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Home My WebLink About143 LEXINGTON LN - Building Permits t - 0 M- CITY OF COSTA MESA 1• 4 9 BUILDING DIVISION f• �._ ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER ,y,_ PERMIT J -`^6Po.mmis P02-00401 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 • PLUMBING PERMIT Job Address: 143 LEXINGTON LN Status: ISSUED Suite No Applied: 06/24/2002 Issued: 06/24/2002 Vicinity: Parcel Nunmber: 41916376 ISSUED BY: Applicant: KAMINSKY, PAUL Address: 11612 KNOTT ST • Phone: (714)895-1246 GARDEN GROVE,CA Zip: 92841 Owner: THOMPSON, RICHARD ' al.• Address 143 LEXINGTON LN t�� ' r Phone: i � I' COSTA MESA, CA Zip: 92626 II,�. ! V's Contractor: NOCK PLUMBING Address: 11612 KNOTT ST Phone: (714)895-1246 GARDEN GROVE,CA Zip: 92841 License: 707775 Arch / Eng: Address: • Phone: Zip: License: SCOPE OF PERMIT WATER HEATER CHANGE OUT. . FEE SUMMARY AMT QTY 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 $12.30 1 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(14 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 $0.00 0 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: $35.80 • COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related 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 abandoned for a 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 all 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 244646(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. O 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 et one hundred dollars($100)or less.) O I certify that in th mance 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 ws of Ca omi�Cipld aggg��aaae that if I should become subject to the workers'compensation provisions of Section 37pg00 of the Layyoor Code,I shall forthwith comply with these pr • n4-7 � P g/ / Cl(1- / /0 A Applicant Signature: ei Date: (IF'4( ' WARNING:FAILURE TO S CURE WORKERS' PENSATIQN COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN TIES AND G IL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITI O THE COSY OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR DE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I an ' :. ed uncle ovisions of C4apter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: .�� Date: ware • CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construc I. ending 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 end 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 fore 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.). O I em exempt under sec. Business and Professions Code for this reason: Signature: Date: 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: ❑ 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,Grp 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 a 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? ❑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 ❑No 5 Does or will the applicant Or present or future building occupant require for the work which is the subject of this application a_permit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? 0 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). 6 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 El 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 Quality 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 6 (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 comply with all slate laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property tor I ection oses.(/I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. property Sign u Of LegAlOWner(s to And/Or Aut rized Applicaan Date CODE t If1SPECRON TYPE ,.QAC INIRIALS CODE 1N5PECnON TYPE DATE IKRTIAI6 1616 Fixed System Final Fire Prevention 206 Final Mechanical �c T 1266 Pool Spa Final 208 Final Plumbing S-iA-05 $ ,tl�1-1 0 f 200 Final Re-Roof 210 Final Electrical J 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy �S PROJECT ADDRESS: 143 LEXINGTON LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 069641 r OWNER'S NAME: BROWN MADELEINE M TR ADDRESS: 143 LEXINGTON LN PERMIT NO: B 069641 PLAN CHECK NO: N GOVT: N SUPP: N !:04 COSTA MESA,CA 92626 CONSTRUCTION TYPE; V—N PERMIT TYPE; STR PURPOSE: ALT ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/O RESTH 6 REROOF W/COPM 6 HOT MOP SQ FT; 2, 508 ADDRESS: UNIT: CLAIM VALUE: 2, 508 , 00 CALC—VALUE: 2, 508 . 00 GROUP OCC: R-1 / PERMITTEE: STOUT ROOFING INC ( 310 ) 923-6775 ADDRESS: P 0 BOX 4309 COMMENTS : REROOF SLOPE SIDE W/COMP FLAT SIDE BUR SMOKE DETE. REQUIRED DOWNEY CA 90241 ******************************************************************************* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 2 ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS chem:0 9374 ATELIc.: 402535 class: C 39 EXP: 10/95 (C�� MAIN BUILDING ACCESSORY BUILDING Date: Signature: . �� FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN WORKS S'C MPENS TION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN Compensation Iptruarge2gr.yyegified copy thereof(Section 3800, Lab. a5/1 9/9 5 POLICY NO.: 77 CC LL CC 7 7 EXP.DATE: U COMPANY: AIGPARKING REQ; PROV; PARCEL: 41916376 ZNE: REF NO; ' 7 Certified copy is hereby urnished. ff Certified copy is find with the city Building Division. PLANNING NOTES> , > Date: I _ i Applicant ******************************************************************************* EXEMPTIO FROM•ORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred($100)or less). D E V E L O P M E N T SERVICES REQUIREMENTS 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. ZONING APPROVED BY DATE; Date:II Signature: BUILDING APPROVED BY NOTICE:If.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor : DATE: ' Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. ' CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; • DATE- /n vy f a. which this permit is issued(Section 3097, Civ.C). ************************* ** ************************************414** * *** LENDER: ************************ * **************************************************** ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT;Y • OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 54 , 00 . 5j 0 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN are Professions Code)or that he/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). ISSUE FEE I. as owner of the property or my employees with wages as their sole compensation. win do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTAL S----> 54 , 50 0 , 00 0 . 00 54 , 50 54 . 50 , 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for sale.If, however the building or REVENUE DIVISION TOTALS--> COLLECTED• 54 . 50 OVER/SHORT: 00 orimprovemento is soldfs le)hin one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SHIP/TOT GRADING PLAN—CHECK for the entis of dale). I.as owner of the property.am exclusive) contracting with licensed contractors to construct the project(Section 7044,Business 54 , 00 50 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law). I am aware ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL FEE BREAKDOWN ❑ I am exempt under Section: B.8 P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: SFR 2508 REROOF BY VALUE RESIDENTIAL NOZONE 1 ,00 2, 508 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: 01 00170682-00170683 TOT 54.50 I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county DATE: 10/23/94 TIME: 13:23 ordinances and state laws relating Io building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for i speck purposes. Date: i 0CSL/ Signature: /ll/ Dover's License or Social Security k: / 1641.46 While—Building:Green—Code Entorcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor .iri=-s. CONSTRUCTION AND PLANNING POG SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or-Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4.-Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test - 6. Electrical UFEA Grnd. 57. APPROVAL TO COVER-GUNITE _ 7..:Footings 58, Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, 0 Undr gr nd. ' 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater &Vent-Final 13. Roof Drains - • 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit , 66. Solar System-Final 16. Rough ElectricWiring 67. Fencing & Access Approval - 1 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING �{{ -- I 18. Rough Electrical-T Bar Ceding 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20.. Rough Factory Fireplace - 'APPROVALS _ .Permit # 21. Ducts, in Structure• . . .y ., • • 70. Underground Hydro 22. Ducts, Ventilating - ' -71. Product'"Piping OIGas ❑'Oi1 23: Gas Pipe-Rough & Test it _ ' 1-* • - , , ,72. Underground Flush - 24. Roof Framing ! • - - 73. Undergrnd.Storage Tank C Gas 0 Oil 25. Roof Sheathing t 2,-.gbgs•' 42( . 74. Overhead Hydro' -. 26. T-Bar Ceiling (Structural) & Monocoat1: - in r" .�i• - 75.: Dry Chemical 1 r i-+ . n 27. •Frame and Flashing ; 76. Dry Standpipe -a ; 'I -28. 'Lathing& Siding - 77. FIXED SYSTEM FINAL- 29. Insulation • ., • 1 78: FIRE PREY. FINAL .30. Drywall Nailing • i 7 H HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat- : f C 79` FINAL IN&SPECTION 1 32. Electrical Power Meter:Final 180,nFOOD CERTIFICATE ISSUED 33. Final Electric - • ', : ' Notes: . ,34. Final Heating & Air,Conditioning • • 1• - 35.•'Final Gas Pipe-Test` - ' ' 36. Hood or Canopy *.( - -37. Final Factory Fireplace • • , '38. Final Plumbing • ' - 39. Water Service-Final '' 40. Gas Service-Final 41. Solar Domestic-Final . ' . -, • 42. 'Backflow Preventer . I ,- ' - •- + 43. Backflow Irrigation -44. Landscape Irrigation System . I - -- , • - 45. Sound Attenuation i. ~ • I 46. Handicap.Regulations - 47. FINAL STRUCTURE & BUILDING d-q-qy, 6w66• - 48. FINAL PLANNING 49. Electric Release to Edison - 50. Gas Release to Southern California Gas CO ' •- 51. CERTIFICATE OF OCCUPANCY ,. No._ Date 27784frov ,s 67P°'°oo 528* ****90.00 [KSA COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92828 Foe Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING For 00ke Use Only I ORERS I . w 4A,... Ie.8 pjE••j1L• �F yI REctRT NO. L /�UA} COSTA MESA, CALF ORNIA / G , RECEI , DA C1 O /-.. ifenBOugp6y neR San Vista Bldg. Co. �U -,%-`/ " 1 a IaVr MAIL BUILDING ADDRESS 2249 Wanderer Drive, ADDRESS CITY San Pedro 833-332C ZONE TYPE / GROUP Y ARCHITECT T[L BAPPROVQD DATE OR ENGINEER Clif Olsten No. 923-1221 ZONING ADDRESS 9025 E. Florence, Downey �*4,•�.. rt-t.NO.OF /� UUI OFDI NEW 4 ILANI BVILDINB CONTRACTOR Same h// {� LEGAL Let-C,i TitaAlf-Si 6 3 ADDRESS $aIDe DIOORIn10N CITY Same A.P.NO. I V/"707---- 3 NOTE: NO SAVE OVERHANG SHALL BE LESS THAN SIC. TATENNO. SO"TO SIDE a REAR P.L EAVES OF LOT0-0 7 O NO O NLOT ALLOWED (U.B.C.REQUIREMENT) NOW ON LOT YARDS APPROVED YARDS APPROVED USE OP - MAIN BUILDING ACCESSORY BUILDING EXISTING..BLDY. y (FROM C/L STREET) 1 BETEACKtINIFROM FRONT n PT. PT. CENTER OP STREET REAR YARD SIDE YARD I LEFT I Ij RIGHT R.SIDE 0 FT, PT. DESCRIPTION OF WORK L.SIDE 0 FT. PT. NEW _ALTERATION ADDITION REAR FT. Fr' rDISTANCE BET. BET.MAIN& U� U1 REPAIR MOVING DEMOLISH MAIN BLOBS. ACCESS.BLOBS. Z BUILDING :gars �l VAR.# DATE / ILI SIZE ��" Z& ROOMS 't STORIES ` C.U.P.# / � II APPROVED 6-18--6.3W EXTERIOR WA I ROOK Pa y APPROVE I`^, COVERING �/,S/} I COVERING 1-�ti/(, eT IN�NTW +RATE Cl7- O 6, 5. USE OF DU ILDI AND WORK TO BE P[ FORMED Vt. p, cy ,.d .46.4.4 7J I� R1 a d �f0 a �/ SQ.Fr iJ" u I HEREBY ACKNOWLEDGE THAT.) HAVE READ THIP APPLICATION THE AMOUNT PH N UNDER VALUETION 18 FOR THE O {V AHD STATE THA ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. D.PLY WITH AL ITT O modals AND STATE LAWS REGULATING VALUATION BUILDING CO UCTIO . J SIGNATURE OF PERMIT FEB a jO PERMITTEE /1.V� ))) // .. .y� It IF /Jf /// _PLAN CHECK S 3� w a AUTHORIZED AGE • J TOTAL FEE$ 90--- 0