HomeMy WebLinkAboutLINCOLN STREET 15197_04-00002499C City of Lake Elsinore
PERMIT NO: 04- 00002499
PERMIT 130 South Main Street
DATE: 9/20/04
JOB ADDRESS . . . . . 15197 LINCOLN ST
DESCRIPTION OF WORK . REROOF
OWNER
STEADFAST LSA
20320 SW BIRCH ST STE 300
NEWPORT BEACH, CA 92660
A.P.# . . . . . 379- 111 -016 5
OCCUPANCY .
CONSTRUCTION . .
VALUATION .
CONTRACTOR
ROYAL ROOFING
150 NETTLETON RD
VISTA, CA 92083
760 - 806 -1100
LIC EXP 0 /00 /00
SQUARE FOOTAGE 0
GARAGE SQ FT 0
FIRE SPRNKLR
ZONE . . . . . . R -3
REROOF PERMIT
QTY UNIT CHG
1.00 X 5.0000 PROFESSIONAL DEV FEE
45.00 X 3.0000 REROOF
FEE SUMMARY CHARGES
PERMIT FEES
REROOF PERMIT 140.00
OTHER FEES
PLAN RETENTION FEE .52
TOTAL 140.52
SPECIAL NOTES & CONDITIONS
Reroof 7500sf over existing asphalt
shingles
ITEM CHARGE
5.00
135.00
PAID DUE
00 140.00
00 52
00 140.52
LHte: 9/20/0 20 Ftca4t m: 1570
20A 2499
EP HJnDDZ Had-IIT 1 ;140.52
Trcs rn *Er: g:OE
K a-ea< 9CC4
Trans dale: 2/X)/C4 T17Te: 9:47:17
L,,,c Fkii i
Pw't 111 coflq)icu11u1 place
lift till' .Jilt)
L! Itte'"; t ll tl {'I n ll tfi } rl,{ i _'
10B \DDRI
1111. Illl •i h ,`Il 11`[
Picase Read and Initial
I I am Licensed under the provisions of Business and Professional
Code Section 70010 et seq and my license is in full force
2 1 asow-neroftheproperty ormy emploveesw /wages as their sole
compensation will do the work and the structure Is nor iniendvil or
offertd for sale
3 1 as ownerol the property am exclushely contracting with licensed
contractors to construct the project
4 Iha% eacertiricateofconsentioselflnsureoracerurrcAteofWorkers
Compensation insurance or a certified copy thereof
5 ]shall not employ any person in any manner so as to become subject
to korkers Coompensation Laws in the performance of the work for
which this permit is issued
Note If %ou should become subject to Workers Compensation after
making this certification you must forthwith comply with such pro-
visions or this permit shall be deemed re%oked
Jce A:o a, a s Da'e I-sce•: o•
EL_ Te--o F ec Se -: ces
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OTHER DEPARTMENT RELEASES
Ce 2rt, k t Approval required prgr to the
bu aiN being released by the CityD }J S _ - Fo - -s
r_X Pao P'_ —? -- D-ess Tes
D•e C_- e
Da,e Inspector
ELCE na_- Px E-x
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S_J L c Aa -- 0-,a
La- ,csca:>e
J = Pco Fe . -C Access
Finance
Pn J D e Pis e
Engineering
o, y F --a . PO-0 S:e
LIRE"",..
APPLICATION FOR
BUILDING PERMIT
VALUATION CALCULATIONS
1st FLOOR SF
2nd FLOOR SF
3rd FLOOR
BUI
JJ, -j nt1P S
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RACT BLOCK/PAGE LOT/PAR EL
GARAGE SF
STORAGE SF
DECK & BALCONIES SF
OTHER- SF
VALUATION.
FEES
BUILO:NG PERMIT $
PLAN CHECK
PLAN REVIEW
SEISMIC
PLAN RETENTION
1 certify that I have read this application and state that the
now mfonnalron is correci 1 agree to conhUly with all city
and ccanty mdmanv ,- and --tale laws relating to budding
construction, and hereby authorize representatives of this
city to enter upon the above - mentioned property for nnsp-
tion purposes
Signature of Applicant or Agent Date
Agent for Vq.
Agents Name_
gents Addre:
Street City
contractor owner
State Zip
City of Lake Elsinore
130 South Main Street
AP 4ATI02O4 4)t I
APPLICA 47Z7()--( DATE
AP 4
1
79 P&
BY
BUI
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RACT BLOCK/PAGE LOT/PAR EL
NAME
VJ
N
ttAILING PHONE _
ADDRESS r / z-
E ITY 1 AT
C
N
1 hereby affirm that 1 am licensed under provisions of chapter 9 (commencing
with section 7000) of division 3 of the business and professions code.and my
license is in full force and effect-
LICENSE t _ CITY BUSINESS
AND CLASS T' TAX it
T NAME
A
C
MAILIN
ADDRESS
T
O
CITY STArErzw PHONE
t,, y
R CONTRACTOR'S S16NATURE DATE
A
NAME L IC "'it- r
R
C
MAILING
ADDRESS
H ,Ill' STATEJZIP PHONE
U NEW OCC GRP / _ CONST
ADDITION DIVISION TYPE
ALTERATION NUMBER OF NUMBER OF
STORIES BEDROOMSOTHER
SINGLE FAMILY Zr)N>-
AFAR TMLNTS
CONDOMINIUMS HAZARD YES
AREA ? NOOTOWNHOMES
El COMMERCIAL SPRINKLER; YES
REQUIRED ? NO0INDUSTRIAL
REPAIR PROPOSED USE OF BLDG.
PRESENT USE OF BLDG0DEMOLISH
JOB DESCRIPTION
S S
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