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391339 (SFD)PERMIT NO. 391339 ..� DEPARTMENT OF BUILDING & SAFETY COUNTY OF RIVERSIDE n--. / rb- FIELD OFFICE M -1T - CONSTRUCTION E I A -1-1' NO. ELECTRICAL FEES NO. PLUMBING FEES I ST FL. 1)2 SQ. FT. @ ^v UWTS Owner SQ. FT. @' M .00 I YARD SPKLR SYSTEM 2ND. FL. SQ. FT. @ex,00—I312.00 MOBILEHOME SVC. BAR SINK POR. SQ. FT. @ n POWER OUTLET ROOF DRAINS GAR. A ti SQ. FT. @ � Community r A n TY 1 hi T DRAINAGE PIPING w.. Valuation f CAR P. SQ. FT. @ MH. Permit Fee $ DRINKING FOUNTAIN WALL SQ. FT. @ URINAL Micro Film Fee VALUATION n WELLING WATER PIPING ESTIMATED CONSTRUCTION NOTE: Not to be used as property tax valuation v `� ' SWIM POOL, PVT FLOOR DRAIN MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER VENT SYSTEM '1 FAN EVAP. COOL HOOD SIGN WASHER (AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED O T 1 C V J LAUNDRY TRAY rV AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK .. ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC4-Mrl WATER CLOSET COMPRESSOR HP POLE,TEMP/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT 4SHOWERBOILER B.T.U. SQ. FT. @ cBATH TUB SQ. FT. @ c WATER HEATER Inn, SQ. FT. RESID @1'hcSEWAGE DISPOSALSQ. FT. GAR @ 'i cHOUSE SEWER f GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL. TOTAL FEES MOB.HM.FEE MICRO FEE ME PL. CK. FEE CONST. FEE SMI FEE FEE PLU ^n Mileage Fee f Address City Zip Witness Fee f Reinsp. Fee f Owner/Agent Ir EN N — v _. • y . 46 • v V .► WV • 4/ y v J. • .J i /w ♦ A V T 1 ♦ _/ IV PERMIT NO. py 7 2C A Job Address 77350 Space Zip Owner r"� 391339 � Community r A n TY 1 hi T _._ A w.. Valuation f atr e f rs +' Off. r A F.C.C, MH. Permit Fee $ se of rmi e d Use/Case CkAffr Micro Film Fee Cop j WELLING AND AIT• GARAGE ., e acks Lot Size Mech. Fee DL;I f PI. Ck. Fee f Construction Fee Dbl f Legal Description F S S R h Electrical Fee Dbl f O T 1 C V J 4 /2 1 1G y� O T 11 b y 1 91 .Ll/ i i7.L .7 Zone Restrictions Group Type -i4 SMI Fee f r 2T Plumbing Fee Dbl $ Bond Amt. Plan No. Plon Checker FinY Date Inn, Unit Sp. Insp. Fee f f I Dental. Fee f Const. Lender Branch Supplimental Permit Numbers ja B 03 9 1 T 2 A spar rr .7 {J i7.7 Registr. Fee f Mileage Fee f Address City Zip Witness Fee f Reinsp. Fee f Owner/Agent Ir EN N 2711 007 Tel. AQd —Ar -4 Zip _Irnm Total Fees f Address ' ity Zip M.O. N.C. QCosh Chec Dn MAY A.4st Received by Contractor Te .. License# Trees required Sewage SY?&N rlfVf� Address City Zip T LL P THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK Aer District FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH \\C/_ THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN CCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. Form 284-208 (Rev.8/78) verified by: +. v r. • v � �. v • v v ,�. � .r x. /. iJ y • yr G' aJ 1 � ..J i PERMIT NO.DEPARTMENT OF BUILDING & SAFETY 391339- 913 3 9 COUNTY OF RIVERSIDE FIELD DST CONSTRUCTION ESTIM ".' NO. ELECTRICAL FEES NO. PLUMBING FUS IST FL. SQ. FT. @ $ r UNITS • 2ND. FL. M y SQ. FT. @ `r • YARD SPKLR SYSTEM POR. SQ. FT. @ MOBILEHOME SVC. BAR SINK ti GAR. SQ. FT. @ v • POWER OUTLET r6uww� ROOF DRAINS • CAR P. SQ. FT. @ • Ulu DRAINAGE PIPING WALL SQ. FT. @ DRINKING FOUNTAIN SQ. FT. @ URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation • SWIM POOL, PVT # FLOOR DRAIN MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER VENT SYSTEM FAN EVAP. COOL HOOD SIGN WASHER (AUTO)(DISH) APPLIANCE " DRYER A GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY L AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC i WATER CLOSET COMPRESSOR HP POLE, TEMP/PERM LAVATORY It 9900 HEATING SYSTEM FORCED GRAVITY 9 SO— AMPERES SERV ENT SHOWER BOILER B.T.U. —1-5 law SQ. FT. @ t V, BATH TUB X.•11;' SQ. FT. @ t r WATER HEATER [ SQ. FT. RESID @1'/.t SEWAGE DISPOSAL 4 SQ. FT. GAR @ %C AIDHOUSE SEWER `F' v GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL. TOTAL FEES MOB. HM. FEE MICRO FEE MEE PL. CK. FEE CONST. FEE ELE• . 6/ SMI FEE FEE PLUAN.Y 06 4 4 U A +' • Z IU 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 29A 298 30 31 32 Ground Plumb Water Piping Rough Plumb Vents Sewage Disposal 7d Sewer Water Heater 6 -'L� •-go Water Softener • ' i Water Service rZ Gas Test SEWAGE SYSTEM SIZE & LOCATION �c�, Final '�� � Tank Pit L. Line REAR OF PROPERTY LINE t y ELECTRICAL APPROVALS Power Pole «, J Conduit �j- � t Service Entrance __� Wiring'01-ft Grounding Wire PSL PSL O Bonding Fixtures �Z ,- Service -Z -7-9b Final X27 80 Z 7-36 2 C`��/� ���� STREET NAME PERMIT NO. Job Address r + i50 f fE Space Zip Owner 39133 Community � � �- Valuation ..w y ~a'ie ! � ^E 1Dii}.Off. F.C.C. MH.Permit Fee $ ^YT 8 F Micro Film Fee Cop $ of'V.KP - wx Pdn6-eIsN9.,' .GVJ - C We/Case _ Ck.l'(3W I Fee Dbl $ ti M,. WELLING AND ATT. GARAGE a 20*k,2 lot Size Pl.Ck. Fee PI. Ck$ Construction Fee Dbl E 17 Legal Description F S S R a o. Electrical Fee Dbl $ .41 LLtf1 13 S12 p�JT LOT j� It- BL 191 one estrictio'ns � Gro p � pe SMI Fee $ 'm Tr '! n Fee Dbl b ondAmt Pion No. oChecker -Fin Inspe nPlumbing Z 7-80 Sp. Insp. Fee $ E (q Demol. Fee $ Const. Lender V Branch 5upplimentol Permit Numbers Registr. Fee $ `i 3 B. u'^"" Mileage Fee $ Address City Zip Witness Fee $ Reinsp. Fee $ Owner/Agent ' Tel. Zip ;A91 es Total Fees $ ress • j� - - 4600 n Zip M.O N.C. ,.Cash tj Check e Received by r:, Contractor License# Trees required Sewag/e�Sy � Address City Zip 1 ! Sa [V V -T LL TP THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK SAer District y FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. t I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. b 1 I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN 7'g ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE,OF CALIFORNIA. Form 284-208 (Rev.8/78) verified by: l� te:. NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR 12 BUILDING APPROVALS 7r MECHANICAL APPROVALS I Set BackZ Z f y; j 33 Ventilation System u 2 Ftgs 8 Frms -� s — f% 34 Plenums 8 Ducts _Z 2A Slab Grade � �0, I a 35 Furnace Comport. Ceiling (Blown) 3 Steel 14 1 Final 36 Inlets 8 Outlets 4 Grout Blocks 37 Combustion Air 5 Bond Beams 38 Compressor 6 Roof Deck i 39 Appl. Clearance 7 Framing i. _ 40 Fire Damper 8 Vents 41 Smoke Detection Device 9 Garage Fire Wall G .� Z7� 42 Commercial Hood 10 Fireplace P. L. 43 Final 10A Fireplace T.O. 11 Exterior Lath �- 12 Internal Lath 7r 12A Drywall 13 Finish Grade Z 1 r INSULATION Thick R Value 7A Walls (Batts) 3'/z it S-1-90 12B Ceiling (Batts) 12C Ceiling (Blown) 14 1 Final iZ PLUMBING APPROVALS J P' ADDITIONAL INFORMATION L,/ PERMIT NO. 391319 DEPARTMENT OF BUILDING & SAFETY FIELD OFFICE DST COUNTY OF RIVERSIDE t CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 3 r� UNITS space IST FL. SQ. FT. @ Owner"' Community 2ND. FL. SQ. FT. @ I YARD SPKLR SYSTEM FOR. SQ. FT. @ MOBILEHOME SVC. BAR SINK GAR. SQ. FT. @ POWER OUTLET ROOF DRAINS CAR P. SQ. FT. @ Use of Permit DRAINAGE PIPING WALL SQ. FT. @ Parcel No.n/ / Use/Cose No. Ck. By 7 �eT/ — I t 2 r ffJ( Set Backs Lot Size F S S R DRINKING FOUNTAIN SQ. FT. @ Construction Fee Dbl E URINAL ESTIMATED CONSTRUCTION VALUATION $ Electrical Fee Dbl E WATER PIPING NOTE: Not to be used as property tax valuation SWIM POOL, PVT FLOOR DRAIN MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER VENT SYSTEM FAN EVAP. COOL HOOD SIGN WASHER (AUTO)(DISH) APPLIANCE DRYER Inspector GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED Dental. Fee LAUNDRY TRAY AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE,TEMP/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B. T, U. SQ. FT. @ t BATH TUB Total Fees SQ. FT. @ c WATER HEATER SO. FT. RESID @ 11/4 c SEWAGE DISPOSAL M. N.C. ^Cosh heck SO. FT. GAR @ 3/. t HOUSE SEWER Contractor GAS PIPING PERMIT FEE Sewage System PERMIT FEE PERMIT FEE DBL. TOT L FEES jn / MOB.HM.FEE MICRO FEE MECH. FEE PL. CK. FEE I CONST. FEE ECT.. FFEJ r SMI FEE FEE PLUMB. FEE ffl PERMIT NO. 391319 Job Addre s 3 ,y L-�s space Zip Owner"' Community I Va uotion E Date Dist. la .2c9 Off. F.C.C. MH.Permit Fee $CQAA Micro Film Fee Cop E Use of Permit +r Parcel No.n/ / Use/Cose No. Ck. By 7 �eT/ — I t 2 r ffJ( Set Backs Lot Size F S S R Mech, Fee Dbl E PI. Ck. Fee E Construction Fee Dbl E Legal Description 1 ,( ` L �� '^ �'�♦ �Final Electrical Fee Dbl E Zone Res ns Group ~Ll Type SMI Fee E Plumbing Fee Dbl E Bond Amt. E Plan No. Pian Checker Date d (J ¢ ` Inspector Unit Sp. Insp. Fee E Dental. Fee E Const. Lender Branch Supplimentol Permit Numbers Registr. Fee E Mileage Fee E Address City ip / . Witness Fee E. Reinsp. Fee E Ow yeri ,( i Tel.6-:4, Zip Total Fees E Address City Zip M. N.C. ^Cosh heck Received by Trees required Contractor Tel. License# Sewage System Address City Zip T LL P Sewer District Form 284.208 (Rev.8/78) @s THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by: FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. PERMIT NO. 'r DEPARTMENT OF BUILDING & SAFETYDST 391319 COUNTY OF RIVERSIDE FIELD I l / I CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. @ $ - UNITS 2ND. FL. SQ. FT. @ YARD SPKLR SYSTEM POR. SQ. FT. @ MOBILEHOME SVC. BAR SINK GAR. SQ. FT. @ POWER OUTLET ROOF DRAINS CAR P. $Q. FT. @ DRAINAGE PIPING WALL SQ. FT. @ DRINKING FOUNTAIN SQ. FT. @ URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation SWIM POOL, PVT FLOOR DRAIN MECHANICAL FEES SWIM POOL, COMM WATER SOFTENER VENT SYSTEM FAN . EVAP. COOL HOOD SIGN WASHER (AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED ( LAUNDRY TRAY AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE,TEMP/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. @ c BATH TUB SQ. FT. @ c WATER HEATER SQ. FT. RESID @1'/.c SEWAGE DISPOSAL SQ. FT. GAR @ 314 c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBI. TOTAL FEES MOB.HM.FEE MICRO FEE MECH. FEE PL. CK. FEE CONST. FEE IIICT. FEE SMI FEE FEE PLUMB. FEE I 0 or 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 29A 29B 30 31 32 Ground Plumb SEWAGE SYSTEM SIZE & LOCATION Water Piping Rough Plumb Vents Sewage Disposal Sewer Water Heater Water Softener Water Service Gas Test Final Tank Pit L.Line REAR OF PROPERTY LINE ELECTRICAL APPROVALS ` PSL PSL Power Pole Conduit Service Entrance Wiring Grounding Wire Bonding Fixtures Service Final STREET NAME PERMIT NO. .39139 Job Address' pace Zip ? ^�, P.4.✓a�� Ownw.-- " �%�► �-�� �Ry� Community IL V uation $ Date D'st. Off. �. F.C.C. MH.Permit Fee $ Micro Film Fee Cop $ Use of Permit Parcel No... g✓ `°� " ! 1.2 - tqj/ j Use/Case NOV. Ck. By Mech. Fee Dbl $ Pl. Ck. Fee 4. $ a Set Backs Lot Size - Construction Fee Dbl $ Legal Description t F i i` ( R �-K S S R Electrical Fee Db1 $ Zone Restr ns Group Type SMI Fee $ Plumbing Fee Dbl $ Bond Amt. $ Plan No. Plan Checker Final Date Inspector —T+ Unit Sp. Insp. Fee $ Demol. Fee $ Const. lender Branch Sup plimen�it Numbers Registr. Fee $ Mileage Fee $ Address City Zip �' Witness Fee Reirisp. Fee $ Ow gents - _ Tel. / _ T " {p Zip Total Fees Is Address (� i City �-.. Zip +� M.Q.N.C. ^'Cashheck Received by Trees required Contractor Tel. License# Sewage System Address City Zip T LL P Sewer District Form 284-208 (Rev.8/78) ©s THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by: FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID. I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA. I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN {l� ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA. Y NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System ' 2 Figs 8 Frms 34 Plenums 8 Ducts 2A Slab Grade 35 Furnace Comport. 3 Steel 36 Inlets 6 Outlets 4 Grout Blocks 37 Combustion Air 5 Bond Beams 38 Compressor 6 Roof Deck 39 Appl. Clearance 7 Framing 40 Fire Damper 8 Vents 41 Smoke Detection Device 9 Garage Fire Wall 42 Commercial Hood 10 Fireplace P. L. 43 Final IDA Fireplace T.O. NO ADDITIONAL INFORMATION 11 Exterior Lath 12 Internal Lath 12A Drywall 13 Finish Grade INSULATION Thick R Value 7A Walls (Batts) 12B Ceiling (Batts) 12C Ceiling (Blown) 14 Final PLUMBING APPROVALS NOTICE: THIS IS NOT A BUILDING PERMIT APPLICATION TO CONSTRUCT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF RIVERSIDE DISTRICT U Permit No finer_ A W-2, 3d7 ej­� Architect N om' L42 <AA-" Contractor ('>' `dres`7'Addressl7 02 S ! i/tE1lVl-.�ci+�u.> Address_ ty LA4 6A City City - one Phone ;Z2,4� -,ou/ Phone. 111111 1 (we) the undersigned, hereby certify and acknowledge that I (we) have read the application .and agree that if Curb and Gutter, and Mg. and/or Dedication of right of way is required by the County of Riverside, the Riverside County Department of Building and Safety ill not make a Final Inspection until said requirements have been met. I am also aware that no work is to be done within the County R/W an encroachment permit. 1 �hout NOW, therefore, it is agreed that I (we) will not occupy said property and will not cause said property to be occupied until I (we) have replied with all laws of the County of Riverside and the State of California governing said property. , 11 TE _ SIGNATURE OF OWNER AND/OR AGENT �y7 1 / Approval by Signature from the Following Departments Listed Below Must Be Obtained -Prior to the Issuing of a Construction Permit. NO. lI�SPACE - � � � � L. ��'C G' '` �� USE OF STRUCTURE B ADDRESS M" SINGLE FAMILY DUPLEX —%�-7iGALDS(RIPTION OF PR PERTY M APARTMENTS AGRIC. �] �g7— � t7 COMMERCIAL INDUSTRIAL [] MMUNK •---ITw� ALTERATIONS n � 0 OF SUBMITTED'PLANS — USE OF PERMIT '� SE NO. h��_. t� ). OF PARKING SPACES REQUIRED NO. OF BUILDINGS NOW EXISTING — NE e / SETBACKS: FRONT Ota SIDE Q �' REAR 7 LADING PERMIT REQUIRED? YES ❑ NO ❑ LOT SIZE TBACK ORDINANCE N __ OF FEET REQUIRED ON- -^�—�1 STREET ITE _G SIGNATURE OF LAND USE OFFICIO -- EDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET__— _ NO ❑ 4 /_e6 ' STREET LRB AND GUTTER REQUIRED: YES C32 ,41 4 AN CURB AND GUTTER FEASIBLY BE INSTALLED? YES [INO ❑ AS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET I PROVEMENT? YES _C2,- NO ❑ A TATEA SIGNATURE OF ROAD DEPT. OFE1CIA !is– � u1NG PAOI C PIIBI IC :WAGE DISPOSAL kiM.E DlT ATER POLLUTION REMARKS LOOD CONTROL 1 IR POLLUTION OF HWY �IV YOUR PROPERTY MAY BE SUBJECT TO f FLOOD. RIVERSIDE COUNTY ASSUMES - NO RESPONSIBILITY IN EVENT OF FLOOD. =: a CANARY—FILE, PINK—APPLICANT - .":t•''' z 3: 0 0 �_' < CL 0 UA 0:0 0 >- Z �- Uj LL _j co ca .6 �: a CL W z z 0 < .4 _j 0 A. er 0 z z IL 4 Uj _j APPLICATION FOR TREE PLANTING I (we), the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if trees are required tmder River- side County Ordinance No. 457, the agplicant agrees to install said trees prior to final inspection. It is understood that no final in1spection will be given until said requirements ave been met or exception has been granted by the County. Now, therefore, it is agreed that the prop- erty owner shall cause the property lines to be surveyed in the event no survey stakes can be found. Further, it is agreed that the County of Riverside shall assume no responsibility should trees have to be removed due to lot line errors. __1Owner's Name AQ -1-1114-, —Building Permit No. 349/ 33 Mailing Address. 907, L-4 Q0111.1-4 CW(—f -City(14- 4k;J,16 —State r-4, zip -,nZ25-3 Job Address -Y,;J ,Y- community 4 1 ef-!�R" _,-T-4- L ZlcuLa44-- 1 1 ,�e D...,.'ptin *4,dt � :5 Assessor's Map, BooL& Page Type Structure Type of Soil Is water available Road Dept. Plot Plan No.— Type of existing trees in road right-of-wa i Trees preferred by applicant (1) )A&2 I i4n AeW_W% (2) C-4.1 i6r,-' ( 200A (3) 9A_4Y_!A Date 7 Owner's Signature .-622 Planning Commission Case No. ROAD DEPARTMENT APPROVAL Approved species Ceratonia siliqua (Carob) Number of trees 1 Spacing of trees Distance from lot lines: Front 2' in R/W Side Additionaf� requirements Per plot plan on reverse. No street trees will be planted within 10' of driveways. 'Date Buildisig and Safety notified 3/80 Signature Reason Request for hearing - Owner's Signature YES F1 REQUEST FOR EXCEPTION (attach additional page if necessary) (Forward application to Planning Dept. if exception requested) NO REQUEST FOR HEARING Planning Dept. Concur M D ate Non -concur M Explanation — Signature Road Dept. Concur n Non -Concur 0 Date Signature REQUEST FOR HEARING AND COMMITTEE DECISION Date hearing established Approved CD Disapproved Date Building & Safety notified 70 Date hearing notice mailed to owner Date Owner notified of decision Signature —