HomeMy WebLinkAbout981 VALENCIA ST - Building Permits;,
; .
(714) 754•5273 • Fex (714) 754-4856 • www.ci.coste-mesa.ca.us 77 FAIR DFIVE, COSTA MESA, CA 92626
BUILDING PERMiT
Jobnddress: 981 VALENCIA ST
Suite:
Vicinity: GARAGE
Parcel Number: 14166520
Appliwnt: ALVIDREZ, CARLOS
Address: 259 LILAC LN
COSTA MESA, CP.
Owner: LAMAS, PAUL TR
Address 574 STURGEON
Zoning:
Phone: (714) 6467569
Zip: 92527
Phone:
COSTA MESA, CA Zip: 92626
Contracror: BEACHWOOD CONSTRUCTION
Address: 259 LILAC LN
COSTA MESA, CA
Zip: 92627
Arch :
Address:
Phone: (714)646-7569
license: 456742
Eng:
Address:
Phone:
ISSUED BY:
Status: ISSUED
Applied: 01I71I2001
Issued: 01/112007
Phone:
Zip: License: License:
SCOPE OF PERMIT
REPAIR AUTO DAMAGE PER INSPECTOR'S REPORT. REPLACE SUPPORT POST & HAROWARE IN GARAGE, REPAIR ALL
INTERIOR DRYWALL IN GARAGE, AND REMOVE ALL PARTITIONS IN GAR4GE.
Plan Check: $0.00
Permit: $29.60
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $30.10
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0- 0
PARKING Existinq: o
NOTES:
Rear 0. 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING 8 ZONING
Left 0- 0
LeR 0- 0
Proposed'. �
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0-0
5700.00
s�oo.00
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements untler Califomia statutes and relatad
regula�ions. (Ord. No. 92•28, § 1, 12-21-92)
EXPIRATION: This perm�t shall automatically expire and become void if work is not commenced within 180 days, or it work Is suspended or abandoned
for e period of 180 days.
INSPECTIONS: In orcle� (or the work aulhorized under t�is permit lo be considered legal, such work must comply with all epplicabie codes, and all
requlred Inapeetlona end Iinal epprovel must be obtained. Failure to obtain inspections and final approval will result In the axpiration ot this pertnit.
FOR INSPECTIONS CA4L: (714) 7545628
244&4818/00)
WORKERS'COMPENSAnON DECLAflATON: �
I herehy aHirtn un0er penalry of perjury one of t�e lollowing tleclarations:
❑ I heve end will malntain e certilirate ot consent to sell�lnsure tor workers' wmpensetlon, es Drovitled for hy sectlon 3700 0l the Lebor Code, for the peAormance of ihe
work for whiCh Ihis pertni� i5 I55ued.
❑ I have flntl vnll maintain workers' compensetion in5urenca, az roquired by secllon 3700 ot Ne Le6or CoOe, br Na peAortnance of lhe work br whiCh Ihis pertnit is issued.
My workers' compensatlon Insurence cartler antl pplicy numDer are:
Cerrler: Policy Num6er:
(Thls secfion need nof be canpletea if Ne pemu( is veluetl ef one hundred dW/aro (S I00J or Iess.J
��f ce�tity that in t�e peAormance W Ne work tor which thi ertnit is issued, I shall not employ eny person in eny menner so es to became sub�ect la Ihe workers'
—compensatlon laws af Califoml , antl agrea t� t II I sh bewme sub�ect to the workers' compensatlon provlslons of Sectlon 370 of Ihe Lehor Code, I shall forthwiN
�comply wit� t�ase pr elgns.
Applicent SlgnaWre: � Date
WARNINO: FAILURE TO SEIXIRE O(ER ENSATION MGE IS UNUWFUL MID SNALL SU&IECi AN EMPLOYER TO CRIMIN�L PE � TIE D CML FlNE$ UP TO pJE NUNDRED
THOUSANOOq1ARE(5f00,000),INADDfTIONTOTHE005T PENSATIpJ,DAAi4GESA$PiqVI�EDFOfiINSECilON3]OBOFTM�tABO CpDE.INTERE5T.ANDATTORNEI^SFEES.
LICENSED CONTRACTORS DECLARATON:
I hereby eNirm that.l�em licensetl und,�r p`roWsic
force antl eMect. Lia,q. � H�i�ia
Sectlon 7000) ol DMslon 3 ot the Busingss end P�plessions Cotla, end my license Is N tull
CI849'M � 6'S i .
CONSTRUCTION LENDING AGENCY:
❑ I hereby attirtn Ihat there is e construction lending epency tor Ihe peAortnance ol Ihe work lor which this pertnit is luued. (Sec. 3097, Civil Code).
Lendefs Name: Lendefs Address:
Signature:
OWNER-BUILDER DECLARATONS:
Date:
I hereby eNirm thet under penalry of perjury Ihet I em E7(EMP7 FROM THE CONTHACTORS LICENSE LAW lor the Iallowing reason (Sec. 7031.5, Buslness end Prolessions
Cotle: Any Gry ar counry which requires a permit to consWct, elter, improve, tlemdish, or repelr any siructuro, pdor to its 15suenco, elso requires t�e eppllcent tor such pertnit
m file a signed statemem that he or she is licensed pursuant to t�e provisions oi the Comrectors License Lew (Chepter 9(crommencing wilh Sectlon 7000) of DMsion 3 of Ihe
Business antl Professions Code) or thel he w she is exempt Iherelrom flnd Ihe Desis tor the ellepe0 e:emptlon. Any violatlon af Sedbn 7031.5 6y any applicant for a petmit
subjects the epplicant to e civil penalry oi not more than fne huntlred tlollars ($500).):
❑ I, es owner ot t�e D�aPerty, or my empiqrees with wages es their sole compensation, WILL DO THE WORK, end Ihe siructure is not Intended or oXerad for ule (Sec.
7044, 8usiness antl Professions Cotle: The Contrectors lJcense law does nof appty to en owner of property who bullds or Improves thereon, and who does such work
himself or herselt or throug� his or �er own employees, providatl that such improvemems ere not imended or ottered for sale. If, however, the Duiltling or imD�ovemeni is
sold within one year oi completian, t�e owner-builder will have the burden of proving Ihat he or she did noI build or improve tor puryose oi ule.).
❑ I, as owner of the proparty, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRAGTORS to wnstruct the project (Sec. 7064, Business and Professions
Code: The contractors License Lew does noi eppty to an owner ol property who huilds or improves thareon, entl who contrecls tor such pro�eci with e wnirector(s)
license pursuani to �he Contractors License Laws.).
❑ I am exempi under seF Business and Profe55ion5 Code tor thl5 r8a5on:
SigneNre: Date:
Owner ID verified by drivafs license. ❑ Ves ❑ No Orivels Licenso No. Expires:
Vedlicetion ot Owners�ip by (type ot tlocumem, i.e. - property tax blll or deed):
DIVISION OF INDUSTRIAL SAFETV PEHMR CERTIFICATION:
❑ I hereby cerlify that no excavetion five (5) or more faet in depih into which e person Is requlretl to Oescentl, wlll be metle in connection with work eulhorized by this
permil, and that no Duiltling swcture, scaMolding, falsework, or demollllon or dismentling thereof, wlll be more then Ihirtysix (38) leet hlgh. (Chep. 32, Grp 2, A� 2, Sec.
341, Title e, Celifomia Administrative Cotle).
❑ As ownar-builder, I will not employ enyone to Do work which wauld reQuire e permit irom the Divislon ol Intlusiriel Selety, es nated ebove, unless such person hfls e
permit ta tlo such work from the tlivision.
Signa�ure: Dale:
Division oi Intlus�rial Safery Permit Number:
CERTIFlCATE OF COMPLIANCE AND AllTHOR¢A710N OF EMAY: I certiry under penalry of perjury thel I have read this epplication and slate that Ihe intormation given is
correc�. I agree to compty wlth all state laws and dry ortlinances relating to builCing construction, entl euthorize representatives ol the Ciy of Coste Mesa lo enter upan the
above-described properry for inspection purposes. I agree not to occupy ar allow accupanq ot any building aut�orized by this permil until f nal inspedlon.
COOE �. INSPEGTIONTYPE
1818 Fl:etl System Final Fire Preventlan
1268 Pool Spa Final
200 Finel Re-Foot
201 FIneI BIocWReteining Well
202 Final Factory Fire Place
203
204
Finel Sign
Final Demalitian
Q6g It�lS
4QQ� INSPECTIONTYPE
208 Finel Mochanical
208 Finel Plumbing
270 Flnal Electricel
212 Finel Flre Preventlan
220 Flnel Plenning Approvel
222 Finel Slte
250 FInelBullding/Occupency
�
�
City of Costa Mesa
Building Safety Department
P. O. eox 317
Costo Mma, Califomia
CERTIPICATE OF OCCUPANCY N� 1$$5 C
The Buiiding lowted ot 981 VS3Cric4Et 8trect� A� � C 8e D
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable ihereto
for a Group R& J Occupanq.
Use of Building Fbtu�lqc ResidenCO Vith pLtCched GBie$e
Legal Description Int 111�Ttta.Ct �j011 __
(See reverso aida for Moto� and Boundf)
Building Permit No.�.��5 Elecfrical Permit No._211�i plumbing Permit No. �74
Floor Load Stgns have been insralled as Room Capacity Signs have been instaled as
required u�dor Sec. 2308 U. B. C. . required under Sec. 3301 (1) U. B. C. �
17050. CERTIFICATE OF OCCUPANCY. (a) No aporiment house, horel, or lodging ho�se shall be used or occ�pied
until the owner or operator has been issued a valid certificote of occupancy by the enforcemenf agency.
(b) A new certificate of occupancy shall be obtained whenever ihere is a change in:
1) Occupancy classification of a building or porfion thereof
2) The number of aparimenis or guest rooms
3) Ownership
If Group H Occupancy, number of opartmenfs and/or guesf rooms as required under Sec. 17050.1 (d), California
Administrative Code, Title 8, Chapfer 9, Article 8.
Number of apartmenis ��' and/or guest rooms
ISSUED TO:
Iiv�cx+oPt Terrace. Incorporated
Building Official
by �/SX��%i�^�`'��.0"/.'/_!
Date Feb=vax9 27. 19�1
This Certifitate of Occupancy SHALL BE posied in a eonspicuous place on the premises and SHALL NOT BE removed
oxcept by the Building Official of the City of Costa Mesa under Sec. 306 ie) U.B.C. Forn, sus4—�m—ii-ca--s-s r
�
V/
ADp��cant to flll ln all soaees except tnose withln neavy eortler linas ane sign all aDoroodate tlaclarations.
CITvqF cOSTA MESA CONSTRUCTION PERMIT
Project Address q/`�� ���� �i.�l/C; / .�
Appli�nt's Mailing Address J� 3��%/ �!/�✓1rG1�
Owr�2r's Name r f.f-.� B' V� �one
Prldress � 5������� aS'� � �' 7�1�
Arch/Eng. License No.
Address
Contracror's Nam /� �
Phone ��
Address (mailingl.� k'� �
City License No. �
LICENSED CONTRACTOR DECLARATION
I hereDy afiirm Ihdt I am Ilcensetl untler prOW5lons o! Cnarter 9(CommanUng
wi[� sectlon 7000) of Dlvltion 3 of the Business antl Professions Cotla, antl
my Iicense is in full torce antl eflecL � '
LJ<ense Clast G�'�' 9--y�y LltenSe No
DatefO"��'-� naig5 �urn'�LY/�
. WORKER$' COMPENSATION DEC ION �
i here�y attirm that I �ava a cmtlficate f consent to SelNnsure or a certiticate
' Workers' Compansatlon Inzurance, or a tertHietl copy [hereof ($ection
100, Lab. C. 'I� �]�.�.� �
Policy No. �T � � S� Company �'-" "" —
Certi�letl copy is hereby fumishetl.
Cerilfie co is filetl with the city Bulltling Div(I1cl`on_.p �
' Date� APPIi<ant Pe'�"-` T^�5�
EXEMPTI N FROM WORKERS' COMPENSATION DECLARdTION
(This settlon naetl not be completetl if the permit is for one huntlretl (5300) or
less).: .
I certi(y lhat in t�e Oarformance of tM1e work tor whlch lhis parmk is 15sueC, I
•shall no[ �employ any person in any manner so as to Decome sub7ect to the
Workers' CompenzatlOn LawS Of CdlilOmia. i
Date 5ignature
-NOTICE: It, after making t�is tleclara[lon, you shoultl b¢coma sub�ect to the
Worker5' COmpensatiOn provlslons ot tne Labor CotlO, y0u muit (orthwith
comply with suc� p�avlsiOns Or IItIS permit snall be tlaemed �evoketl.
CONSTRUCTION LENDING AGENCV
� I hereby alfirm tnat t�are Is a mnstrucHon lentlin9 agency tor iha pertormance
ot tne work tor whith ,1h15 permit is issue� .(SecNOn 309J Clv. C.)
Laneer's Namo
L.entler's Atltlrait
OWNER BUILDEH OECLARATION ��
I hereby dfflrm lhat 1 am o%ompt trom the ContldCtor'S IICBnSo Ldw fOr tlle�
followin9 reason (Sectlon 7031.5 Business antl Professional Coila: Any tlty or
. counry wbl<h �equires a p9�mlt f0 cOnst�uct, al[e�, imp�ove, demolish or rEpair
i�. any structure, prior to Its izsuance, also requlies the applicanl for sucn perml4
ro fiie a signea statement ihat he/she is licensetl pursuan[ to Ihe provisions ot
�� .[�e Contractor's Litense' Law (Chap[er 9(commencing wi[n Section 7000) of
'�. Oivision 3 oi t�e Businass antl Professmns Cotla) or that ne/she ii exempt
'her¢from antl tht�Uazis fOt tne allegetl exemption. Any vloldtion of Section
�3L5 by any applicant for a permit subjects, the appliwnt to a civil
a�dlty of not morc lhan five hunOretl �olla�s ($500).
I❑ I, as owner of lhe propmty or my employe¢5 witn wa985 as Inei� sole
� wmpen5ation, wlll ao the work, antl the structure is not Intentletl orAfieretl
� for sale (Sec[lon 7044, BUSiness antl PrOf¢s5iondl Cotl¢: Th¢ Gonttactot'S
Llcense l.aw tloe5 00[ apply to an owne� ot a O�operty who EUIItlS or improv¢5
' IhEreon, antl wh0 Uaes'such w0/k nimself/Iterself or fNouqh his o� tfer own
employees, provitletl ihat Su<M1 Improvement5 ar0 not IntGOtletl O/ ottereE tor
sale. If, nowever, lh0 Oulltling or improvement IS Soltl wllhin one year ot com-
� pletion, tha ownar will nava the burden of proving he/sno aiE not builtl or im-
prove for tM1e purposa oLsale). " ' ' '
❑ I, as ownar al tho property, am exclusively contracting wilh Ilcensetl ton-
i�acton to conslruGt lhu p�ojaGt (Seclion ]044, Buslnass antl PrOfesslons Code:
. The Contractor's LI<ansc Ldw doCs not apply to an Owner o1 property wh0
builtls or Improvos tneraon, antl who contracts for sucn projects wIN a con-
� tractor(51 Iicanse pursuanl to the Contractor's Licensa Law�. 1 am aware that
'. proof of t�eir Worker'S Compensation InsuranCB shoultl be provitletl t0 me.
'� 1 am exempt un0er Section , � B. d P. C. �or this reason
, Date Owner
I Drivers' CicenS
CMF 0865-46, rev.
�tata tnat tha aGave
tl county ortlinances
aby autnorize repre-
lonetl Droperty for
oate�l/—LJ-9'fi=
(� i S�hq 1 I I I
TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTH
DESCRIPTION OF WORK/USE OF BLDG. ��� -� -
TVPE OF PERMIT GRAOING FOUNDATION � STRUCTURAL
❑ TENANT ❑,ELECTRICAL ❑ PLVMBING ❑�MECHANICAL
❑ OTHER ' ' � ,
VROJECT DESCRIPTIO SO. FT. oCCUGANCV
CONSTRUCTION TVPE VALUATION $ Z._� `J^Z�—
20NE GRADING CU. VDS. ACRES
Remarks: � -
Backflow Preventer �
Backflow Irrigation �
Bathtubs
Clarifiers
Dishwasher ' �
Drinking Fountains
Floor Drains �
Floor Sinks .
GasService Oudets
Interceptors "
Kitchen Sink
lavarories . , ,
P—Trap
Roof Dreins • -
Reinspeetion Fee 575
Boiler
Duct - Under Ground. �
Duct - Structural
Duct - Ventil2ting_
Exheust System ❑ Multiple
Firepl/Fact Blt. ICBO �
Heating System & Ducting
❑6100,000 BTU 0700,000
Fee � $15
White - Bulltling; Canary - Applicant; Pink - Atcounting; Goldenrotl - A55essor
Showers
Service Sink -
SewerCap
Sewer Connection
Solar Collectors
Solar Piping
SOlar Tank
Swimming Pool w/Spa
Urinal -
Wecer Clout
Warer Heater � .
Auto�Wash ,
Launtlry Trays
laue Fea
Hood or Type I O
Canopy Type I I ❑
Re(rigeration System
❑aioo,000eTu Oioo,000
System Repair/Alteration
Fire Dampers .
Regizters
Issue Fee
FEES
S 3
A.P. #
S Main Buildi
E
T Front
B Rear
A
C Ri9ht
K Left
S
Ping.�Ref. dp
Planniny Notes:
Auroma[ic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas .❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0�5 KW C
Fee
08U� �!l�t.,?�li�;
Zone
Accessory Building: -
Parking Req./Provided �.
ELECTRICAL
Trensformer ❑ 15-50 KW
050+KW
Meter �up to 100 amps
Meter �over100amps
Sub Panel �
Motors O0.1 HP O1 h- 6
InaSolar �9�15 HP �16-15+
Microwave '
Pole Light /� �
Ranga , . �,r
_ .,,c,. i,_
Z
O
N
I
N
G
R
�E
�
M
T
S
FEES
;Standing Sectioris. �::
5 KW Trash Compactor � ^
�`� '
. �� , •.
�
.�
515 Issue Fee , , § 3
DEVELOPMENTSERVICESREQUIREMENTS: ' '�„
Zoning Approved By
Bui�ding APProved BY _ . . .
' D�L �CC SUMMARV OF FEES i SO
' BUILDINGPERMIT $ ��•DO SMIP . $
. PLAN CHECK ,$ PERMIT ; ! �
ISSUANCE $ �
PLUMBING � �S � .
PLAN CHECK 25% S ENERGV P.C. �$
ELECTRICAL g GRADING $
PLAN CHECK 50% S ' MICROFILM $
� MECHANICAL 3 TOTALFEE '$ �'��
PLAN CHECK 25% �$ � � •
CONSTRQCTION AND PLANNING - POOL __ SPA
APPQrOVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Loca[ion
2. Soil Pipe=Undrgrnd. � 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit=Undrgrnd. . 55. Electrical Bonding
5. Stegl Reinforcement 56. Rough Plumbing & Pressure Test .�
6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE '
7. Footings' ,� 58. Electrical Conduit-Undrgrnd. _ ��
8. Foundation �' � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd: � � 60. Backwash Lines, P-Trap, � Undrgrnd. .
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 Electiical-Conduit 66. Solar System-Final
16. �Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping � Gas OOiI
23. Gas Pipe-Rough & Test � 72. Underground Flush
24. Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing ' 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ,
27. Frame and Flashing 76. Dry Standpipe �
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. DrvWall Nailing , - HEF\LTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
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 pomestic-Final -
42. Backflow Preventer . '
43. Backflow Irrigation �
44. Landscape Irrigation SYstem
45. Sound Attenuation .
46. Handicap Regulations , , J 9j ��
47.FINALSTRUCTURE&BUILDING ^ � � � ds(/BC�
48. Special Requirements Completed
49. Electric Release to Edison - �
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY - �
N0. Date
.
. �9���
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOR 917 COBTA MESA,CALIFORNIA
For Appllcan� ►o Fill In Completely
TYPE OR PRINT
i�o�N� a encia
oaess T,nt. 47.i Tract 5011
� COSTA MESA. CALIFORNIA
ARGHITECT
OR ENGINEE
■ STATE
ller
TEL.
NO. 5�17�
no. .,..� ,..,.
OF LOT '/(1 � X QZ � N01
USE OF �
E%ISTIN6 BLO6.
6ETBACK LINQ FROM /�
CENTEN OP BTNEiT �i�J � REAR
SIOEYARCI LEFT ZO� I RIOHT
DESCRIPTION OF WORK
BUILDIN6 � � NO.OR
srze 55 x 73 rcooMa
EXTERIOR WALL " I ROOF
COVERING c-Fnrnn C�VF
�
�
FEE RECEIVED
JUN 1 0 jg$�j
FINANCE DEPT.
���I�BUILD�N��IT
For Office Use Only
PECEI'T NO. PI
6y GT O/yr[ N¢cirvlD D�
/// //i��%i�% `N1R
APPROVED
BT
zon,' �
ZONING
I U6EOP
am�ou
'E: NO EAVE OVERHANQ SHALL BE LESS THAN
TO SIDE Q REAR P. L.
ES
.OWED fU.B.QREqU1REMENT
YARD3MPROVED VARDSAPPROVED
MAIN BUILDIN6 ACCESSORY BUILDIN6
:OM WLSTREfiT)
I OISTAfJGE BET. BET. MAIN 2
MAIN BLD6S. ACCESS. BLI
VAR.aj' DATE
2 Q l� P$ L\ APPROVEO
��c
sc. Fr. �A•
1 HEREBY ACKNOWLEO68 TXAT I�HAVB READ THI9 APPLICATION THE AMOUNT SHOWN IINDEH VwLUAT�ON �6 FOR TH6
AND 6TATE THAT TH8 ABOV6 IH CORRECT AND AOREH TO COM. PUNPOSE O� EBTABLI6HIN6 A pERMIT FE8 ONLY.
PLY WITH ALL CITY ORDINANCHB AND GiAT6 LAW9 R60ULATING ypLUATIOI`i
BIIILDINO CONeTRUCTION.
HYCRO PERMIT FEE § / / f_
SIGNATURE OR �
PERMITfE $ ,// �% ,
u//] /`• A CHEC D
AUTHORIZ6DA6ENT�� • //
TOTAL FEE $/�U/ �