HomeMy WebLinkAbout2876 STROMBOLI RD - Building Permits • '4
� _ __yr._ _ Applicant to.fill in all spaces except those within heavy bortler lines and sign all approoriate deel_arations. • -Bi�20 -•- • • IDQ 9 ATL
Y OF COSTA MESAr ) I, •. P T.NO.. TRACT NO. LU I NO. I BLDG NO o _ t : o 1 • •
1r CONSTRUCTION PERMIT ' ' 'V c; I ' op 7! 1`: I • 4. It:� �. i " : I c , - : r'_ ' •` 1 ` ' 04. i" , < r•
SS• �3/1 I 70 '' I
A' Iicent s Mallin Address �7 }?77c.17/AOL . .. , 1 . ' i �•i I . �• 1 t •' • I •r'
PP g ss- _ , ` TYPE OF CONSTRUCT_ION .I• NEW T ADD LIJ ALTERATION, L'J-REPAIR L ( - I Z a t :rt ` I 11;
Project Address• �p Ifl'/�O/19�j7L/ ',- Y v ! ! ' • t❑ CONVERSION ❑ DEMOaL•ISH I❑ OTHERx • "-- = - ' - • - -- ' I __Ti I I 1 1 • 1 - ek ' ,
Owners Name •' 277ffCL LL-i*ie -• .- Phone /2/L -::-,DESCRIPTION-OF WORK ')?L/9A' 10rA114 I/1'r4-//A/e - - - - -- - -
n , " J _ ; c • ' _ r _ - - I' • ' •- • f ZONINGIREGUL�ATIONSI F/fR4• i .1x)1'1'_0'01 TI-
Addressv�1' • frgOA'fdit' 1 - i _
r _ - TYPE OF PERMIT- '❑ GRADING 'u FOUNDATION ❑' STRUCTURAL +- "A. •P.as G39= 3q -`, ., ' ZONE !A I L,• S I 1:--i
Arch/Eng - ' ^ License No. - ❑ TENANT ❑ ELECTRICAL ,® PLUMBING ❑MECHANICAL• - •' - ( _'BUILDING
• ' _ - ; i 1 I ' I • - - 'PLNG.RE F.9k,' > I
Address •- ' ' • - ❑rpTHER •r SETwerr co eT -
( �/ TO BUILDING' EAR YARD(T0 P/L) +'
Contractors NBTP �y/77 -T���n' �i4�I1+PhOn /'fir . - PROJECT DESCRIPTION- SQ FT,"^ 2a0 ' ' 'OCCUPANCY' `PROPE RTV LINE //(J��/�pjAµ� I i' - ,
�,[�4,„. •LEFT SIDE YARD % RIGHTSIDE YARD ( -
Addreulmailin9) •✓1ZKLG �/'Ll�i'.rJL' 'Cite: ��,r G�r/lrr7nl CONSTRUCTION TYPE l ' I VALUATION$ L3J'IY �% 'ISI
License No. ',�5��'�� • i - { ZONE ! GRADING CU.VDS: ' 'ACRES _�` •
PKG.SPACE'REQ. i PROVIDED 1 . - ":.11:
`.; .o_
LICENSED CONTRACTOR DECLARATION ` Remarks: n I N. .STREET WIDTH �, ., (PARK FEE$ c
hhereby,affirm that-l.am licensed under provisions of Charter 9(commencing ` '' ' �� ' ' ✓ �� - I �V '-' l '
with section 7000) of Division 3 of the Business and Professions Code,and ' 1 _ II SPECIAL CONDITIONS: 1 - _ • I
Y lice:se:is in full force and effect, - 1 •- • 1
rise Class l f"" . - License No �a• .^ ; PLUMBING '. I _ ( - 1 t,
+�gy •
�5��'��f� Signature ! Bar Sink 1 Sewer Cap I ELECTRICAL
• YVORKERS•COMPENSATION DECLA ATIO/ I '
I.hereby affirm that.l.hive.a certificate of con • to self-Insure o'r.a certificate.-: _ -. _ _ _ .. Automatic Washer- ' _ _ Neter. Omer 100 amps, :
' of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Pfeventer- < Sewer Connection-- "' - ,` j
3800, Lab, cr.)J ` r Irrigation '; - Solar Collectors_ L/,1-�Q ie Construction Pole , t /( .Sub Panel. ' , - I • ,
Policy No, ,ty, tZ-i Lig S4,; Company/ 4;02/2/4Q1t' 49072 Backflow I _ _ '
Certified-copy 1s hereby furnished. ' 1 - - coking Unit ( - 'Sub Pole 1 • i '
A 1 Bathtubs Solar Piping C
.Da CerJ),>65pppy s no with the city I Cpis n ' r '• s - Dishwasher Motors 90-1 HP '01%-s i ' '
DateM �j�:7 Applicant OL.t�/� 7�//�J LAiG _ Clarifiers 1 SOIar Tank _ .. _ - .__ . _ ...
EXE 10 FROM WORKERS'COMPENSATION DECLARATION - - y Dryers ❑Gas ❑Electric ;Inc:Sol-art HP ❑16-15+
(This section need not be completed If the permit is for.one hundred(8100)or , Dishwasher I Swimming Pool w/Spa ; ( •
/
. less - - . . . . Microwave. I 1
I certify that in the performance of the work forwhichthis permit is Issued, I ' Drinking Fountains Urinal ; + 1 i' ( Fan
'.shall;not employ any person In any manner so;as to become subject to te I - - -'- - - i F.A.U. ! ! Pole Light ' ' I r i i
Workers'.Compensation;Laws of i 1 Floor Drains i _ Water Closet i r _
• Date ' Signature California.;' - 1 - - _•_• r Fixtures - y
' 'HNOTICE:If;after making this declaration,-you-should-become subject to the FIOOr Sinks -- Water Heater, - ' '• ••^ --"'-' - - -' ._.
Workers', Compensation provisions of the Labor beou.muedforthwith _
, comply ;with: such ;provisions_;or-this-.permit shall be deemed revoked. Gas Service. ;Outlets( - ',1 Water.Service .- 1 s' ' Device Boxes I Sign 1 I 1 ' -
CONSTRUCTION LENDING AGENCY ' 1 ' ' I •
t
(hereby affirm that there is a-constructionlending agency,for the performance ' Interceptors - I : r ) ' - t- • I I ''. Outlets i Standing Sections ' •
of the work for which':this.permit is ;issued ;(Section '3097. Civ. CJ. - - -. ` - , I
- - ' ° ' Kitchenisinki � _x Sw •itches , I. --
• Lender's' Narita- Ir I 'Trash Compactor •
_
Lenders Adtlress' 4< • ' . : .. -� I 1
OWNE R,BUILDER DE Gs.'A RATION °' I - 1 ., y I 1 •, •' Lavatories 7 i is - f ] C.' Garbage Disposal I' r ,. I
1 hereby;affe-in that I am-exempbfrom the,Contractor'srLicense Law for the - I P-Tra v. ' - ' -r 't": Generator 00-5 KW 05-15 KW t 1 I f
r Mowing reason;(Section-7031:5 Business and Professional Coder Any city or P ; c I f
I aty which requires a permit to construct,alter,improve,demolishior'repair I j
VC_r. •• - ,_ Transformer 15-50 KW '
a s•stra e;prior to its issuance, also requires the to applicant for such permit T. Roof Drains' 1 - ,- F ! t I i r* ' •' '
Ki rt -de a signed statement'that he/she is licensed pursuant to the.provisions of ' 11 05U+KW'
Contractor's IJcensi Lawl(Chapter 9(commencing with'Secshe i 000)of -• • - - ' `e -' v I 1 •Reinspection Fee I' ,_ $15'
Division 13-of.the-Business and Professions coder.or.that:he/sheris.exempt I 1 Showers "' IC. E' Reinspaetion'Fe_e ' h .$15" _1
' Meter Dup to 100 amps I :Issue Fee' r 'S 3
therefrom-and the'basis for the alleged exemption. Anyy'olatlon rof;Section - ' ' ;
7031$ by_any applicant for a,permit'subjects the.applicant to. a' civil - ':'"$ _
( LJenalty of not more than five hundred• dollars($500): •-•C t , i. i Service Sink - -+_ I Issue Fee�T • 3 Zoning Approved By P-Steles , ' 'Date ' ffIiSA
I,'i as owner of•the property or`my employees with wages•as their sole I ' v'
compensation' will,do the work,and the structure is not intended or offered . _ ! , . - - ' r-• MECHANICAL - 1 I. : Application Approved By a'� ' 'Date 0 V G '
I for sale.(Section 7044; Business.and I Professional. code:.The-Contractor's ; _ - -
• License Law does not apply to,an owner of a property who builds or improves . 1 Boiler ' (" 1 I Refrigeration System • 'I;el •') 'Ail S' - ' ! 1 - a
. thereon,land who does(such work himself/herself or through his or her own I ' . , < Application Issued By ' • ,Date av
' employees, provided that such improvements arelnot intended or offered for I Duct Ground 1 DO-100,000 BTU 0100000 BTU i'r •
; , ' i -
; sale, If, however, the building or Improvement is sold within one.year'of corn- , 1 l I i SUMMARY OF FEES
elation, the owner twill have the burden of proving he/she did not build or Im- - 1 - ,- : 1 i 1 :' '
( LIrove for the purpose of sale): I I ' i I Duct-Structural 1 System Repair/Alteration fr...) 'BUILDING PERMIT $ L/N.SO SMTP 1 $ rya'
I, as owner of the property, am exclusively contracting;with):licensed can- - 1 { I ' ,
_tractorsto,construct thelproject•(Section 7044,Business and.Professions.Code:_.1-_. Duct_Ventilating. ....1_!..,,..4_-_ L__• ! •_:e .', PLAN CHECK, $' l- L: PERMIT I I
F The Contractor's License Law ddoes not apply to an owner of property who I - - ! '•; - ; • I • '� el D% ISSUANCE ' , .$ I
. builds or Improves,thereon,and who contracts for such projects with a con- I Exhaust System 0 .Multiple 01 I i ; I 'i i 1•,-a ,r,° �; (PLUMBING ' I $ - I I I
, tractor(s) license pursuant to the Contractor's License Law). t I 1 O GRADING ; $ '
' 0 'Pam exempt under Section B.&P;C.for this reason I 1 Firepl/Fact.Blt. ICBG# ! , 1 I PLAN CHECK; i $ = Is I I I
! Date ! Owner 1 1 1 ' • • ' i Heating System& Ducting I I 1 ;Lr, ELECTRICAL ; $I • I 1 1 $ ' '•
-1'hereby: certify-that-I have-read-this!a plication and^state-that above i _ ; MICROFILM • $
Y P -'h 00.100;000jBTU ❑100,000 BTI - --1- - r - ;PLAN CHECK; . $ I 'i • I 1 I .
I information is correct. 1 agree to comply with all city-and county ordinances - I i ' I ,: I TOTAL FEET $
• a sentatives
to laws his'cit to buildinganter <onstructio bove- hereby authorize re re- Flood ;MECHANICAL $ 1 i
,roster. of,thls'city:to enterpo .he above-mentioned property for j • Cano or Type I ❑!
f I
py. Type
Reinspection Fee f ' $15 ,PLAN CHECK $' I • I LESS i
I :gnat re Durp•.•a. I ). �i�'`J j , Cano T eII ❑t t _ 1 _ ADVANCED;PC 1 $ i
, Signature - ." /'' /I• 1 1 ) Date
j Registers 1 ! 1 , 1 lune Fee • $ 3 I i I I
` FINAL FEE; 1 $ 1
CMF 0865-46 rev.12/82 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor - / 00• '
/�CONSTRUCTIONaAND:PL'AN-MN =z r
0 + ' �' a t- g c ***Mate r - Inspector ' ._ } Date ^ Inspector
y.•^•APPROVALS Permit# APPROVALS Perrmrt# .� ' .4- P
rr I1" Temporary'Electriical Service or;Pole I" .t.:4: ":! "0...!::::„! n - :c52`'Po'ol &•`Equipment'Lo'cation`'! z T.J.. " 1 ;2712;I.i1 - ;F
v -Boll Pipe=Undrgrnd=' Si .1F ��� R : -- ` - ''? I 53 Steeel Reinfo-Cerrient- °: s • ' ! ,' 5. ;I
h
l 3' Electrical Conduit.Utility Undrgrnd r,' _, • = u ,541'Forms';� i c -r w r ..i ' , t 'i•-`• N
15? 4• Electrical Conduit-Undrgrnd; - '-:n fi! ' t' . TI: .i ; ••.`55- Electrical I:Bonding - - • - :, ` � =a '
r:'i ._ . I 1 t , - n or S•`. •
5: SteellReinforcement , r' ;, T-,': c -. N o g c'-II. '`56. Rough Plumbing& Pressure Test;= _ • 1?
6: jElecti-ical LIFER �Grnd:' ' c j= .' I . '' • q-' On - "_57' APPROVAL,TO'COVER-GUNITE:: .:� °"- ''-!�
' i i J 1 * ' ' _�- E ',•gym >•i: ' 58 . Electrical - 4c '• -
7. Footin• gs ;1 !_ I i; ,. : .. I. _ _ . c: • • : Conduit_Undrarnd'- - ;c .•_ - ,
8, Fdundatiori I 1 ' I u '" ! it ' _`: L.', '-59. Gasf1) pe; Q Undr'grn6 Test�„ '^ I ' I -:L • 1 '4'
9, Wate4 Pipe-Uridrgrnd. I e ° -_ 1,1:66. Backwash Lines,'P-Trap,OUndrgrnd.'s -
107 Structural Floor System I „ - ; -!!! •e I 1'61. APPROVAL TO•DECK r _
11- Propertt,Sewer Line&.House-Connection - a.' `E ; 1,62. Backwash'&-Receptor-Final `rr 1 �
' - -a1
•
12- Sewef•Cap I : I i i I IT.'%•-
i- • o` ;; I -'63 Heater&Vent Firlal , : ?• '
.
13. RooflDrains i ' I l'
t.i "7 764. Flumbing:Sy.stein- Final ! - ^ - - a I :.- ••'
a 14. hough Plumbing I„ I r*..- • i' ' " - _ ! 1165. Electrical'Final:4 ! ' -' •- - i'• ; ' • • -
a I
1-5"'Rough•Electrical;Conduit- - I G I f i I�! T 7 -.66�ISola�ISystern=Final ' - : - - • , T • -, .;
' 16.,L'Riough_Electric,iWiring, ' I g j jl I"1 ,,1 tri h j ,_=fi '!67-�Fencing&'AcEess:APproval i-;. -- 4-,;!-,..71!.:17;'"( _ -
6.17 IRough Wirinng'Sigh:• v • I r I ;! •i!�, 1 - I o I, i - ! ' , , - Ix •• - -' --
.� : ! 68, APPROVED FOR-PLASTERING; I - t '
'1 18. Rough_Eleculcal,TBa Ceiling` I, it-'! :: • ', I I L c I 69 ' POOL/SPA SYSTEMS'FINAL , . II
I ~• I ' ' ._
19;'Rough^Hesni
tig&;Air Conditioning ii + 'I' + I I I _ I I FIRE DEPT-R ;;
EQUIREMENT ' _ I c j ' I - 1 L : - '
x p 20, IRough;Factory Fireplace) "' .j II I j 1 j I, 1 _ I • APPROVALS! j Permit;# ' ' ' I ' ,
e 21, Ducts cn Stiucturey m I 9 I I I , 1 1 1 70.1 Undergrouna Hydro ! I
e� Iy22aDucts;Ventilating j.. Ha I II 1: I 1 I I 1 ; , 71-�Product Piping O Gas ❑Oil ! ; ' �, I I '
''g'23.!:Gas.Plpe-Rough &Test ,c c• r-1,-' j r72 Underground Flush ! I + I ' I • '
a'?24: Roof Framing; I",i t . 1"• I '111. I i•� ! ,I _ l - I' 73.; Uride• igrnd.StorageTank�OGas;O�OiI, ; I
;4 • .I.� _ . r: c. ii7.•r1 1 , t
S$ 25.IRoof Sheathing j I I j 1 21 ilre!1; ! ,j c: 1 , I{ I - ! ; ' '74.i Overhead, Hydro 'a ; - I ' I i
° r26,'T Bar;Ceiling (Structurat)I& Monocoat-'�_i .: 1 0, S• I^I 1 I , 75,1 Dray Chemical I : t I I I ^ '
r 27: Frame and Flashing i '' I ;i II:
I i i I r ; j 1- f / 1 76,1 Dry Standpipe I 1 • _ '
r , I 1 I I. '- I f f ' , i I - ,
n ,1 28. ;bathing& Siding j ^1. I 1 j ,! ji } I ! I I 1 77.1 FIXED SYSTEMcFINAL. ' : •; j I I
° 29. ilnsutatiod c ` ' a " I I II l-1 I 1, j . I { 1 78.• FIRE'PR,'EV. FINAL i : ; . 1 1 I ' I '„ 1
i A •
o t30. O'rywall Nailing , F 11 Hi, 11 I I I I I i 1 ;Notes: /. �'2IL I tU I, /,J D 2r/„ .
" ° ir31. Plaster Brown Coetai•a i j I r -I -1 t . - ;.�' ,- V - - --i''-u-7� +G�yy�QI --i�., •�GILf- �1 $ / --
•� 41'32. 4, - ,, . Power MetervFinal I j I LI'!" , ! I I� �'�, ems' F.
t L
rc ;1 33, !Final Electric.__ 1 ! ! i�1_li.- I I__ L ' 1 1_ 1 • .. _ : I,. '_,�_.._ I._�
I� it 1 1 I 1 - I ' -1 I cs 1.(,:::
r 34. Final Heating &'Air Conditioning •, ', l I ! I I I
-- II -1;.-.tri. m t a I :xi la I
35, Final GasiPipe=Testi :- I , .1 -1 1+ i-c i . I I 4. '^ I? I•- 114 1 -Y 1 l a' c- gy m - _ _
a 7
36. Hood `or Canopy , ih I n c , I ;- 1 • ,I _, I • .!. .. F F - '
37: Final Fa ' - • 'r,^ : .j Ir.1 • • ;1 , . 1 ' I 1 .c _ _ ._
dory Fireplace i;' I- - _ 1 , I I -I:_ I . : i,
38. Final Pluittbing l -I, .I -j , ri 1 I ' ' ' I i ' I I I I � r >i' I- `• i"' SII rt
39. Water IService-Final' c1. I I I( j I i . 1 I II I I - J
40. Gas Se vices-Final .;�,_*.; I ' I g I I • I I I 1 ' •, '-- : i - ' !
41- Solar Domestic-Final," I I I 11 I' I. ' _L -i_I i_ ! j •1 , I > 1
ii7/1I ",' I I I j ' i" ,I I - . . i - I i i ,
42, Backflow,Preventer; _I _ F I -_ ,
trail ..1 r., I I "_iI' _ -1--- .--. - !--f,
r . . ,.. ! 1
N --' ; !R
40.11 --' , .1 -i I 1 � ! 7'' I , F1 � '_ f ,
43, Backflow,IIrrigationl j . I ` I !.I; I , j 2 0j:. 1 t ( ; - ,?; - I I .
•, r-� 1r, i 1 I ;.7I I > 1 1'_, i • 1 ' -1 ,I l K
44. Landscape'Irrigation•System 1 �t Ir I ;.,l = I , • -
45, Sound Atte;uaiion ,';i: i T I a I I ,I• ; ` r " - I I I I " - I I ` 1 'i , - % .
_ ' I I I ," 111! :I °) 1 , '1 ' ry �
46, Handicap Regulations) 1 r.I 1 i 'r I I I' i + I I ; j 7.i, , _ i,
.I' Ii 1 I -_ n 1_. I I f ! �I . '
47-;FINALSTRUCTURE& BUILDING4 4f I ' I ' 1 ' _f , ?
ii I 1 I + I y I i i.! 1 I 11 • '1. I t,_ I , I
1-- Try' I I. •, „' -
48. Special;Requirements CoMpleted, , . I I I I 11 , f 1 ` I -i- I -.. I
s 11 1 1 1 1 1 1 11 I .:I 1 I .
49, Electric Release to Edison I I ! 's }.- t__._.4_. �. _w-__ ` i _i '_ _-F-.j,_.t I
1. u 1 , a r , -i- I• 'r - .'l n�'- �1 1 ,
.50. Gas Release to Southern California Gas Co I S 1 HI I 1 11 I - I I . ;•;:i. : . j . 1
°51, CERTIFICATEOFIOCCUPANCY 1 !- , I 1 '_- .1 _ ' _._, j 1 '_I
b ; I"
No II I I I Date I I , i ( ' 1f I I 1 : I I 1 ' !% : !: 1,. .
•�-JL--___,-'...J,.�...-.- ...�.,^,....--J:_ t _! __J_. .- .-_.-.1._:�1-J1M - > :_. _ __ f ifC_
PROJECT ADDRESS: 2876 STROMBOLI RD UNIT,: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B . 047178
OWNER'S NAME:,SHROEDER . I • . . -
AODREsscSAME . PERMIT NO: B 047178 PLAN CHECK NO: • N GOVT: N SUPP : N
/ •
CONSTRUCTION TYPE: . PERMIT TYPE: SIR - ' PURPOSE: OTH
ARCNSEMc1NEER: REG.NO.: JOB 'DESCRIPTION : REROOF 3800SF W/COMP , SHINGLES INST SHIN SQ FT:. - 8, 100
ADDRESS: • UNIT: _
•
CLAIM VALUE: 8, 100 . 00 CALC-VALUE: 8, 100 . 00 GROUP OCC : R-3.: , / •
'f'PERMITTEE: CHAMPION ROOFS (714 ) 898-8600 I •
' ADDRESS: 3257 VERDUGO COMMENTS : p
ORANGE • CA 92667 *******************�F�r+e+r�r*�t**x*yt**�r*�E** ****�tx *�r�P�t�t*�k***iet I®I DETECTOR
1
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQU IR EMEN T
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETH ACK S p IR
caruc.: 042725 • STATE :429481 suss: C-3 IfIEQUIRE�
s�� � ( • MAIN BUILDING ACCESSORY BUILDING
' ,, Date: C=2,x Signature:�04✓`�� Q� FRNT: • FT IN REAR: FT IN FRNT: FT IN REAR: " FT IN
y}IORKERS'COMPENSATION DECLARATIO : I hereby affirm that I have a certificate of consent to self-ins re or a certificate of Workers'
;;;,,*compensation Insurance or acrtified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN'
c"POLICY NO.: 0 7 8 3 0 63 8 8 EXP.DATE: 10/01 /9 0
COMPANY: STATE FUND PARKING REQ: • PROV: PARCEL : 13939315 ZNE: REF NO:
0 Certified copy is hereby furnished. • Certified copy is file 'th the city B/uildinn visa PLANNING NOTES> '
/� r / >
Date:—�--2 Applicant: A/IA **************:*****************************************4***********.W4.0********
D E V E,•L O P M E N T SERVICES R E Q U I R E M' E N T' S I
' EXEMPTION FROM WORKERS'COMPENSATION OECWIATION: is section need not be completed if the permit is for one hundred(1100)or less). _
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become / —_
subject to the Workers'Compensation Laws of California. ZONING APPROVED- BY DATE: - ..
•
Date: signature: BUILDING APPROVED BY : DATE:
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby'affirm that there is a construction lending agency for the performance of the work far APPLICATION ISSUED B Y: S ' DATE: 'ice 1 O
which this permit is issued(Section 3097, C). *********************************************' ********************* ** ** *****
LENDER: - **********iF********************************************************************
ADDRESS: - LEGALIZATION:N F E E S U M M' A R Y ' STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following 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 108 . 00 ,57
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed • 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 .
.,applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE i
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----> 108 , 57 0 , 00 I 0 , 00 108 . S7 108 , 57 . 00
' __I 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: 108 . 57 OVER/SHORT: .00
improvement purpoesolsle)hin one year of completion,the owner will 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 puryaseof sale). 108 . 00 . 57
E
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 an owner of property who builds or improves thereon ***********************,*********-***,*k**iE*.****************,*******-*********,)E*****
and who contracts for such projects eith a contractar(s)license pursuant to the Contractors'State License Law).I am aware ri
that proof of their Worker's Compens.bon insurance should be provided to me. IND I V .I D U A L F E E B R E AK DO W N
❑ I am exempt under Section: B.8 P.C. •
for this reason: ' . TYPE QTY DESCRIPTIO 'N UNIT COST TOTAL COST
t:.
Date: owner: •
SFR 8100 REROOF BY VALUE RESIDENI'AL NOZONE 1 . 00 • 8 , 100, 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF.r'JF E ES
25534 and that I or any future building occupant will/will not(circle ane)need to comply with said state codes and the requirements for a -
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions. 'n '
Date: i Applicant:
I hereby certify that I have read this application and state that the above information is coriect.I agr J/ o comply with all city and county .43 V , •
ordinances and state laws relating to building construction and hereby a i•irize represen • : of;cis,. ^ e above-mentioned _ I et - •
properly for l>acFtion purposes/.. (/7 " ' /
/
Gate: 5.�� "`�
01 00060020-00060021 TOT 108.57
1641-48 White-Buildad
ing;Green—Ce Enforcement;Canary-Applicant Pink—Revenue;Goldenrod—Assessor DATE: 05/02/90 TIME: 14849
A
CONSTRUCTION AND PLANNING- • ' - JOL & SPA - -
APPROVALS *Permit# - Date - Inspector APPROVALS Permit # • Date Inspector
1.-Temporary Electrical Service or Pole -: 4 - 52. Pool & Equipment Location
2., pe-Undrgrnd.-, - 53. Steel Reinforcement ..
3..Electrical Conduit Utility-Undrgrnd:. '? 54. Forms •
4. Electrical ConduitUndrgrnd. 55. Electrical Bonding' ,c
- 5. Steel Reinforcement . • - , . , 56. Rough Plumbing & Pressure Test
•
:-. 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings - ' - 58. Electrical Conduit-Undrgrnd. - ' %--.
8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test i
. 9. Water Pipe-Undrgrnd. . -� 60. Backwash Lines, P-Trap, 0 Undrgrnd. L' r
10. Structural Floor System . 1'; 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 / r
I
14. Rough Plumbing /' %, , ,. . 65. Electrical-Final - •• ;•
•
15. Rough Electrical-Conduit • 66.,Solar Sy-stem-Final
16. Rough Electric Wiring r67."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 IL. APPROVALS' "rPermit # . -
^
21:40 uPts,in'Striicture'' - - " - - , s ,70. Underground:Hydro -
22. Ducts, Ventilating- "i J. ' . -71, Product Piping O d_as 0 Oil
23.-Gas-Pipe,Rough & Test - . k . - '72. UndergroundFlush'_'
24. Roof Ft.amirig - - 73.YUndergrnd.storage_Tank OGas OOil
25. Roof Sheathing V r 1G ' /'' 74.-Overhead Hydro?
26.'T-Bar Ceiling (Structural) & Monocoat -• . 75. Dry Chemical ..
27. Frame and Flashing i _
76. Dry Standpipe -
.28. Lathing& Siding '. - ' • .4 77. FIXED SYSTEM.F.,INAL-
29. Insulation : ; 78;-FIRE PREV. FINAL '
30. Drywall Nailing , _ HEALTH-DEPT:. REQUIREMENT
31. Plaster Brown- .1:Ct . ^79. FINAL INSPECTION A - . •
-,.32. .Electrical Power Meter-Final _ ' I , - `80. FOOD CERTIFICATE ISSU D
33. Final Electric- Notes: Mir, - S
34. Final Heating& Air Conditioning li
35: Final Gas Pipe-Test S!lLd;Gt-:D ( �
36. Hood of_CanoPy r - •7
-37..Finai Factory Fireplace, I- • • .i
38. Final Plumbing ; - "' .- -
39. Water Service;Final, . - i . -, '
40. Gas Service-Final ' '
41. Solar Domestic-Final - ' , • -
42. Backflow Preventers • - _ -- • .. •
r , , • • . J
43. Backflow Irrigation • . _ - r -
44. Landscape Irrigation Systeni '- • _ • _ ,
•
45. Sound Attenuation -
46. Handicap Regulations : 11 + -
4 FINAL STRUCTURE & BUILDING 31 (Qt
48. FINAL PLANNING • .•t '{
49. Electric Release to Edison - '
50.. Gas Release to Southern California Gas Co .
51. CERTIFICATE OF OCCUPANCY - -
No. Date .
OWNER STEWART, W. DATE11-5-62
JOB_ ADDRESS 2876 Stromboli Rd.. BUILDING PERMIT NO. 18120
GENERAL CONTRACTOR Riviera Pools, Inc. VALUE $ 3100.00
AP No.139=393-15 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Pvt.Swim Pool
INSPECTIONS Signature DATE GROUP j TYPE ux ZONE R-1
Soil PERMITS ISSUED
Gas SUBCONTRACTOR DATE NUMBER
Water
Rough Corn. Refrig. 0 Air Cond. 0 --—
Rough Heating n�- (/y C T . q—
Rough Plumbingle�j,t .t//6).) ,V}/i%j ,CAL ?/.v'�/Z 1 '142,, O-NG /F Jr-- + _37,0,57------
Miscellaneous
l
Miscellaneous y 6`2 703 _
Prop.Swr.Line 0 House Con. 0 St.Swr. 0 —�� >a�7
Sprinkling System
Construction Pole
Underground -/ Power ❑ -
_ _
Rough Wiring r • '- .' . /a3 -6a /
'Trenches S Forms 0 Steel Reintere /2AY/f,z - -Y
Floor System
Bond Beamer Steel Reinforce 4- // ,./ 9 ---01:Ct
Sheathing _
Frameame and Flashing q/VvT
Lathing — In ❑ Out 0 flc _
Plaster, brown coat Plaste. ❑ Au• Cond. ❑ Final Heating, Final /7l__
Plumbing Fixtures, Final �� r,t,
�pCA,,,,
7i e
Final Gas Test .2^ '] °t
Electric Fixtures, Final /,Z-e:::,/_ / _ _� 3)A
Building, Final S'
OCCUPANCY `�
FORM BU4-5M - 7-61 HOLD FOR SPECIAL RI;QUIREMEN IS
18120
181 EE RECEIVED
. COSTA MESA BUILDING-SAFETY DEPARTMENT NOV , 1R62
P. O. BOX 817 COSTA MESA. CALIFORNIA
YINANCE DEPT.
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
B�S IP 1 TYPE OR PRINT • BUILDING
BUILDING _I R 7 / Ste-{ M OF/- I
ADDRESS CJ
f` COSTA MESA.ppCALIFORNIA For Office Use Only
r�
OWNER 1/u I Stew Ae. f I RECEIPT NO. I P Mpg !�
MAIL OI 7 / 'D Y- r O .w a 0, L 1 RECEki BY ` DATE/IECEIVi‘ M/)/�/ ISSUED�n
ADDR(E//$$St '1p71' A (/qJ� �V.J 11 /PI I �- (/ I� /{��
CITY &6.j-A M C-;-.S a NO.TEL. BUILDING .
++,, 11 /' / ADDRESS
ORREENGIINEER/W �(�. �.({.[9/,7) NO.�7 S¢}3n COSTA MESA. CALIFORNIA
ADDRESS-•-((/ 7 S (V\,`1pS ISI FIRE
//�/
T (I ZONE T'-`TYPE "40-GROUP /J
CONTRACTJORS�r V Lo �.A- i U` OIS�NP- BYPROVEDJ r/ J DATE // /�/J C-
ADDRESS(fl / 4Sr J�2L e 1 A /��`U d. �'4 KJ ZONING ' //
CITY �1 C L 4 A (0 A )c1 I �/ >� ZONE/ PLAO.NE �)_I USE OF NEW
BUILDING .(" � /C
1 LIATE C.NO. / / 9 2. NOTEL. h. 1 • Y xl DEGAR' - 7 °) 7--P.., 44/3
.. • Lai/3i 1
( LEBLRIPTION -7-4-J �L
SIZE '7 p • 10—f- I NOW ON LOTS• / A.P.NO. I / _ , /U
OF LOT
USE OF �/ I.'L 1^� �{- / �1
K YARDS EVES
EXISTING BLDG. 1 ��•• Rl -l / 1 1!� Ii APPROVED ALLOWED
SETBACK LINE PROM / // (CENTER LINE ST.)
CENTER OF STREET ,/j ., REAR YARD C_o FRONT v FT. "C-/ • IN.
SIDE YARD I LEFT ( a I RIGHT eD'C, 1 R.SIDE c FT. IN.
DESCRIPTION� OF WORK L.SIDE / FT. N
NEW IL/ .
II ALTERATION I V ADDITION I REAR d FT. IN.
APPROVED /y / //� 1
DATE I` s-C`7
REPAIR • I II MOY/I3yG,�Q/ DEMOLISH BY
L(l T-/(l`� I�Y�L `��-
SIZE BUILDIN'i ki X38, I/ ROOMS STORIES ��(.H ad+--AJC.56M QUrREIVIE tT'�
EXTERIOR WALROOF /
COVERING /yI)/ COVERING __
- `OF BUIL (IG AND WORI9O BE PE'FORMED S-7 --lrhC1 /
•
.� W I I J Y d 4...--.1.., rel al
i
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND'STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNTSHOWN UNDERVALUATIONISFOR THE
FEE
OF ESTABLISHING A PERMIT.PEE ONLY.
PLY WITH ALL CITY ORDINANCES ATE LA REGULATING
BUILDING ION; VALUATION {''
SIGNATURE O ,{}'(`�fj(� ) (�,�.((� PERMIT FEE $ �L�/ —y
PERM ITTEF ' "' -"��'-� " " `" `` N
\/'�\ $ g /0 d PLAN CHECK $ , ✓ 4
UAUTHORIZED AGENT 1 I/ _I'0 v �)�2/ {' E
TOTAL FEE $ E '^ •`l LL
OWNER ' STEWERT, B. _ _ DATE 11-8-62
JOB ADDRESS 2876 Stromboli Dr. BUILDING PERMIT NO. 781811 r
GENERAL CONTRACTOR Pacana Masonry VALUE $ 355.00
AP No.139-R9'-15 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Com.Blk.Ws11
INSPECTIONS Signature DATE GROUP J TYPE III ZONE R-1
Soil PERMITS ISSUED
Gas SUBCONTRACTOR DATE ` NUMBER
Water -
Rough Corn. Refrig. 0 Air Cond. ❑
Rough Heating
Rough Plumbing
Miscellaneous
Prop.Swr.Line 0 House Con. 0 St.Swr. ❑
Sprinkling System
Constructionpole
Underground 0 Power 0
_ Rou•h Wirin__ _
rent es • orms • tee 'ern UFloor System _Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing — In 0 Out 0
Plaster, brown coat
Refrig. ❑ Air Cond. ❑ Final
Heating, Final
Plumbing Fixtures, Final
Final Gas Test
Electric Fixtures, Final
Building, Final Yt/ /9 I-2L1-63
OCCUPANCY
FORM BU4-5M — 7-61 18181''
1 184 FEERECEIVED
NOV a 1662
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P. O. BOX 917 COSTA MESA. CALIFORNIA
CITY OF COSTA MESA
For Applicant to Fill In Completely • APPLICATION FOR PERMIT
TYPE OR PRINT
^. BUILDING
BUILDING )8'7{ 5"ram bD J' / /�
ADDRESS [ o / ICI //,
COSTA M
ESA. CALIFORNIA For Office Use Only
OWNER R. .J1/29 uC r+ IRECEIPT NO. 'WW2/
`9j (� -y J C `
ADDRESS (X.Pi / 6 ,J ira n-) be / / RECEI D BY 1 DATE�CEJS[!D, DAT9)^BUSD�2
COS.{ TEL. BUILDING !/ 4y E /f/ A(/
CITY eS�1 NO. ADDRESS '
ARCHITECT TEL.
OR ENGINEER NO. COSTA MESA. CALIFORNIA
ADDRESS �- 9 FIRE
���44fi/�� � ,
r// ZONE TYPE _ ROUP y
CONTRACTOR 4C4-S '!/ /�
3 , 1 j-r n APPROVED
/' 9
�J^ BY DATE
ADDRESS 9034. ` " (;:a _1'1 • ZONINGiiji
we c� mils-
ZO NO.OF SUI OF NE/'
CITY P r 1......F
PLANE I BUILOINO W ��n 0
STATE I Y77 ,�TE 71 LEGAL Lot
r^/ rt /� / V
LIC.NO. �/J /I// /q�� ND. ! u� - 3�6 3 L DESCRIPTION /.-�((t [. V i {�� c` ,1 I /
SIZE
OF LOT /O F /` -a 'NO. OF BLDGB./p 1 n]/ l
y/��{/ 4
NOW/ ON LOT ! A.P.N O. ll/ 3 1 ^ 3 y I - / ,S
USE OF
EXISTING BLDG, .//0 C i(GU- i/ YARDS EVES
APPROVED ALLOWED
SETBACK LINE FROM �) /� (CENTER LINE ST.) 57)
CENTER OF STREET ( � REAR YARD FRONT FT. -I- IN.
// (.
SIDE YARD I LEFT I RIGHT l� R.SIDE FT. Cf IN.
DESCRIPTION OF WORK O IN
NEW I/ C L.SIDE FT. /�
ALTERATION I II ADDITION I REAR FT. IN.
I REPAIR H MOVING I I I DEMOLISH APPROVED 4// /) 011/Z)
/ VD I it-D�
BUILDING NO..OF
SIZE ROOMS STORIES
EXTERIOR WALL I ROOF
COVERING COVERING
U6 OF BUILDING AN9CRK TOcu PiR/ MED
4 ' ' i( c 6 K / 7 /T -
I HEREBY ACKNOWLEDGE THAT-1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IB FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OP, ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY NCEB AND STATE LAWS REGULATING
BUILDING CONSTRUCTION.TION. _ VALUATION ..e,.�
SIGNATURE O1[^t PERMIT FEE $ J
PERMITTEE `I,0�� a
0 Si PLAN CHECK $ oi
Z
3SS
AUTHORIZED AGENT J
3 0
So
TOTAL FEE $ r
OWNER STADLER, PETER H.i., DATE 2_14_69
JOB ADDRESS 2876 Stromboli Road BUILDING PERMIT AlliedNO.29698
BuildersDESCRIPTION of WORK CONTRACTOR Add Study and Extend Entry
AP No. 339,..,3q3-15 LOT 70 TRACT 4nJ. FIRE ZONE VALUE $ 1000.00
INSPECTIONS Signature Date GROUP 3 TYPE V ZONE R-1
SOIL SUBCONTRACTOR PERMITS ISSUED
GAS Date Number Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE Q HOUSE CON. n
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND n POWER ❑ J
ROUGH WIRING /n1 . 72t-cy Heating and Vent.
TRENCHES El FORMS 03 STEEL REINF. El /f j.-'/O-tn7
FLOOR SYSTEMf� ).-r0—y
BOND BEAM L I STEEL REINFORCE n 55 /
SHEATHING 42'S A')/•6
FRAME ANO FLASHING "Z.0
LATHING — IN 121 OUT P '✓q�j'���/
PLASTER, BROWN COAT l iffi Sire
�I IT
STRUCTURAL, FINAL t 17 V (, Ele t i''c�j /� 17-177 J
HEATING, VENT., REFRIG. AND A.C., FINAL (4/ (1. / J !/ ,4 q/- --
PLUMBING, FINAL AND GAS TEST f /� IV
ELECTRIC, FINAL J/ �'IZ-6/n 7
•. 29698
PAID
COSTA MESA BUILDING-SAFETY DEPARTMENT FEB —4-69cp,AOO 069* ****34.50
P.O.BOX 1200' COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For
QApplicant to'Hill/in Completely �j gECE EDB DATE RE�C/E,IVED DATE ISSUED
BUILDING 576 /!_foj po // IX L= / �� 2-L/-/L.
ADDRESS //�.q �/ A / p p ji Fi
OWNER PE-/L /l W. ..5/ig �AF� A.P. NO. I3 ! "3 / 3 -/S PL �o O
MAIL ,/ y� z�' BUILDING
ADDRESSSSS?42, (� ADDRESS
t9 u.iF-aZ CITY / j S7 774_5.4 NO. -' \� TRACT 43 i LOT g O BLOCK
z C CONSTRUCTION NEW ADD ALTER REPAIR MOVING DFMOI ISH
O y LENDER v i>.'---
O. co
iam _ •
J ( BRANCH C
Jtn S
OWNER a lin 'e��
< (11 ADDRESS
mm ` 5 /'/ �Ty VALUE QOO
J< OR ENGINEER0� F. 1 Di)zE NO
S/l/Y.E USE Sfa(/J �"'� / $
U N /
/� Q FIRE �
W CC ADDRESS.4 S' -///e.1) p N/IOi"C ZONE /C TV PE GROUP Tr-
ci_Ly JO CONTRACTOR APPROVED '�/yam/ DATE2-1 9
,41/�fD ,r3a�ID�,v�j I 9
ww ADDRESS%23 37 S. //q/n/ .5,4/�1/�Q.r9/I //s ZO/NSE NO.OF USE OF NEW —
Z)- CITY S�4h* AMA NOkanS- .10 U r. t PLAN �r BUILDING
w O STATE CITY YARDS APPROVED YARDS APPROVED
WCC LIC. NO. .25-70 y) LIC. NO. MAIN BUILDING ACCESSORY BUILDING
7 0 (FROM C/L STREET)
SIZE , NO.OF BLDGS.
OF LOT T'I 0 0 p NOW ON LOT RONT 63 FT. FT.
USE OF /
EXISTING BLDG. r I R.SIDE z FT. 1. FT,
h SIZE OF NO.OF ,,----
Z
IZ NEW BLDG. ROOMS • STORIES) L.SIDE ✓ FT. FT.
Q EXTERIOR WALE .--' ROOF {
V
COVERING ,S/LAG Gad COVERING�7f. f
REAR M . (1, �y FT.
J USE OF BUILDING AND WORK TO BE PERFORMED
Cl. DISTANCE BET. / BET. MAIN&
0. MAIN BLOCS. ACCESS.BLOCS.
< fiebte 5 7;7 9- "'XfLzI'J/J flyLROVEDcLLl ,DATEC.U.P.#
VADATE
APPROVED
0 / w 1 / f
Y F/
Z
O
VI hereby acknowledge that I have reed this application and state
O that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
CC
1"' any person in violation of the workman's compensation laws of
N the State of California. b
ZI hereby certify that I am properly licensed as a contractor under .2.. SO.FT. 0
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 0
am exempt from the provisions of the State of California Business g:
VALUATION pa
and Professions Code,Division 3,,C/hapter 9. PERMIT FEE $ 2 3,a 0 N
Signature of A/��/ i,p / X� $ L P/t// •�� PLAN CHECK $ ///...57) E
Permittee „:4 C es//(Jd�1.,.y/Cq" /L' ✓ Cw(/ [/ o
Authorized Agent �.CGa lC .esC / TOTAL FEE $ 3 //-CO LL
I_6068 7E RECLIVLU
COSTA MESA BUILDING-SAFETY DEPARTMENT JA 1
P. O. BOX SI7 COSTA MESA. CALIFORNIA FINE V1.1 T.
cm OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT
BUILDING76 .-
LOC 70 Tract 4311 BUILDING
ADDRESS 28T.4a.h OL/ ?dap
COSTA MESA. CALIFORNIA For Office Use Only
OWNER Adams Street Compamy I RECEIPT NO. I 1 tIti )..4
MAIL 1653-Minorca Drive RECEIVED BY ( YTQ_RECfI7D/y ISD`AATEE ISSUEDISM(]
ADDRESS // O<%•,C�/ b/
Costa MesaK19-U395
TEL. BUILDING
CITY ' ' NO. ADDRESS
ARCHITECT Earl Kaltenbach TELKe5-0533 COSTA MESA. CALIFORNIA
OR ENGINEER NO.
ADDRESS 9772 Kate118_Aye. ,Anaheim FIRE L p
SZONE TYPE GROUP `
vie-
CONTRACTOR Jamar Construction Co. ,Inc. APPROVED
1653 Minorca Drive By DATE
ADDRESS - ZONING
/1 ZONE NO.OP USE OP NEW SA S.,*As
C
CITY osta Mesa . .. 41-1 I PLANS C.. (BUILDING cola*,-q.2, -
LIC. 197835. NO. Ki 9 0395 DLEGAL 401-ESCRIPTION 7o Te `/ 3//
SIZENO. OF BLDG
OF LOT 70 x 100 (NOW ON LOT
A.P.NO. c__________
USE OF - - YARDS EVES
EXISTING BLDG. APPROVED ALLOWED
SETBACK LINE FROM 42 28 (CENTER LINE ST.)q _
CENTER OF STREET REAR YARD FRONT a. FT. IN.
SIDE YARD I LEFT 5 I RIGHT 5 R.SIDE '3 FT. _— IN.
DESCRIPTION OF WORK L.SIDE FT. _____ IN.
NEW I XII ALTERATION I V ADDITION I REAR a (9 FT. _—_. IN.
REPAIR .I . (I MOVING I H DEMOLISH I BBPYPROVED tui/Aitean
DATE / 2-/L74(
MELDING(DING 1650 NO. OF
ROOMS 7 STORIES 1 •VV
EXTERIOR WALL WOO/C1- 1ROOF G✓
COVERING //the CO . COVERING Shake (-''
USE OF BUILDING AND WORK TO BE PERFORMED 1 47 I./ C!
Single family residence and d
attached garage PAN/L.7-4,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
THE AMOUNT SHOWN UNDER VALUATIONMIS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDCES AND STATE LAWS REGULATING
CONSTRUCTION VALUATION
SIGNATURE OF AD+.,., S I' T n rill' PERMIT FEE $ .�7--
PERM ITTEF // 1 J Q [�
/ $ / 7 76�— PLAN CHECK $ / •�J• ) 47
AUTHORIZED AGENT £
�S5 C' E
TOTAL FEE 5 D