5763 Red Haven Adak CITY Of EASTVALE PLCK No: Permit No:
R Ail INCORPORATED
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Errcoeeoewren Date: Dale: 'r
^ OCTOBER", - IO-18-LoIO
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woilding Combination Permit G 2. 1 o S �y
To Be Completed By Applicant
Legal Description: ,, ,( rU)L Planning Case: F: L: Rt: R
Property Address: 76 Z Assessor's Parcel Number.
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Projectlfenan a✓� Unit#: Floor#:
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Name: �✓ r f1�IJ•57`� P7o�/NS 76-- 3i Z d Fax No.
Property Address: -/v 2, Unit Number Zip ode $�
Owner tc
Email Address:
Name: / Phone No. Fa&No.
96"/- 7S-715-1 4s / 72 3 -E751
Applicant Address: �'ft�1� 5 Unit Number Zip Co
2 ti S-PS
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Email Address:
Name: •� � Fax� S�+ 5iq; N Z3 �3 4( N 72-3 J' 791
Contractor Address: City State Zip Code
46 C- I`� zA cd�c n�cl 'rCt 9z5�S
ontractor s City Business Icense o. Con actor's Ci S.iate of alifomia License No. Classifcatio
-53- 5 D-3 3
per of Squares:
Square Footagesm
Description of Work S1.4,/AME"r I✓(, Pot)L z" - - Cot of Work $
Applicant's Signature' Dale:/
To Be Completed By City Staff Only O
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'A x 11)
Foundation Plan ❑ Structural Calculations
❑ ❑ Cross Section ❑ Plumbing Plan
❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan I ❑ 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 Indicate Indicate if YES or NO Indicate all Geo-tech.Haz.Zone
At Project Construction Sprinklered that apply: Coastal Zone
Completion:
Type(s): C Of O YES or NO Noise Zone
Required? Listed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. I Planning Comm. Zoning Administrator
Fee Exempt City Project Elea Vehicle Charger Landmark Seismic Retrofit special ase:stag.
ODecalA rival
dite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Safety Permit Specialist City Planning I Civil Engineering EPWM-Admin Transportation Mgmt. Rent Con Vol
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