13278 Wooden Gate Way T`SP : qs� 3bl - 0900
CITY OF EASTVALE PLCK No: Permit No:
RECETIMOr-, /0- oo45
1NcO"m,Ten Date: Date:
OCTOBLQ
NOV 0 21610 Amount: Amount:
4 307,fa 0
Ck#: Ck#:
CITY OF EAR a VALE 049 348
Building Combination Permit
To Be Completed By Applicant
Legal Description: Planning Case: F: L: Rt: R
Property Address: t As essor's Parcel Number.
Project/Tenent Name: Unit#: Floor#:
r
Name: YJt il % . l ID Phone No. y �/ „& Fax No.
PropeOwner Address:` -Gd P P- 11 r Unit Number Zip Code
Email Address:
Name: ) / ' P�hoPe
Applicant A S S(.n / 1.../' y } r t�i� Unit Number Zip Code
Email ddress:
Jre C I/
Name: //� 1 Phone No. t Fax Now
Contractor Address: 6
.f.r e/
Gity Staty Zip Code
� C ° >ti , ,, CIr//-. r,a..a ., �e. /rep Cie
ontractor s C_�Busme S L cense o. Contrac 'sLi(y State OfCalifornia License No. Classification: Iri
mber of Squares:
-, uare Footage
Description of Work: Cos[of Work:$
Applicant's Signatare
cei l); h Dater
To Be Completed:By;Clty Staff Only -
Indicate As R-Received or N/A-Not Applicable
5 Completes sets of fully dimensioned,drawn to sale plans which include: 1 set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Goo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8%x 11)
❑ Foundation Plan ❑ Structural Calculations
❑ Cross Section ❑ plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan 8 Detals ❑ Shoring Plan ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration* Addition* Means/Methods
Work Type: Repair' Retrofit' Revision to Existing Permit Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicat Indicate i
e i Indicate allJGeo-tech.Haz.Zone
At Project Sprinlered YES or NOCompletion: Construction that apply: Coastal Zone
Type(s): C of O NO Noise Zone
YES or
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retrofit Special Case:elaq.
OlfcialA royal
expedite Project(s): J. Child Care City Project Green Building Landmarkl I Affordable Housing
For Staff Use Only
Building/Safety Permit Specialist City Planning Civil Engineering EPWM-Admin Transporlatiort Mgmt. Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY