The URL can be used to link to this page

Home My WebLink About2160 JANIS WAY; ; CB040384; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 G~~\ 01-21-2005 Residential Permit Permit No: CB040384 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: 2160 JANIS WY CBAD RESDNTL 1672401800 Sub Type: RAD Status: Lot#: 0 Applied: Valuation: $52,306.00 Construction Type: NEW Entered By: Occupancy Group: # Dwelling Units: Reference #: Plan Approved: 0 Structure Type: Issued: Bedrooms: 0 Bathrooms: 0 Inspect Area: Project Title: RUSH RES 490 SF 2ND STORY ADD, Orig PC#: FAMILY RM & 144 SF DECK, 100 TO 200 AMP UPGRADE Plan Check#: Applicant: RUSH JOHN D&ANTONIA M 2160 JANIS WAY CARLSBAD CA 92008 Building Permit Add'I Building Permit Fee Plan Check Add'I Plan Check Fee Plan Check Discount Strong Motion Fee Park in Lieu Fee Park Fee LFM Fee Bridge Fee Other Bridge Fee BTD #2 Fee BTD #3 Fee Renewal Fee Add'I Renewal Fee Other Building Fee Pot. Water Con. Fee Meter Size Add'I Pot. Water Con. Fee Reel. Water Con. Fee $365,61 $0.00 $237.65 $0.00 $0.00 $5.23 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Owner: RUSH JOHN D&ANTONIA M 2160 JANIS WAY CARLSBAD CA 92008 Meter Size Add'I Reel. Water Con. Fee Meter Fee SDCWA Fee CFO Payoff Fee PFF PFF (CFO Fund) License Tax License Tax (CFO Fund) Traffic Impact Fee Traffic Impact (CFO Fund) Sidewalk Fee PLUMBING TOTAL ELECTRICAL TOTAL MECHANICAL TOTAL Housing Impact Fee Housing lnlieu Fee Housing Credit Fee Master Drainage Fee Sewer Fee Additional Fees TOTAL PERMIT FEES ISSUED 02/04/2004 SB 07/20/2004 07/20/2004 PY $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $27.00 $25.00 $30.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $690.99 Total Fees: $690.99 Total Payments To Date:· Balance Due: $5.00 OJ.22 01./2J./C.J·~_. 0 --00.2 01 C:(JF~ Inspector: Date: Clearance: NOTICE: Please take NOTICE tha approval of your project includes the "Imposition" of fees, dedications. reservations, or other exactions hereafter collectively referred to as "feeslexact1ons." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition • I PERMIT APPLICATION FOR OFFICE USE O~ ,7e;) PLAN CHECK NO.~ D 0 LJV...)01 CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 EST. VAL. -~----0__,t._Lf_?=L)-=-------:-- bY ") 1. PROJECT INFORMATION ~ddress (include Bldg/Suite #) Business Name (at this address) Viz o ..Z-AN'l5! Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units ssessor' s Parcel # Existing Use ' .,, 64 SO. FT. #of Stories # of Bedrooms # of Bathrooms 2. Name ddress 3. APPLICANT O Contractor O Agent for Contractor --v~ .,ti/,11,<I/ Name Address 4. PROPERTY OWNER Name ~HAI' -A, /PUS/-/ Address 5. CONTRACTOR • COMPANY NAME City g.C>wner O Agent for Owner ~p ~ City State/Zip Telephone# Fax# State/Zip (Sec. 7031. 5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law [Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)). Name Address City State/Zip Telephone# State License# _________ _ License Class _________ _ City Business License # _______ _ Designer Name Address City State/Zip Telephone State License# _________ _ 6. WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. O I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: Insurance Company_____________________ Policy No._____________ Expiration Date _______ _ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100] OR LESS) 0 CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensation coverage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE______________________________ DATE --:=========-~--- 7. OWNER-BUILDER DECLARATION I heyi>y affirm that I am exempt from the Contractor's License Law for the following reason: 12(' I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). iia.. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The lc;;ntractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). □ I am exempt under Section ______ Business and Professions Code for this reason: / I personally plan to provide the major labor and materials for construction of the proposed property improvement. IZJ"YES ONO I (have / have not) signed an application for a building permit for the proposed work. 1. 2. 3. I hav~cted w· h the following p rson (f m) to provide the proposed constr ction (include name / address / phone number / contractors license number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone number/ contractors license number): ______________________________________________ _ 5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number/ type of work): -J-. ti° -A -+----t--: '--, -~-PROPERTY OWNER SIGNATURE ,i£3l L i K.. Kl J... ~ -DATE 7 /a a 7 0 1 COMPLETE THIS SECTION FOR NON-RESmiiiTIAL BUILDING PERMITS ONLY I f Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 YES O NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES O NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 8. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code). LENDER'S NAME ______________ _ LENDER'S ADDRESS ________________________ _ 9. APPLICANT CERTIFICATION I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the Citt of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY ANO KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit I ed by the building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is n c menced within 180 days from date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is con1'tln-'r,r.•lf1 tor a period of 1 0 days action 106.4.4 Uniform Building Code). APPLICANT'S SIGNATUR DATE ~l?~-Y~--~~¥~--- YELLOW: Applicant PINK: Finance - .. . &J City of Carlsbad Bldg Inspection Request For: 02/14/2006 . Permit# CB040384 Inspector Assignment: PY --- Title: RUSH RES 490 SF 2ND STORY ADD, Description: FAMILY RM & 144 SF DECK,100 TO 200 AMP UPGRADE Sub Type: RAD Type: RESDNTL Phone: 0000000000 Job Address: 2160 JANIS WY Suite: Lot 0 Location: APPLICANT RUSH JOHN D&ANTONIA M Owner: RUSH JOHN D&ANTONIA M Remarks: Inspector: ----- Total Time: Requested By: TONY Entered By: CW CD Description Act Comment 19 Final Structural 29 Final Plumbing 39 Final Electrical 49 Final Mechanical ----~-·---- Comments/Notices/Hold Associated PCRs/CVs Original PC# PCR04205 ABANDOND RUSH RES REV TO STRUCT; lns11eclion Histo!Y Date Description Act lnsp Comments 02/03/2006 89 Final Combo co JM LABEL ELEC PANEL 02/17/2005 18 Exterior Lath/Drywall AP PY 02/08/2005 13 Shear Panels/HD's AP PY 01/25/2005 11 Ftg/Foundation/Piers AP PY HDS 01/25/2005 13 Shear Panels/HD's WC PY 11/02/2004 17 Interior Lath/Drywall AP PY 10/28/2004 16 Insulation AP PY 10/25/2004 14 Frame/Steel/Bolting/Welding PA PY 10/25/2004 23 Gasrrest/Repairs AP PY 10/13/2004 13 Shear Panels/HD's PA PC UPPER FLOOR ONLY 10/13/2004 15 Roof/Reroof AP PC 09/23/2004 23 Gas/Test/Repairs co PY SEE NOTICE ATTACHED 09/21/2004 11 Ftg/Foundation/Piers AP PY DECK FTGS zH /°" /,,E5;; 1 +c.:, i ! v ( 011uc-/--f-T t.,, s "> )_ \\ , \,:_q -l'.:c:"':) -..Al)_:t. c.,..:t ~ CL,"1.,--n±;,;,_ ' "-I 11 / o , 1 -~ c: ;:,_fa1 GI PS/() C1 -~ {!_uY) CB040384 2160 JANIS WY CBAD RUSH RES 490 SF 2ND STORY ADD, FAMILY RM & 144 SF DECK RESDNTL RAD Lot# RUSH JOHN D&ANTONIA M 7 I I r; Ir l,l Ir Tr -viJ , ,/01Jd (I,<-ciGQ ✓ /JJJ>tac/2~ _,/t+ ->rv½lf) -1--!JtJ cJ fltlM.) dffC /(i ti/ !JV /) f uW !, \ 1,;'\t,r ,'~ ~ \ 'i:i!> ~ '\-t> 'LJ l<,( 0(,, 211 {/ t) y BUILDING ~/q/o'4 o~ l\Nt..JING -2}!'./r?._'-( ' -:r:cil"JG ''A ('' BLt:'.:.i. ~1.r,AGIN'._; ._!: --'-< ; C' FROM APPLICANT APPLICANT ----+----PLAN CORR -----+-----ENG CORR ----+----SCHOOL FORM CFD FORM ----+----PE & M WORKSHEET ____ ...._ ____ BLDG FEES COMPLETE City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 08-25-2005 Plan Check Revision Permit No: PCR04205 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: 2160 JANIS WY CBAD PCR Lot#: 0 Status: Applied: Valuation: 1672401800 $0.00 CB040384 Construction Type: NEW Entered By: Reference#: Plan Approved: Issued: Project Title: RUSH RES REV TO STRUCT Inspect Area: Applicant: RUSH JOHN D&ANTONIA M 2160 JANIS WAY CARLSBAD CA 92008 Plan Check Revision Fee Additional Fees Total Fees: $0.00 Inspector: Owner: RUSH JOHN D&ANTONIA M 2160 JANIS WAY CARLSBAD CA 92008 Total Payments To Date: $0.00 Balance Due: FINAL APPROVAL Date: Clearance: ABANDOND 11/18/2004 SB $0.00 $0.00 $0.00 NOTICE: Please take NOTICE that approval of your project includes the •imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions." You have 90 days from the date this permit was issued to protest Imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any t . hi h v r . I i n N Tl E imil r i flimi in h r vi I . PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carl~b,d, CA 92008 ;_x Ol{ , o , 'is ~ -z..,.1 &o ,,.,J AJ\S FOR OFFICE USE~L Y PLAN CHECK NO.~j_oC/2 o~ EST. VAL. __________ _ ~ 1. PROJECT INFORMATION .Address (include Bldg/Suite #) Business Name (at this address) Legal Description Lot No. Subdivision Name/Number Assessor's Parcel # J ~of'r/4.,, -c;n-wcn.-tU-<../ :.},. Description of Work Existing Use V\t.v,c;{i;w SO. FT. f\J 2. CONTACT PERSON (if different from applicant} 17' W \ L---P tc.--(U)o ,4Q Name Address 3. APPLICANT O Contractor O Agent for Contractor 0 Owner f\ r_~meJPB_OPERTY OWNER lX. 4 "cMN a...vs. rt Address Name Address 6. CONTRACTOR -COMPANY NAME #of Stories City 0 Agent for Owner City City Unit No. Phase No. Total # of units Proposed Use # of Bedrooms # of Bathrooms State/Zip Telephone # Fax # State/Zip Telephone# State/Zip Telephone# (Sec. 7031 . 5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law [Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code] or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars [$5001). Name Address City State/Zip Telephone# State License # _________ _ License Class _________ _ City Business License # _______ _ Designer Name Address City State/Zip Telephone State License # _________ _ 6. WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. O I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: Insurance Company_____________________ Policy No._____________ Expiration Date _______ _ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$1001 OR LESS) O CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensation coverage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($1 00,000), in addition to the cost of compensation, damages as provided for In Section 3706 of the Labor code, Interest and attorney's fees. SIGNATURE._____________________________ DATE--:::--:::;:=:--=:-:::::;:::;::::::;:=:;,_ ... _. __ _ 7. OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: O I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). 0 I am exempt under Section ______ Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES ONO 2. I (have/ have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction (include name / address I phone number / contractors license number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name I address / phone number/ contractors license number): ______________________________________________ _ 5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type of work):. ________________________________________________________ _ PROPERTY OWNER SIGNATURE _______________________ _ DATE _________ _ COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 YES O NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES O NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 8. CONSTRUCTiON LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code). LENDER'S NAME ______________ _ LENDER'S ADDRESS __________________________ _ 9. APPLICANT CERTIFICATION I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the Citt of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. i EXPIRATION: Every permit issued y the building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not co enced within 180 days from the date of such permit or 11 the building or work authorized by such permit is suspended or abandoned at any time after the work is com ced for a period of 180 days (Section 106.4.4 Uniform Bu1ld1ng Code) APPLICANT'S SIGNATU ~~r:~~~===::::::::::::=:::::::_____________ DATE ____________ _ WHITE: File YELLOW: Applicant PINK: Finance EsGil Corporation In IPartnersfiip witfi government for (}JuiCaing Safety "DATE: December 2, 2004 . JURISDICTION: Carlsbad PLAN CHECK NO.: 040384 REV (PCR04205) PROJECT ADDRESS: 2160 Janis Way PROJECT NAME: Rush Addition SET:I □ CANT . REVIEWER □ FILE D The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. D The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficiencies identified below are resolved and checked by building department staff. D The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. ■ The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. ■ The applicant's copy of the check list has been sent to: John Rush 2160 Janis Way Carlsbad CA 92008 D Esgil Corporation staff did not advise the applicant that the plan check has been completed. ■ Esgil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: John Rush (.--,0,-..1;) Telephone#: 760 729 8994 Date contacted: 12 /2. /0,1 (by: f'A--) Fax#: (?GD) L/ 34 '2 Lf O 'B Mail ......-felephone / Fax/ In Person ■ REMARKS: The revision consists of structural changes. By: Bryan Zuppiger Esgil Corporation 0 GA O MB O EJ O PC Enclosures: 11/22/04 tmsmtl.dot 9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576 /[/re (o ( 6~/c>~~/ C 0 1-+y @_ ~cR v/4 r 9 C /3"' c r o '"!,Cb'-/ J2p) ( 5,. q_ G,,"" t' ie-f' "',-~ t T1-'1s /2Y~~j}lLf1 $ / 22 / 0'? ,,&,,,u:_, P / C.. Ut/JL~ ,,l._a;(_u._ 'Vl:.jJ"-~ /I/ I '3 / C5 •'17'-//o'5 f.D ~ ~ -~ ~ ~t ~-M ~ o-6 ~ Pu., . lU i.Ll CJ,fV.XL<:,j-/)'U.,,'!v -,;/25/05 Ciruli..JU[EL ~ ~-tv-o UJ.10-~ -iv ~A-. > ~-~. .• f0k-~, -M~ ~ -~ ~ lo A5i hu1./,0 (?I~ PCR04205 2160 JANIS WY CBAO RUSH RES REV TO STRUCT PCR Lot#: RUSH JOHN D&ANTON IA M ______ BULDING ______ Pl-«3 -------------F1AE APPRIFORM ______ HEAl.llf DEPT _______ T/AIRQlW. ------OTHERSEWERDISTR TO FROM ----·---·--··- IICHOOI. FOAM CFDFORM PE & M WORKSHEET BlOG FEES~TE PlANCORR ENGCORR ESGILCORR FIRE CORR