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1987, 01-12 Permit App: 87000074 Residence•1 (THIS IS NOTA PERMIT) BUILDING PERMIT APPLICATION WORKSHEET . 'PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERST COMPLETE IN INK (Please return this original and your building plans to the Department of Building and Safety) S _----___ ...._.._...._. _.. __........._..,.,- a,a,._ Projedttymbar" �- ._.: 7�� O+mer'a Name ^ i LAST FIR /J MI / • Project Address (Str t Name 8 Number) 3a a (aZe l Zip Applicant / _n,^ , Addres - ift:-/A /C CSta Zip 9%; Phonebil ySz2 Q) �S-O / a Z ✓ Business Phone ( ) �t Contractor/Agente- Add t/4 ,i' ess �� , /6 0, a -fZ5( e -07E City , State Zip x'�// y / /�ot 19101-6t Phone �\..� / n p} (/9 �.�-6r t Contact License Number (Required) L14. /67.)4450i Business Phone Archllary.1ngineer4(sz 0q128/Di Address City State Zip Phone ( ) Contact Business Phone ( ) Lender Address City State I ZIP Phone �be .fid Work � ''rg?Sijf'.'�,-.Fcfy=4-ii°rj^r,e'i6„y3 --_;aw:fr�t;e. '_c`i:-t ri^' t t to it 0 - %1ww�.�>o G r Res,"' -.''., ' .Comm:;J`';,i+ar'. k' e: :in(�s/r 4- x; (Subdivision/ Iat,Namel: ,"Lg. ;rAl. -; :'•+ 'r fSi, -, ..'t�'t•F..•.,; k..eJS�:t i-'y ^rnr ���j���Tv:.-\ it eNum%l c•?7i:is.Ea:, f;lt .iry±'y��?n -•._tya_s'..tr. [eesor-aide-NutiL_1st, ."in? y.x•yiBitiCk 6��+?•' «p'R ° >Vlat Numbei rr,.'�,ry.�,`S."fN,rhEJr.x'tay"✓;.•�a�4 ,+..a3:Si t' �/%!�ty'.-.4+- r...a 'Pertl' 1P71eNAbers'-! '+ . \x••{^t'Cmp'plar_ 'SuZonex,,oy 4Ti Y_"''.L' In, +iCenss y14F. , -u> • Tial„ '[aW• 4'C•.YI fNul4t_..gY9Ui»^nc.. lU •i.-4'I'. E Id wrt .s -. ., N;umberof 6urtlltllnf.'g^^3a'r.�1Ml•O�.^w;3:4P—'�•. ,,s:,}: ;Lot Size.,si(Sq:Ft.Aire), ire) 'L1a'TYr.,1i-':.r-C.ff•- "I''Depth 14k � a ‘r:_;2. - J9-T .d, CX' iv,. frontage 'alga •,,, rtes D iyv."4.,Le�nk'_1••'E t } 3 •- retro. "l •Right Setback +b"'�1,,,d1.r ' Aa ;� Reaiselbec kf.� : k.g: `t,�„In'•f G>.qv d.✓:'.S.•:i�}ryY R/WyWi— '•i` '-•;.r x 1 1oUtIa4� sr21K .. *• '' n �neyljf.' h .M ,� .<• S I s',, ^..Sr.'\,R. > ” 'Z �Y Ai '4. . ` 7.(+.�YC• yyi<-?Rt d . ''S ; 5 ' ' - '�"ri? ! �:i . -SS' _tae y' "it�,•�j7 S: t ✓ ot"'d I K'S.' f+•2G�.taa�1' B• a Y a +'tEt'''+® nor r VN, '. Y I 'Q 1i 4'`i t�'y .d� x t-l.."R`t_1 f �'. [Y'h'r# h a. '• a i,• -'Q G `rbxt� ; Y..9y ISM .h. ,>•. d 1= }} _ e''rt,.. i 'f P ^erT•` N8I + �� fix •rr��G� � r`. � *.it fie a ' J .. I ....` ♦a iv S . ' t� T�a, li_ �i� I i '"5h�, = r h xs 11. !.r- t.A� EP r �'�' ,. '"�e45»a4 #?i.+�.,+Ir .ta .:�`fYt`•i•'Y�''�.,' •Cei < 6LLG ?mak` M;•' -L, : r. +¢ ,.t ii�A>T lits ..y, r"''"•��k TiYi GS'*nt; M:. Y'•' r�'y,,!.tia'Fx� >,t%y " k•. w u..ti.r �ye23 aY F- r' N. °;`.t' s�°d7`.;?•gc•' ."MLf '" Frx i; .S-ic 'ti'Y '..d-�ji? } r. r. ;'.�• ,- t} eat.r++cC .< G7S: .fisT"-a! I j tv sx:'s'. .y- �.. tea^4 r ..,,,,{t _': v i +? ^f'tL�•:i1�"'":n"`.sr ..' . `.vY C•..fis�z� E92. Wa4i>. ,-,$S 'Biu'"fx°c.'F.."..wtiSY:'':'D:L" ' �.iL � t � Number of 8edfoanL9 t "lit -it- yG ' �� t ''' .y rn x 1,�'el* *leg, }L' j :, F as a #1•E-;iE{'. �-' iM2�R4^.jg1. 'W 3Y.:{.hQ".,�..� GP.x 3Tt:r f°T•fAYC..Ri}Q.�' `Y'1 y'9' 41W FJY �{ �,+� ' `+'?..[� .y ���}}}}vyt 9'� ie µ, {� p�` t. yt'�ru+k.r ,.,.x mmf lfwt tBltildl Il'9ch \n ttgs kfe!t . t'r 3 � b� a Date„ :.�'e�•h� e 5r% a ..•.t� ..i•f'.� :: �.•e. r it"'''^''`�. +.r: 'z � 'F.�,�:.�`„'•jl p,r :>> CcQ1l rel !3 L8k= , a.: ..= .:r.•......r..�•_:r.,_a,.:::_ : I,.re.r. I `. Grotto ; t?=.. ',e-.a.� Type �?YPe 3..a. .±.:. DEPARTMENTAL REVIEW I certify that I have examined this application and state that the Information contained in It and submitted by me or my agent to compile said application is true and correct. u--/✓C-.�' Date 'r' Approved Cond. Approval Hold Environmental Health Application Of W. 1101 College Room 200 Planning/Zoning N. 721 Jefferson ' Engineers w�t���t7 /- N. 811 Jefferson fG'/CM4- 60e, 74-2- 4- 6d % �/1 �7 ;1 /Utilities N. 811 Jefferson S____ — SetaeR- Ter> W' !'J7�Nt0ctcID Th Mrot t --..s4 �i1FSD. 5E 12 ' THAA OTOm1� an-8.a."A.4T RE4tfu2isTi Plan Review/Fire Prevention N. 811 Jefferson Other (SEPA/Critical Material/etc.) Fast Track/Special Inspection Information Project Representative Phone Address I certify that I have examined this application and state that the Information contained in It and submitted by me or my agent to compile said application is true and correct. u--/✓C-.�' Date 'r' W Q I- H LL U- O ccw m Z PLUMBING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND IProtect Owner's Name Last First MI Probed Address (Street Name & Number) City State Subdivision/Plat Name Assessors Parcel p Lot Block Plat a Applicant Address City I State Zip Phone Business Phone Contractor Address City I State Zip Phone Contact License N Business Phone Describe Work Bar Sink(s): Drinking Fountain(s): Floor Drain(s): / Wash! g Machine(s): / Oeh Wshr(s): / Garb Disp(s): Kit Sink(s): / Lndry Tray(s)' Sew Eject(s): Urinal(s): Wtr Closet(s): G— n Lev(s): 2_ Shower(s): / Tub(s): / Bidet(s): Other: Type; Waste/Grease Interceptor(s): Sewer Y N Septic/Health No.' Electric Water Heater(s)' / Drains -Roof: REPAIR OR ALTERATION: Drainage, Vent, Water Piping/Treatment: V N Lawn Sprinkler System(s), Including backflow device on any one meter: Vacuum breakers or backflow devices In excess of line 16:1-5: (Or) 5+ I certify that the above information as submitted by me is true and correct and further, agree that all pro- visions of laws and ordinances governing this type of work, including inspection requirements, will be com- plied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state of local laws regulating construction or the performance of construction. SIGNATURE OF OWNER OR AGENT DATE APPLICATION ,, t-111-" r T 1.,.l- r r .r T ! . i SS ]> 1 14. rq N 64 IJ r -N a At_/i� yia-i NA -s -e NI �1 N FL. rL Ojai 1f%b�"'� ire) Q, 1 GOO L mak Ji - //IA � Yu _,L! •\- aW11L KNE 85' Himalaya Homes, Inc. Address: ale 3224 S. Pines Legal: Lot 4 , Blk 1., Midilome 4th Scale: 1" = 20 /N1; PAS ri P/1e o 01/4-N Y c.,->itk 9 APPRio hc.w Si A6A_ a/ ver,..) INA74-.2 g.S'r-wtiV cLSpki -% ,