7379 Lower Creek Cir C'+1
��II ��nn CITY OF EASTVALE PLCK No: Permit No:
RGCIGI QW
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,rrcoxeoxwreo Date: Date:
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OCT 212010 v- 2t-zolo
qS( �� ( _ 0
9 00 Amount: Amount:
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CITY OF EAST'VALE I7 $
Building Combination Permit
To Be Completed By Applicant
Legal Description: Plamm� Case:
9 F: L: Rl: R:
Property Address: -y375f 40k 7 Gt Assessor's Parcel Number.
GUr5O/V/1 �i� 9Zb'$c7
Projecu tenant Name:
Unit#: Floor#:
Name: `,I, Q Phone No.
Property Address. w)] II �� 9s;_ �-7-33 Fax No.
Owner '737 Z—Otc� Unit Number Zip Code Gi p
Email Address: r Z�O
Name: ,7—vi)o �� /`/� Phone No. Fax No.
Applicant Address: 1' -IC24�
73 7 17 Z Q tt-yf� Unit Number Zip Code
Email Address: C/�/�
Name: Phone No. Fax No.
Contractor Address: City State Zip Code
ontractor s City Business tcense o. Contractor's City State of California License No.
Classification:
N, of Squares:
Squ-..,rootage
Description of Work: 17A15 T1N- C PA710 LC7 ✓iL I� 12-rX Zit Cost of Work:$ ,3 SU d
Applicant's Signature /g.fIr�c''
m Axicidb.Z. LG-rttlC Date: /II ^�(. I
TO Be Completed By City 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 ❑ Geo Tech/Soils Report(on cd only)
❑ Plot/Site Plan ❑ Roof Plan ❑ Mechanical Plan ❑ Title 24 Energy(on 8'/,x 11)
❑ Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Structural Calculations
❑ Floor Plan ❑ Single Line diagram for Bled.services over 400 AMP
❑ Structural Framing Plan 8 Details ❑ 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: It Stories: Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicate if Indicate all Geo-tech. Haz.Zone
A[Project Sprinkleretl YES or NO
Completion: Construction that apply: Coastal Zone
Type(s): C of O Noise Zone
Required? YES or NO
Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
ALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm. Zoning Administrator
City Project Elec.Vehicle Charger Landmark Seismic Retrofit Special Case:Bldg
OfficialA roval
`ts) Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
0ermit Specialist I City Planning Civil Engineering EPWM-Atlmin Transportation Mgmt. Rcnl Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY