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Home My WebLink About210 KNOX ST - Building Permitsr -1- ' 7‘ i • • - 1 CITY OF COSTA MESA 4r .- BUILDING DIVISION F i „_r' i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT Stario P01-00009 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 210 KNOX ST Status: ISSUED Suite No Applied: 01/08/2001 • Issued: 01/08/2001 Vicinity: Parcel Nunmber: 42533304 ISSUED BY: _____*_____-‘ Applicant: ANDERSON, NICK T Address: 204 1/2 FERNLEAF AVE Phone: 949-422-4888 CORONA DEL MAR,CA Zip: 92625 Owner: ANDERSON, NICK T Address 204 1/2 FERNLEAF AVE Phone: CORONA DEL MAR,CA Zip: 92625 • Contractor: OWNER-BUILDER Address: • Phone: Zip: License: 0 Arch / Eng: • Address: Phone: Zip: License: SCOPE OF PERMIT REPIPE/REPAIR EXISTING GAS LINE. FEE SUMMARY AMT On AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $9.80 1 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $33.30 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and relater regulations. (Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandone fora period of 180 days. . INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS ( ) -' 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 for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ 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,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: 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 DOLLARE($100,C00),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 370e OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I 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.Lic.q Class N Contractor's Signature: Date: 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,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(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 or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she 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).): ❑ 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 Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her 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 or she did not build or improve for purpose of sale.). I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exec der Business and Professions Code for this reason: Signatata// Date: /—n'tar Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aaermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Duality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to com ly with all state,laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-desc' rty for in pectin purposes.I agree not to occupy or allow occupancy of any building authorized by this permit fiinspection. 0/ Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date gE t, IN$PECTIONTYPE gdlE INTMALS CODES INSPECTION TYPE BATE MALI 16 Fixed System Final Fire Prevention 206 Final Mechanical 6 Pool Spa Final 208 Final Plumbing !//07.0/ a/�( /�V,,r{,, Final Re-Roof 210 Final Electrical Final Block/Retaining Wall 212 Final Fire Prevention Final Factory Fire Place 220 Final Planning Approval Final Sign 222 Final Site Final Demolition 250 Final Building/Occupancy liemmir AODREssaBUL Nc: 210 KNOX ST BN* CITY OF COSTA MESA BUILDING PERMIT OyMEWSNAMERI0g1,N: ANDERSON, NICK T PERM NO: B 071531 ` ADDRESS: 204 1 /2 FERNLEAF AVE CORONA DEL MAR,CA 92625 PERMIT NO: B 071539 PLAN CHECK NO: N GOVT: N SUPP : N 675-5634 APPL.MMUNO ADDSESS: CONSTRUCTION TYPE; V-N PERMIT TYPE: SIR PURPOSE: 0TH ARCHITECT OR ENGINEER: LIC NI: JOB .DESCRIPTION T/OFF 6 REROOF W/COMP SHINGLES SQ FT; 2, 470 ARCH.OR ENG.'S ADDRESS: WIT: CLAIM VALUE: 2, 470 . 00 CALL-VALUE: 2,470 . 00 GROUP OCC: R-3 / caxmAcrorrsNAc CRANK BROS ROOFING CO ( 714 ) 548-5569 CCPBRACTORSMAIUNG 126 COMMERCIAL WAY COMMENTS : SMOKE DETECTORS ARE REQUIRED PER 91UBC , REROOF 1600SF RESIDENCE ADORES& COSTA MESA CA ucNO.: 408677 ************************************************4***** *** +�+�� +qw w 4 92627 UHT: ZONING REQUIREMEN, ��F VC I GV , UCENSED CONTRACTORS 0ECORsTI : hereby affirm under penaltydthat I am licensed provisions of Chapter 9 SETBACKS (commencing with Section 7000)d Division 3 I he nese and P aeons Code.and liexact. CITY LIC.NO.: 005993 uccuss: C39 No. 408677 X 06/95 MAIN BUILDING ACCESSOR .� ED 3` 2U C,� ��/�.//�C FRNT; FT IN REAR; FT IN FRNT: FT IN REAR; FT IN Date: Contracto ^ LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN OWNER BUILDER DECLARATION:I hereby affirm under y perjury that I am exempt from the Contractors License Law for the Bowing reason(Sedion 7031.5 Business aro Prof ' ' ny city or county which requires a permit to connect alter,improve, PARKING REQ: PROV; PARCEL: 42533304 Z N E; REF NO: °mol'sh.Of repair any structure,prior to its issuance, nes the applicant for such permit to file a signed statement that he of she is licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING N TES> Business and Professions Code[or that he or she is exempt therehom and the basis for the alleged exemption.My violation of Section > 7031.5 by any applicant lora pernet subleds the applicant lo a civil Penattyof not more then five hundred dollen;(WOW ***************)t****************!9******************************************if*** ❑ I,as owner of the property or my employees with wages as their sole COMMISOli011.WM do the work.and the stnicture is not intended D E V E L O P M E N T SERVICES R E U I R E M E N T S or offered for sale(Section 7044.Business end Professions Code:The Contractors License Law does eat applyto an owner of property Q who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.lf,however,the building or improvement is sold within one year of completion,die ZONING APPROVED' BYDATE; owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale), ❑ I.as owner of the property a°'exotusively contracting with licensed contractors l0 construct the project(Section 7044,Business and • BUILDING APPROVED BY ; DATE: Professions Code:The Contractors License Law does not apply to en owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law). f ❑ I am exempt under Section: B.aPc..orthis reason: APPLICATION ISSUED BY; DATE; (30-0 (i Date Owner: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25513.and • 25534,and Mal I or any future building occupant will/wD not(droit one)need to comply will said state codes and the requirements for a permit for construction Cf modification from the Ar Gurney Management DIstdct.Residential mtntlianappltatlas are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 54 . 00 _. . 50 • Date: Applicant: • SMIP/NON-RES PLAN - WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: ISSUE FEE " t ❑ I have andeil maintain a certificate of consent self-Immo or wodrers'compensation,as Provided for by Section 3700 of the Lord BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE Code,for the performance of the work for which this permit is issued. El have and MI maintainwoMers'compensation insurance,as required by Section 3700 d the Labor Code,for the performance of the TOTALS- > 5 4 , 5 0 0 , 0 0 0 .00 5 4 , 5 0 54 . 50 00 work for which this permit is issued.My workers'coat nation insurance carnet and policy number are: Carrier: SLATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED; . 54 , 50 OVER/SHORT; . 00 Policy Number: 185- 5UN11114 01 /01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC • FIRE SMIP/TOT GRADING PLAN-CHECK (This section need nor be completedIthe perms is for one hundred dollars(slog or less) 54 . 00 , 50 ❑ I pertly that in the pedonmance of the work for which this permit issued,I shall not employ person in any manner so as to become subject to the workers'compensation laws of Calif and agree that f I s subject to the workers' **************************************.****************************iF************ 01301. 11011 provisions d sedo 3700 d the Labor cmc.I I fmhwltcomplyh mcomplypromo I N D I V I D U A L ' :,F E E BREAKDOWN 20 Date: 1J on •5l Applicant: ..e.----=r+/{ Warning:Failure to secure wodteri compensation I i.wM,,and shell aWJacl an employer to criminal penalties end TYPE DESCRIPTIOI O NI r UNIT COST TOTAL COST civil tines up to one hundred*mend dollars(6x04 addition to the cost of compensation,demgps as provided for In Section 3706 of to Labor Cod.Interest,and attorneys hu. SFR 2470 REROOF BY VALUE RESIDENTIAL" NOZONE 1 . 00 2 , 470 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury That there is a construction lending agency for the END' OF FEES performance of the work for which this perms is issued(Section 3097,CN.C). LENDER'S NAME: LENDER'S ADDRESS: half rtttrw�� Ind state laws have read this apptiWntend statethat the above informationizeepesis coned.Iafirel totcomply withal)drysedmunry ordinancesopEXPIII r and rewimg to Wilding Construction and here authorize repeaentetives of this ay to enter upon the above-mentioned properly /�- forinspection purposes. �, /� C4 Al m e S DATE i s 6,�i ` �J , •�� • Date: —�U —(S^ A. y es_ 0C17S353-07178354 TOT 54.50 AOF Sig .edOwr,er/Apent/APpu'anuCanb°dor DATE:: 03/20/95 TIME: JI;Ua 15151 da.WP) White-Binding A Safety:Green-File Canary-Appicant:Pink-Revenue:Goldenrod-Assessor - 1 11.11111111k4 Y ', CONSTRUCTION AND PLANNING PO_ .& SPA I APPROVALS Permit 4 Date Inspector APPROVALS Permit 4 Date •nsp'ctor • 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location 1 - 2. Soil Pipe-Undrgrnd. c: 53. Steel Reinforcement - , :•3•_Electrical Conduit Utility-Undrgrnd. 54. Forms .. :P.4. Electrical Conduit-Ugdrgrnd. 55. Electrical Bonding - 5. Steel Reinforcementr . . 56. Rough Plumbing & Pressure Test . -6. Electrical UFER,g,Jne. 57. APPROVAL TO COVER GUNITE _.7.-Footings rr4_. _ 58. Electrical Conduit-Undrgrnd. c8 -Foundation Cr- 59. Gas Pipe, 0 Undrgrnd.•Test • 9:,..'Water Pipe-Undrgrnd. 1 60. Backwash Lines,P-Trap;0 Undrgrnd. 10. Structural Floor System 61. APPROVAL T.04DECK 11. Property Sewer Line & House C,onhection 62. Backwash & Receptor-Final 12. Sewer Cap - 63. Heater & Vent-Final 1 t. 13. Roof Drains - 64. Plumbing System - Final.' t. 14. Rough Plumbing. r 65. Electrical-Final 15. Rough Electrical-Conduit - 66. Solar System-Final 16. Rough Electric Wiring c, . 67. Fencing & Access Approval 17. Rough Wiring Sign • - 68. APPROVED FOR'PLASTERING C, 18. Rough Electricai-T Bar Ceiling' 69, POOL/SPA SYSYEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20.1-Rough Facto}•y Fireplace y_r `'-t $ <, t_ APP fOVA'L -'S" Permit# 21. Ducts, in-Structure • . •• •• - :c '% -x -. 70.`Undet§round Hydro 22. Ducts Ventilatin ;., 1 .-T= -OWNER DONALDSON.. Arthur DATE 8-23-57 JOB ADDRESS 210 Knox p BUILDING PERMIT NO. 5618 GEN RAL CONT L ACTOR Owner-Builder VALUE $ 972.00 1 1 OT �� TRACT 973 FIRE ZONE DESCRIPTION OF WORK Garage Addition to Dwelling GROUP J TYPE V ZONE Rt,_ PLAN NO. 5645 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED p,/ / DATE NUMBER Trenche Forms Steel &24/3 / Floor Sy em • Steel Reinforce Chimney Re-Rod Bond Beam Frame and Flashing /'�'' l0,iJ Lathing, In Out /9e/7-5 Plaster, brown coat t7+ /V,t 1,{7 Underground soil W/G Pipe Top Out Furnace _ Gas Vents Rough Plumbing _ Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final Plumbing Fixtures, Final Final Gas Test Construction Pole Underground Power Rough Wiring . • Fixtures, Final "'' ./ - 34-OCCUPANCY (/14 -- /711/S7 Form 210-5M-1-57 .5618 �: • • 5645 FEE RECEI . ED COSTA MESA BUILDING DEPARTMENT �4). ICI t �7•--• 'CRI P.O.BOX 317 - COSTA MESA. CALIFORNIA FIC��77DppEPMMT..��pp FOR APPLICANT TO FILL IN - AP�LYI@K 9f7N , PERMIT BUILDING 210 /clue:, is BUILDING ADDRESS COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY RECEIPT NO. „ E[tMIT NO OWNER HR Ti-1UP �EaA/4tD .50/11 `T �� MAIL / Al / IV�o Br RECEI oMTE ISSUED ADDRESS pZ�O/� /�I��//4J�/{ JOJ/\ J .r[� /� N to S'' r/zts�A J CITY des T/T ! /C /7 TEL c/O%J`DO EIS �/,�/ . [/•f PI/' i. , • ARCHITECT } n`R/S& OR ENGINEER/ITC/0H/•/. POR !J`,II COSTA MESA. CALIFORNIA 9 /7 /f ),/ FIRE T ' ADDRESS jO Q 3 /uo YC6,C4vs- e/yr ZONE ZONE NO.OF TYPE GROUPT 'r J'� CITY LIC. PLANS . -IY/ V CONTRACTOR p /V C r NO. A .r /^V �J �/ TEL APPROVED >/ ADORESS�/O /GAIO/1 NOl/- $-,3ou< BY aq O14rC DATE r `723 3-7) LEGAL LOT CORRECTIONS - DESCRIPTION NO///61 ,/7 BLOCKSLO� TRACT 973 A.P. i�/O/�lyi / !/_ / 1 �BL s/� APP R °V -' D OF LOTS /^ Q NOW ON LOT CITY Of: CJICT-\ MESA USE OF EXISTING BLDG. elO M: PLAIII.QIW DEPT. SETBACK LINE FROM / Sug,EL1 Ili gl'•�G. DefT. REG. CENTER OF STREET t}- REAR YARD 44.-C/ • ' SIDE YARD 141. L(.,-.Rik/- J BYt'J'ILI - DATE rV/I'-% DESCRIPTION OF WORK • PLAN TECH/fl' NEW X ALTERATION ADDITION �y(T ♦♦♦ AH (ice**'L�yji REPAIR MOVING DEMOLISH • Ai I { i 1 Y C ", . SIZIE DING/ /x,02// ROOM / p.X V�� ROOMS STORIES dp yy `` �` EXTERIOR WALL `aTO[GO ROOF /D S{�.• 1L II.I COVERING ¢ U.0000 COVERIINNG eontog//AM) • USE OF NEW (.2.,0912# �& (1-4iLWN'.r1[^i •iI ,l i ,.J _ l I .P 3J} el--.u� UAo VAR. No.-- LTS "./9 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND" STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING REGULATING BUILDING CONSTRUC- //� TION. PERMITTEE ( ,442 yL iii L'f jG'I= MVALUATION�` PERMIT FEE S SIGNATURE OF ��v VVV l/ PLAN CHECK S S AUTHORIZED AGENT TOTAL FEE $ -, ,,,di