVT : N SUPP : 1,1 557-6760 APPL.IMIM°ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE : OTH ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : T/OFF RESHEATH; REROOF W/ 40 YR COMP SQ FT: 5, 100 ARCH.OR ENO'S ADDRESS: WIT: CLAIM VALUE: 5, 100 . 00 CALC—VALUE: 5, 100 . 00 GROUP OCC: R-3 /M-1 CONTRACTORS NAME CHAMPION ROOFING ( 213 ) 259-0451 CONTRACTORSuuuN° 3257 VERDUGO COMMENTS : SMOKE DETECTORS ARE REQUIRED IN EVERY BEDROOM & HALLWAY /91 UBC ADDRESS: L .A. CA UC.NO.: 429481 +E**+ESE*BS********+E*SEx******BE***RE+ESE** ******SERE*BE***+ERt+E**KRr****ore**+ESE*****RrSEBERE***RE** 90065 UMI: Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under parlay of perjury that I am licensed under provisions of Chapter 9 S T B ACK S (commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license is in lull brae end effect. CITY LIC No.: 042725 LIG.CLASS: C_39 LIG.NO.: 429481 n EXP: 11 /95 MAIN BUILDING ---• -- ACCESSORY BUILDING /� h1` FRNT: FT IN REAR: N FRNT: FT IN REAR: FT IN Data' Contfactor' LEFT: FT IN RGHT: N LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I- r��:�'��d+��� m t rectors license Law for the • following reason(section 7031.5 Haase and Professions code:Any city or countyape to COMIMMl,alter,improve, PARKING REQ: P•(Ae.. ' PARCEL : 14102403 Z N E: REF NO: demolish,or repair any structure,prior to its issuance,also requires the apol' , e•f' to fib a signed statement that he or she ts licensed pursuant to the provisions of the Contractors License Law(C •�' With Sadiron]000)d Division 3 d the PLANN ING NOTES> Business and Professions Cede)or that M d she ts exempt therefrom and t. + .ed eaemption.My vidallon d Segion j 7031.5 by any epplicenl for e permit subjects to applicant loacivil pet ehundred dollen If 500j). **********************sib **'***************************************iE********Rb** ❑ I,asearner dthe propendormyemployees with wages astheir �+ Idotedworkand the structure is not intended DEVELOPMENT SERVICES R E U IR E M E N-'T" S or offered for sale(Section 7044.Business and Professions !( ., Law does not applyloan owner of property Q who buide or improves thereon,and who does such work Nm•. . through his or her own employees.provided that such improvements are not intended or offend for sale.if,however,t .'�1(1`pelr improvement is sold within one year d completion,the ZONING APPROVED BY DATE: owner-builder will have the burden of proving he or she did not buil. . prove for the purpose of sale). ❑ I,as owner of the property.am exdushefy contradi g with licensed contractors to construct the praje((Section 7046,Business and Professions Code:The Contractors'sense Law dose not apply to an owner of property who builds or improves thereon and who BUILDING APPROVED BY . DATE: r . ' contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law). ❑ lamexempt under Section: B.AP.C,.for this reason: APPLICATION ISSUED BY: DATE: . -' - **********************************************************************REaF w**** Date: Owner LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y I do hereby certify that I am aware of and understand the requirements of California Heath and Safety Code Sections 25505,Pall.end and25536, or costwaoormanastiongomtheAQuayMana wit not gmbme)roved�ecentalconstruction lhsudnapodunsred erefrmtse BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING 2 perms that I or an hmedifiml in homipanl will I Quay Management.)nee to comply cu h said st le codes exempt remeisfthese provisions. PERMIT 81 . 00 ' ,51 Date: Applicant: • SMIP/NON—RES • WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of penury one of the following declarations: P LAN ISSUE FEE ❑ Ihave and wig maintain acattiest,dconsent toself-insure forIssueers'compensation,asprovidedforbySwbn3]Wdtheabor BUILDING—DIV—> PERMIT ISSUE PLAN—CH' TOTAL PAID DUE Code,for the performance of the work for which this permit is Issued. TOTALS————> 81 . 51 0 .00 1 81 . 51 81 . 51 . 00 9 I have and wig maintain d workers'compensation Insurance,es required by Section 3700 of the Labor Code,for the performance the ][ work for which this permit is Sued.My workers'compensation insurance carrier and policy number are: Center: ZENITH EXPIRES REVENUE DIVISION TOTALS--> COLL 'g. 81 . 51 OVER/SHORT: 00 Policy Number: 704000R0 05/01 /96 BLDG PMT PLUMBING ELECTRIC META A. FIRE SMIP/TOT GRADING PLAN—CHECK ,This section need not be completed a the permit is for one hundred dollars(5100)or less.) 81 .00 `�� * . 51 ❑ I certify that in the performance of the work for which this permit Is issued,I shell not employ any parson In any manner so as to v become subject to the woken'compensation laws of Catitomia. and agree that N I should became subject to the workers' ******************************** * • .*.****** *.******************************* compensation provisions d Section 3700 of the Labor Code,I shall forthwith comply with those provisions. INDIVIDU FEE BB R E A K D O W N Date: Applicant: Warning:Failure to secure workers'compena.don coverage la unlawful,and shall subject an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines up to one hundred thousand dollars($100,000),M addition to the coat of compensation,damages as provided for In Section 370gofthe Labor Code,Interest,and aromey'a fees. SFR 5100 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 5, 100 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that tare is a construction lending agency for the END OF FEES performance of the work for which this permit is issued(Section 3097,CM.C), LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and state that the above Information le cosec.I agree to comply with all city and county ordinances end state laws relating to building construction and hereby authorize representatives of this ply to enter upon the above-mentioned properly for inspection purposes. KIMBERELY MILLER Print Name Date: Signature of Owner/Agent/Applicant/Contractor • mmammamm a le a M a M M — (5151-0B.WP) White-Building A Safety:Green-File;Canary-Applicant:Pink-Revenue:Goldenrod-Assessor CONSTRUCTION AND PLANNING POOL - 'PA .. 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 :,Electrical UFER.,Grnd. 57. APPROVAL TO COVER-GUNITE c,_`•71.:Footings - 58. Electrical Conduit:Undrgrnd. - 8:-Foundation -- 59. Gas Pipe, 0 Undrrnd., Test - <9.:Water Pipe-Undrgrnd. " - i "\ 60. Backwash Lines,P,-.Trap, 0 Undrgrnd. .-10. Structural Floor System ( , 61. APPROVAL TO DECK 11. Property Sewer Line.& House,Connecti n 62. Backwash & Receptor-Final 12. wer Cap S"eJ 63. Heater & Vent-Final 13. - rRoof Drains 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 ea ca 68. APPROVED.FO.R;PLASTERING 18. Rough Electrical? Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning - _ r _ FIRE DEPT.,_REQUIREMENT r, i- 20. Rou�tiFac'tor Fice'lace .r.r': s "' '� ` - g Y � S:' �.< . , r '-'x C'APP{20VRLS- Permit # t. - 21. Ducts,in'Structure''e -.^ _ -: le. .; 70. !tindery-n:141 Hydro 22. Ducts;VdNtilatingF, • - 7.-.. �, s.; c: 71. Product Piping OGas Gy Oil 23. Gas Pipe-RougA& Test - _,S •• to • - r." 72. Underground Ftush_" -' 24. Roof-Framing" _c `" •' p' R- .:L ': 73, Undergrnd.StorageTank.0Gas ❑Oil - 25. Roof,Sheathing .. t -• , +. 74. Overhead Hydro . i 26. T-Bar*Ceiling (Struci ra0 & Mo'docoat .:: C = !'i" 756,Dry Chemical Y1 - - 27. Frame and.Flashingl Sti m _ .- 76. Dry Standpipe r 7 • - ,.. --28. Lathing Sr-Siding v Y. -1Cr; - -. 77,, FIXED S-YSTEM-F[NAL -, .-, c.k 78. 29. InsulationFIRE PREY. FINAL n:.: 8, '30. Drywall Nailing < r- .< x Cr ',,HEALTEi DEPT REOUIREMENT y a f I -,31. Plaster Brown•Coat'- '\ c , ' 79• FINAL INSPECTION V 32. Electrical_Pow'er MA:ar'Finial.,..� c 180:1FOOD CERTIFICAT UER. 33. Final-Elecuicr: ,....,D.4; , • `\ C ,� I h. Notes: `.r 34 .Final Heating'& Air Conditioning.-: x _ Si c' - •• 35. Final Gas-Pipe;Test„ ;yr- -. i . I _ I I ". : -'•r - 36. Hood or Canopy l; - _, _ : + t• 2rl'\"v v "" -- c• I:1 - ,^ r.ti . `\ _37. Final Factory Firep{ace';r _.-. -, - _. \v\ t . c - 38. Final-Plumbing •' ; A%REss OF eMLCII 1317 STONEFIELD ST DMT: CITY OF COSTA MESA — BUILDING PERMIT — ,( OWNERS NAME"wow"' CARLSON, CARL H FLOOD : X 46 PERM NO: B 075084 MDME53 1317 STONEFIELD ST COSTA MESA,CA 92626 PERMIT NO: B 075084 PLAN CHECK NO: N GOVT: N SUPP : N 557-6760 APPL.MAIUNG ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE : 0TH ARCHITECT OR ENGINEER: LIC NO.: JOB DESCRIPTION : T/OFF RESHEATH; REROOF W/ 40 YR COMP SQ FT: 5, 100 ARCH.OR ENG.'S ADDRESS: WIT: CLAIM VALUE: 5, 100 . 00 CALC—VALUE: 5, 100 . 00 GROUP OCC: R-3 /M-1 CONIBACTOWSNMTE: CHAMPION ROOFING ( 213 ) 259-0451 ' CONRIACTORSMNNNG 3257 VERDUGO COMMENTS : SMOKE DETECTORS ARE REQUIRED IN EVERY BEDROOM & HALLWAY /91 UBC ADDRESS: L.A. CA UC.NO.: 429481 ********ae*****fESE*+ *********+t***********x*** **+ ***************+P********f(******* 900 . 5 GMT: ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty. ...ury that I am licensed under provisions of Chapter 9 SETBACKS (commencing with Section 7000)of Division 3 d the Business and Professions Code : •my license is in full force end effect. CITY Dale. Contractor:C.NO.: 0 27 5 LIC.CLASS: C-39 LIC.N• 481 EXP: 11 /95 MAIN BUILDING ACCESSORY BUILDING Date: / , Contractor: �/ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN OWNER BUILDER DECLARATION:I hereby aifinn underLEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: • FT IN penally d perjury exempt from the Contractors License Law for the following reason(Section 7031.5 Business and Professions Coda:Any city a county which requires a permit to constmct,alter,improve, PARKING NG R E PROV: PARCEL: 14102403 Z N E: REF NO: demolish.or repair any structure.prior to its issuance.also requires the applicant for such permit to fie a signed statement Thal he or she Q is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING NOTES> Business and Professions Code]Cs that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section > 7031.5 by any applicant lora permit subjects the applicant tea Mil penalty of not more than live hundred dollars($5001). ******************************************************************************* ❑ I,as owner of the property or my employees with wages as their sole compensation,will do the work,and the structure is net intended or offered for sale(Sacton7044,Business and Professions Code:The Contractors License Lew does not apply to an owner of Propend D E V E L O P M E N T SERVICES R EQUIREMENTS who builds or improves thereon,and who does such work limset or herself or through he or her own employees,provided that such improvements are not intended or offered for Bale.II,however,the building or improvement is sold within one year of completion, ZONING APPROVED BY DATE: awnx-0uildx will have the burden d proving he or she did rat build or improve for the purpose of sale). ❑ I,as owner of the property,ern exclusively wptractrg with licensed contractors to construct Me project(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon and who BUILDING APPROVED BY : DATE: contracts for such projects with a contractor(8)licensed Pursuant to the Contractors License Law). ❑ Iern exempt under section: B.BP.C.for this reason: APPLICATION ISSUED BY: DATE: !I — 7 -^95 , Date: Owner ********************************************** ******************* *3F***** Idohereby cennmof ythatleawareandundertandtherequirementsofSafety CaliforniaoriaHealthardCodeSecins2sw5,25503,and LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y 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 panne for construction or modidirmionfromtheAir u y anagement District.Residential applications are exempt from BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 81 . 00 . 51 Date: Applicant: SMIP/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: PLAN ❑ I have and wit maintain a cenircate of consent to self-insure tor workers'compensation,as provided for by Section 3700 of the Labor ISSUE FEE Code,for theperformance ofthe work for which this pemmis issued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ I have and will maintain workers'compensation insurance,as required by Section 3700 o the Labor Code,for the performance o the TOTALS————> 81 .'51 0 . 00 0 . 00 81 . 51 81 . 51 . 00 X work for width this permit is issued.My workers'compensation insurance carrier and policy number are: Carrier: 7PMTTH EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 81 . 51 OVER/SHORT: .00 Policy Number: 7nAAnn 05/01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK ;Tons section need riot be completed I the permit 0 for one hundred dollars[S or less.) 81 . 00 . 51 ❑ I certify that in the pedormance of the work f«Which this permit o issued,I 1 roll employ airy airy Parson le manner so es Io become subject to the workers'compensation laws d California. res d l Mould bacon subject to the workers *******.*****************************ply,****,************************************** prow+21 Seaton 3700 of the Labor Code.I shall won h those provisions. Date: �m ,—.- Applicant: INDIVIDUAL F E E BREAKDOWN Warning:Failure to secure workers'compensation coverage Is unlawful,and shall subject en employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines cap to one hundred thousand dollars($100,000),In addition fo the cost of compensation,damages as provided for In Section 3706 of the Labor Code,Interest,end attorney's lees. affirm anderSFR 5.1LQ0. . . ' s t -4 D ENT IAL NOZONE 1 ,00 5, 100 . 00 CONSTRUCTION LENDING AGENCY:1 hereby penally of perjury(het there o a construction lending agency for the E..y g END OF FEES performance of the work for which this permit is issued(Section 3097,Civ.C). F s y LENDER'S NAME: 'p �,. .� LEN. R'S ADDRESS: ,+ •ry I certiythat I have :ad this application ed mate that the above information is coned.I agree to comply with all ply and county ordinances .`_�:+ '' 'r"�Y �� and state lawn re•ing to buiing construction and Dereby authorize representatives of Ihis city to enter upon the above:mentioned property i for inspect .. , odiKIM/ RELY MI� LER • cc / , n (/g� $1.4 1' Lhs 4 Print . i S ±)4 1-F I G �'a .. Ag a •�; D// Date://- i `•^^ ""°"'"��`�`�"• �:• 01 00194011-!7019401? T R1'Y' 81.51 signal .d. : "r.n 'PP an tractor DATE: 11/0?/`95 TS!ic": 14:57 (5151'46.WP) Whit: : '.ing A Saiey:Green-Fle:Canary-Appicent:Pink-Revenue:Goldenrod-Assessor J - `-' NERAL II nal, 111G1W, %JIM:W11LCy L• LI-11.G-11.G -r-I-vv - I JOB ADDRESS 1311 Stonefield St. BUILDING PERMIT NO. 25563 ENERAL CONTRACTOR Tri Delta Const. DESCRIPTION OF WORK Pvt•Blk•Wall '$ AP No.141-024-03 LOT TRACT FIRE ZONE VALUE $ 300.00 INSPECTIONS Signature Date GROUP J TYPE III ZONE R-1 Soil SUBCONTRACTOR I PERMITS ISSUED Gas Date I Number I Signature Water Plumbing ough Plumbing Prop. Swr. Line 0 House Con. i0 Sprinkling System Miscellaneous _ Rough Heating and Air Conditioning Temporary Service or Pole Underground ❑ Power '0 Rough Wiring Heating and Vent. Trenches p Forms ❑ Steel Reinf. 0 All n- 9//`A 6 Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing Lathing —In ❑ Out d Plaster, Brown Coat Structural, Final Electric _ Heating, Vent., Refrig. and A.C., Final Plumbing, Final and Gas Test 0 Electric, Final Building, Final--- &I,#4 6 25563I r CITY OF COSTA MESA COSTA MESA BUILDING-SAFETY DEPARTMENT APR 7 1966 P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 {{�� For Applicant to Fill In Completely APPLI�I�Fi�ERMTT TYPE OR PRINT —RIM T * ,./ �p Mon Office Use Only BUILDING ADDRESS /�3// S/O AICA.F/eU 57. [ .O 1TA Mon RECEIPT NO. 25563 COSTA MESA, CALIFORNIA LI�JIVl lYl`V< n 1� per- - ..713 DRY DA 6c(1VRD,/ DATE ISSUED OWNER ! I7A(f N C GV E'P / 1 Vers (/�C/ 761, /i/PJ' `, /y(e Jen r A,1 BUILDING ADDRESSS/ZI 9,(../S/A me r,;es/ST C..f 1. ADDRESSFIRE (/,/J'I CITY 6'tA ( I LSA TELg416//97 ZONE TYPE.� GROUP r APPROVED j\fi�r/� ARCHITECT TEL BY DATE OR ENGINEER NO. ZONING ADDRESS z N NO.OF USE OF NEW V' ...cep I yy� J PLANS 2I BUILDING CONTRACTOR Tv. ripL (/) ed Nr T. ..00A, / "� LEGAL La,r v IR CI 3.554" ADORED. /'-//1 BA tis A fo o DE9C111PTION 't¢) ' ( ^� CITY Al i Dl WAV (.7/ v A.P.NO. l / ( — vat( - C NOTE: NO HAVE OVERHANG SHALL SE LESS THAN LIC.NO. NO g93- 8553 .O'TO SIDE A REAR P.L SIZE / ('�", 3 a I NO.OF RLDGS. / ALLOWED (U.B.C.REQUIREMENT) YARDS Y'J NOW ON WT USE OF YMAIN BUILDING YARDS APPROVED BUILDING EXISTING BLDG. MAIN BUILDING ACCESSORY BUILDING .(FROM C/L STREET) SETBACK LINE FROM FRONT FT. 51 FT, CENTER OF STREET REAR YARD J SIDE YARD I LEFT I RIGHT R.SIDE FT. FT. ' (� DESCRIPTION OP WORK -L.SIDE PT. _f/ , ✓ PT. ' / NEW _ ALTERATION _ ADDITION REAR PT. I1(r'�/ tl. f DISTANCE MET. V BET.MAIN A REPAIR MOVING _DEMOLISH MAIN BLDG*. ACCESS.BLDGS. BUILDING NO.OF VAR.# DATE SIZE ROOMS STORIES C.U:P:# / APPROVED / EXTERIOR WALL t/ I ROOF APPROVED I / /J'� nii9ATE `� 7-I//- a COVERING COVERING MY IA /l USE OFByI LDItlS 4NDWORK 4EPERFORMED 1 d-) �I"/ o ' f to .2e- "1,4e-74.5,- 1 SQ.FT. 2 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION INE AMOUNT SHOWN UNDER VALUATION IS FOR THE j AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CON. PUOF ESTABLISHING A PERMIT FEE ONLY. }yaI PLY WITH ALL CITY ORDINANCES AN TT LAWS REGULATING VALUATION BUILDING CONSTRUCTION. W SIGNATURE OF ((�� PERMIT FEE $ �- PERMITTEF al flint/ d/ t �18�f/j / �o I d S SA}/� - PLAN CHECK S AUTHORIZED AGENT _� .^')sh TOTAL FEE .g JOB ADDRESS 1317 Stonefield St. BUILDING PERMIT NO. , ,S4 GENERAL CONTRACTOR Lifetime Res.Bldg. Corp. VALUE $17,075.00 /i.-/t-� AP No. LOT90 TRACT11-355 FIRE ZONE DESCRIPTION OF WORKRes.w/att.Gar. INSPECTIONS Signature DATE GROUP' & .7 TYPE V ZONE ILL Soil 4., U/ /. .? PERMITS ISSUE. Lr/ /• Gas SUBCONTRACTOR - �/�(_�' DATE NUMBER Water J f-2V—e: Rough Corn. Refrig. 0 Air Cond. 0 Rough Heating M745 9-9.-603 _ c'_c -_t 5L / o/ �//- Rough Plumbing /14-/-5- 2/-8-03 , 7.tntle;-/4e n, c.c L2z(3 -77 j, Miscellaneous �, � y-- y's-� Prop.Swr.Line 0 House Con. St.Swr. 0 9223743 y9 -- ./_, ,� g.of/ 3 .3S• to _ Sprinkling System f" r Construction vole Q1blb" Underground 0 Power gh Wirin ifl S!Y, & 3 L�rr7e A0 .L ee.407�r° 2-u27"tio,sL 7 4/ Trenches-Er Forms iv'"" Steel Reinf. 0 /.>i[ L - Floor System it 7r /-33.?‘3, - • Bond Beam 0 Steel Reinforce 0 Sheathing N0$l!B fir.. Frame and Flashing -n 4//,/ 4/-Ci-.t; _ Lathing — In 0.----" Out g--- /Pelf/ <i-2-r-63 _ Plaster, brown coat J',4t/ ‘-(0-63 _ Refrrg. 0 Air Cond. 0 Final Heating, Final I • ' -.)-.4,, Plumbing Fixtures, Final �' 7-4.43 Final Gas Test /,5 .e 7-i-7-e3 Electric Fixtures, Final _7i f,G?; . Rnilrlin,' Finn! i .f-,r!1_'1 F C; ED COSTA MESA BUILDING-SAFETY DEPARTMENT • Lot 90, Tract 355 D ( ainl + D P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE DEPT. CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT "BUILDING ADD EISS /3/ /•7 -5 4t f/ttd ST; COSTA MESA. CALIFORNIA For Office Use Only i. RECEIPT NO. PERMIT NO. OWNER Harbor Hall of Fame Homes, Inc. I .� 8472 MAIL RECEIVED BY DATE RECEIVED DATE ISSUED ADDRESS P.O. BOX: 2066 .. �1 /a �1 �j2 DEC 1 1 10p? CITY Santa Ana TNOIu 9000 BUILDING ADDRESS • ARHITECT ORCENGINEER Jamison iD4544- t COSTA MESA. CALIFORNIA /� ADDRESS 225 "D" St. , Tustin ZIRE ZONE TYPE � GROUP 1 Vr P(///Jy- CONTRACTOR Lifetime Residential Bldg Cot BYPROVED DATE ADDRESS 2131 So. Artesia ZONING �n1'� ZONE NO.OF USE OF NEW F�-7j,#4.2.-- CITY 'tom+ CITY Santa Ana - -� LANSy.� BUILDING Wert aJ . STALIC.ISD. 208676- TEL. xi 9-2204 LEGAL L0/ 70 re `13-3---C DESCRIPTION SIZE . NO. OF SLOGS. - - OF LOT 60001NOW ON LOT. O A.P.NO. USE OF YARDS EVES EXISTING BLDG:None APPROVED ALLOWED SETBACK LINE FROM (CENTER LINE ST.) CENTER OF STREET 501REAR YARD 23.50' FRONT -S-C) FT. — IN. SIDE YARD I LEFT 8, I RIGHT 7.30 R.SIDE 7' 33 FT. IN. DESCRIPTION OF WORK - L.SIDE `" FT. IN. NEW I X. II ALTERATION I II ADDITION I REAR zit ' FT. IN. REPAIR I II MOVING I II DEMOLISH I APPROVED /n BY �U�J 7. DATE /OA r1/41-. BUILNO. OF SIZE DING 1 60O81 ROOMS 9 STORIES 3. EXTERIOR WALL ROOF COVERING Y1aster I COVERING Shake USE OF BUILDING AND WORK TO BE PERFORMED Single farm residence - ' -/5'907 ` X.,20 m I HEREBY ACKNOWLEDGE TIAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE •=0 IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY O'•IN CES AND ST REOU TING OF ESTABLISHING A PERMIT ONLY. BUILDING CONSTRUCT, . I / )\L/y 7�, VALUATION _ SIGNATURE OF �_ . { \ Aa I PERMIT FEE $ PERMITTEE �w�^' )` J���++NVV _ /J(/{ $ 7�2� PLAN CHECK $/ _i--a AUTHORIZED AGENT F TOTAL FEE $ ����U y