HomeMy WebLinkAboutCAMPHOR WAY 15116_04-00001982 Clity ofLakeElsinore
PERMIT 130 South Main Street
PERMIT NO: 04-00001982 DATE : 7/22/04
JOB ADDRESS . . . . . 15116 CAMPHOR WAY
DESCRIPTION OF WORK PATIO
OWNER CONTRACTOR
HAYNE GORDON OWNER
HAYNE C'YNTH I A
15116 CAMPHOR WAY
LAKE ELSINORE CA 92530
A. P. # . . . . . 387-452-009 2 SQUARE FOOTAGE 278
OCCUPANCY . . . GARAGE SQ FT 0
CONSTRUCTION . . FIRE SPRNKLR
VALUATION . . . 1, 946 ZONE . . . . . . R-1
BUILDING PERMIT
QTY UNIT CHG ITEM CHARGE
BASE FEE 45 . 00
15 . 00 X 2 . 7500 VALUATION 41 . 25
1 . 00 X 5 . 0000 PROFESSIONAL DEV FEE 5 . 00
FEE SUMMARY CHARGES PAID DUE
PERMIT FEES
BUILDING PERMIT 91 . 25 . 00 91 . 25
OTHER FEES
PLANNING REVIEW FEE 17 . 25 . 00 17 . 25
PLAN RETENTION FEE 1 . 25 . 00 1 . 25
SEISMIC GROUP R . 50 . 00 . 50
PLAN CHECK FEE 68 .44 . 00 68 .44
TOTAL 178 . 69 . 00 178 . 69
SPECIAL NOTES & CONDITIONS
AS-BUILT LATTICE PATIO COVER (FRONT AND
BACK)
Date: 7122/04 2 Receipt AM 429
tr �(1IT
CA +caber: 1 917&69
trans date: $180 00
7/2�/84 tire: 19; .
};li,i _i I)I I`I•'I I'lease Wad and Initial
1 I am Licensed under the provisions of Businrtir and Prolessiunal
Code Section 70DO et seq and my license is in full force
In ll)ns')Icti(li place 2 1 as owner of the property orm) employees w/wage-sas their sole
compensation will do the work and the structure is not intended or
on the job offered for sale
3 1 as owner of the property am exe lush,e K cvntracLinµwith hcensc J
} contractors to construct the protect
�„il �1'L'�• i l'�l'`f }�} 1\11 } �I \}}�}-h 'rl, �; _ ; fha%cacenificateotron:rnitosriflnsurrnracerufic-Ate of Workers
Compensation insurance or a certified cope thereof
5 I shall not rmplov am person In am manner so as tobecnmr subject
to Norkers Coompe•ntiaimn laws in the perfonnann,of the work for
which this permit vi issued
Note It you should become subject to Workers Compensation after
mekirig this ceruflcauon )ou must forthwith comph'with such pro
vi,ions or this I- nmt shall be deemed revoked
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ram- h-S D:ar�T)eni Approval required prier to tie
°-o S et, ^ - c-idoing oo-,nc released b� the City
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City of Lake Elsinore
130 South Main Street
APPLICATION FOR APPLICATION 11040.
BUILDING PERMIT OZ4 - J 01 g O
• APPLICATION R TVEO
DATE `7 v�v y
VALUATION CALCULATIONS API 3?-7 --413^ ,_O By O J�
1 st FLOOR _SF euao AooR s G Y
2nd FLOOR �—SF TRACr atocu eAGE IwT/rARCEE
3rd FLOOR _SF
N
GARAGE SF
»
STORAGE -SF �
DECK 6 BALCONIES _SF Aotxtss 3
OTHER: cqr _ sr
_SF 1 t....bY att..r rho+1 t--I.wd..y w...w..d Ct.pgr kwwn..•.c:p.nit.S.c�.nn
GRADING _CUT CY MWI of th.:r:—3 cl rh.Mn••�rs-d co&,6 Irotns.oro d-r
t.c.•...»sn trR to•ct
a.d.««r
City
_FILL CY NOCLA SS tTAX41 Ess
VALUATION: NAMC
FEES IAAIEfNG
AOORESS
BUILDING PERMIT $ CITY STATE ZIP PHONE
CONTRACTORY SIGNATURE GATE
PLAN CHECK
ADDITIONAL PLAN CHECK N"At ttcE"SE r
_ u
Z AiAutNG
GRADING PLAN CHECK = AIwREss
t
< CITY STATE ZIP PHONE
01NEW OREPAIR OCC GRP./ CONST.
DIVISION TYPE:
MICROFILM ADDITION I WOVE NUMBER OF NUMBER OF
DALTERATION !:DEMOLISH STORIES BEOROOMS-
COPIES `OTHER ZONE:
CSINGLE FAMILY units HAZARD AREA? YES NO
IMPRO FEES ❑ SCHOOL FEES ❑ .--APARTMENTS units
-CONDOMINIUMS units SPRINKLERS REQUIRED? YES NO
.TOWNHOMES units PROPOSED USE OF BUILDING:
COMMERCIAL i INDUSTRIAL
PAID PRESENT USE OF BUILDING*
DATE
J06 DESCRIPTION
❑ 1 certify that I have read this application and state that the 1
above information is correct.I agree to comply with all city f' (�U ; l (ti` �'�j If e)
and county ordinances and slate lows relating to building
construction. and hereby authorize representatives of this
city to enter upon the above-menlioned property for inspec-
tion Purposes.
Signature of Applicant or Agent Date
AGt=NT FOR ❑ CONTRACTOR ❑ OWNER
AGENT'S NAME
AGENT'S ADDRESS
STREET CITY STATE ZIP REV DATE 11 1-90