HomeMy WebLinkAbout2861 TABAGO PL - Building Permits •
"'. PPVECTADDRESS: 2861 TABAGO PL UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 054852
OWNER'S NAME: SHAW, LEROY E TR '
ADDRESS: 2861 TABAGO PL PERMIT NO: B 054852 PLAN CHECK NO: N GOVT; N SUPP: N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE; ALT
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF RESHT. REROOF W/DURALITE ICBG 2093 SQ FT: 8, 000
ADDRESS: UNIT:
CLAIM VALUE: 8,000. 00 CALC—VALUE: 8, 000. 00 GROUP OCC: R-3 /
PERMITTEE: COASTRIDGE ROOFING ( 714 ) 557-6048
ADDRESS: 2480 FAIRVIEW RD COMMENTS. SMOKE DETECTOR REQUIRED IN THE HOME
ie
CM CA 92626 ******** ****************** **************3E***3************************3*******
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
70001 of Division 3 of the Business and Professions Code.and my license is in toll force and effect. SETBACKS
CITY LIC.: 049912 STATEUC.:541190 cASs: CO3
---- •_ pioYyr/// gip MAIN BUILDING ACCESSORY BUILDING
Signature: �. - �p FRNT; FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a ce Cate consent to self-in re ora certificate of Workers'
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ: PROV: PARCEL: 13933310 ZNE: REF NO:
❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES>
>
Date: Applicant: *********************************************************************-**********
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMEWTS
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
/� •
— 4:am, _ — 7 Signature: —"CI
til 'r
NOTICE:If.after making this declaration.you should become subject to thCvorleers'Comte ation provisions of the Labor BUILDING APPROVED BY : DATE; ..
Code,you must forthwith comply with such provisions or this permit shall be deemed revo d. • ,./ `
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agenc for the performance of the work for APPLICATION ISSUED B Y: • DATE• 1)-`f k
which this permit is issued(Section 3097,Civ_C). ********************** F***** *It*********1c*-ie*x14-**F4i***ii**}..*-* {(:h 3**6EE4. *1rlr**
LENDER: ***********************************is��ll. ******************************•***********
ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT: Y
OWNER BUILDER DECLARATION: I hereby affirm that l 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 99 . 00 . 80
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($50)). ISSUE FEE
I, as owner of the property or my employees with wages as their sole compensation, wit 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 TOTALS----> 99 , 80 0 . 00 0. 00 99 . 80 99 . 80 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through y
his or her own employees. provided that such improvements are not intended or offered for sale. II,however the building orimpement is isale). BLDGPMTPLUMBING ELECTRICMECHANIC FIRE /TOT
within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION
—
_ COLLECTED ;
S• OVER/SHORT: . 00
tor thepurpose oGRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 99 . 00 . 80
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts tor such projects with acontractor(s)license pursuant to the Contractors'State License Law).l am aware ****.***..*.*.**-**l(.*****************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.&P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST •
TOTAL COST
Date: Owner:
SFR 8000 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 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 8�. 0 000 0
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:
•
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
ordinances and state laws relating to budding construction and hereby authorize representatives of this city to enter upon the above•mentioned
property for inspection purposes.p /�/�/ t �T •
• �Byrir 1I — L signature: / 9� L" n Vl GI�13 . .1_l ' rDriver's License or Social Security x: f/ C,1TEL'./fl ri'+'
164646 White—Builchng:Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor •
s'�,�, CONSTRUCTION AND PLANNING POOL& 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 UF ER 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, ❑ 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 Electrical-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
19. 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 Pipipg 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof SheathingL.S-cj/ �Cc..41_-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 PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat a 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 Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING /( U'/13_ 64,r- C'
48. FINAL PLANNING Y l /
S - q(/✓
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY -
�lo. Date
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
PER T N TRACT NO. LOT NO. UNIT NO.
CITY OF.COST_A MESA
/ CO4ST UCTION P IMIT � 941 A.P.qW I zona
Project Address Qat(&/ / ^�a99�,s,/J - S Main Building: Accessory Building:
Applicant's Mailing A ess J f• " /clero { C TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION REPAIR E Z
d /� f ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' T Front Q
Address Name La (f( + Phone �-+ DESCRIPTION OF WORK/USE OF BLDG. I B Rear N
Address a1221-1
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑( FOUNDATION U STRUCTURAL j C Right G
Address ❑ TENANT ❑ ELECTRICAL YJ PLUMBING ❑ MECHANICAL $• Left R
r9_gO l ❑ OTHERPing. Ref.# Parking Req./Provided E
Contractor's Nam- ���/ - �� 1 Phone,�1[/f///"
7►`f ensPROJECT DESCRIPTION SQ. FT. OCCUPANCY Planning Notes: M
Address(mailing) 1 �'� 4('3 a
T%/tea CONSTRUCTION TYPE VALUATION $ T
City License No. B, ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION (JL—y+�1t/L 11 f\L s• >l �9�� S.
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: R6FY !tl'4r'6J Ott; e
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in flit :ntl effect. 0 7/ R ELECTRICAL FEES
Dicens• ass re •int ` 1 PLUMBING I FEES
Date • - /�iI Signature '� Automatic Washer Transformer 0 15-50 KW
WORKERS'COMPENSATION DECIA RATIONConstruction PoleSub •
0 50+KW
I hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers
of Workers' Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter ❑up to 100 amps
3800, Lab. C Backflow Preventer Service Sink
Policy No. 7q�g,5�ss Company S a Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps
•
I C (tilled copy is hereby furnished.
certified ccppyy�s yled with the city Bprydm o Bathtubs Sewer Connection Dryers ❑Gas -OElectric Sub Panel
ate 4A'/ ?S O Applicant `Z ���J Fan Motors❑0.1 HP 01%-8
•
' EXEM TION FROM WORKERS'COMPENSATION DECLARATIO rT Clarifiers Solar Collectors
(This section need not be completed if the permit Is for one hundred ($100)or F.A.U. Inc.$alar ❑9-15 HP 016-15+
less). J Dishwasher Solar Piping 3 BU
I certify that in the performance of the work for which this permit is Issued, I Fixtures
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Microwave
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light
NOTICE:If,after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Outlets Range
comply with such provisions or this permit shall be deemed revoked.
Switches
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Sign
I hereby affirm that there Is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections
Lender's Name
Lender's Address S Kitchen Sink Water Service Generator 00-5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish orlrepair P—Trap Laundry Trays
any structure, prior to its issuance, also requires te applicant for such permit
-
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000)\of
Division 3 of the Business and Professions Code) or that he/she is exempt - Reinspection Fee $15 Issue Fee $ 3
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). DEVELOPMENT SERVICES REQUIREMENTS:
LI I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 Zoning Approved By Date
compensation, will do the work,and the structure is not intended or offered MECHANICAL
for sale (Section 7044, Business and Professional Code: The Contractor's FEES Building Approved By Date
License Law does not apply to an owner of a property who builds or improves '/l V 245thereon, and who does such work himself/herself or through his or her own Application Issued By r Dat
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0
sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II 0 SUMMARY OF FEES
pietion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground
prove for the purpose of sale). - BUILDING PERMIT $ SMIP $
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System
tractors to construct the project (Section 7044,Business and Professions Code: PLAN CHECK $ PERMIT •
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU PLUMBING $ -J`',a0 ISSUANCE $
builds or improves thereon, and who contracts for such oroiects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System El Multiple 0 System Repair/Alteration I PLAN CHECK 25% $ ENERGY P.C. $
proof of their Worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING $
❑ 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt.ICBG# Fire Dampers MICROFILM $
Date owner Heating System& Ducting Registers PLAN CHECK 50% $
I hereby certify that I have read this application and state that the above
00-100,000 BTU 0100,000 BTL - MECHANICAL $ TOTAL FEE $ 5ort)
Information is correct. I agree to comply with all city and county ordinances _ _ PLAN CHECK 25% $
and state laws relating to building construction,and hereby authorize repre-
-
sentatives of Is ci y to en er -•n the above-mentioned property7for
inspection p s Date/c /O
Dgnerure
Drivers' License or 55# Reinspection Fee $15 Issue Fee $ 3 01 00022992-00022992 TOT
`.L(I
0865-46,rev. 5/88 White - Building: Canary -Applicant; Pink -Accounting: Goldenrod - Assessor DATE: 12/21/88 TIME: 09:55
r •1
CONSTRUCTION AND PLANNING POOL &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 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, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap - rl 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 Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
pis. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. 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 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 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 PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final i 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 3/24891.06
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final •
42. Backflow Preventer ear
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison •
50. Gas Release to Southern California Gas Co 1 J
51. CERTIFICATE OF OCCUPANCY
No. Date
MAIN OFFICE BRANCH OFFICE
1635 WEST GAYLORD ST.,--P.O. BOX 9065 1]14-D NORTH HARPER ST.
LONG BEACH 10-CALIFORNIA SANTA ANA,CALIFORNIA
HEMLOCK 5-7493 JE fGEROON I-204]
SPRUCE 5-6526 JEFFERSON 140456
JACKSON 7.3661
Twini
n • Laboratories of soutfEtfl daLifoznla, Cnc.
Inspection and Testing Engineers Soil Foundation Analysis Chemical Analysis
January 4, 1964
GUNITE PRISMS
REPORT OF. EXXXEMEME TEST s k: :. .s:o t:
Examination No. SC64-128
For - Kenneth Beaudreau, 2861 Tobago P1, Costa Mesa
Project SWIMMING POOL
Sample from Swimming pool
Architect Sunset Pools
Contractor Superior Gunite
Mix 4 to 1 by volume measurement
Specified Strength, psi 2,000 psi
36:1 t Size 3-1/8" x 3-3/811 x 6-1/8" 3" x 3" x 6"
Date cast 12-7-63
Date tested 12-14-63 1-4-64
Cylinder No. 1 2 3 "HOLD"
COMPRESSION TEST 7-Day 28-Day
Total load to destruction, lbs. 39,500 40,000
Pounds per square inch 3,744 4,444
Cylinder made by Al Demmer
Cylinder delivered by Al Demmer 112 7
o
Cylinder received on 12-8-63 krA0 R
cc: Beaudreau o,6
Coati Mesa Bldg. Dept. 4 e� -
67. 17,
„„),
ALL REPORTS ARE SUBMITTED AS THE CONFIDENTIAL PROPERTY OF CLIENTS. AUTHORIZATION FOR PUBLICATION OF OUR REPORTS. CONCLUSIONS. OR EX-
TRACTS FROM OR REGARDING THEM IS RESERVED PENDING OUR WRITTEN APPROVAL AS A MUTUAL PROTECTION TO CLIENTS, THE PUBLIC AND OURSELVES.
I (
•
C I T Y OF COSTA MESA
CALIFORNIA P.O. BOX 1200
FROM THE OFFICE OF THE PLANNING DEPARTMENT
Mr. Kenneth Beaudreau August 3, 1964
2861 Tobago Place
Costa Mesa, Ca]igornia
Dear Pool Owner: 1
The Costa Mesa+Planning Department has been notified of the completion
of your swimming pool.
So that your pool will be a safe one and for the purpose of advising
you of your responsibility regarding the requirements of the Costa Mesa
Municipal Code, we quote Section 9298.9:
i
1: No swimming pool shall be constructed closer than five (5)
feet to any property lines, measured from water line of pool.
2. No swimming pool shall be constructed under any electric power
lines or on any electric power easement.
3. No swimming pool shall be constructed unless the yard
surrounding such pool is completely enclosed by a fence
six (6) feet in height and have a self-closing and
locking type gate or gates.
This courtesy letter is directed to you so that you will be aware of
our ordinances and can make a complete safety check of your pool area.
Sincerely yours, j1
� +
% i`
William L. Dunn
Director of Planning
CITY•
OF COSTA MESA
CALIFORNIA, P.G. BOX 317
From the Office of the Planning Department •
Regarding Building Permit No. 20888 Date: 2-7-64
Tobago •
Location: 2861 Z geo Place, Costa Mesa
Dear Pool Owner:
The Costa Mesa Planning Department called at your property to inspect
the Swimming Pool. Our interest in pools is for the purpose of safety
and to be sure all provisions of Section 9298.9 of the Municipal Code
have been met.
Section 9298.9:
1. No swimming pool shall be constructed closer than five (5) feet
to any property line, measured from water line of pool.
2. No swimming pool shall be constructed under any electric power
lines or on any electric power easement.
3. No swimming pool shall be constructed unless the yard surrounding
such pool is completely enclosed by a six (6) foot fence or the .
pool itself is enclosed with a fence six (6) feet in height and hav-
ing a self-locking type gate or gates.
Note: (Gate should close and latch on a free swing).
Your pool will not receive final approval until the requirements of the
aforementioned Section of the Municipal Code have been completed.
• The following disposition is noted in reference to your pool:
U No one was at home.
lac No springs on gate.
❑ Improper latch or defective hardware.
❑ Wall surrounding pool not 6' high.
•
❑ Other.
[ x Telephone 646-2411 and ask for the Planning 'Department so
that an appointment may be arranged.
Since you have incurred certain liabilities through the installation of a
pool, it is requested that these matters be taken care of as soon as possible
so that your pool will be a safe one.
Sincerely yours,
By •
Planning Technician
Applicant to fill in all spaces within heavy border lines andsig74appropriate declarations.
CITY OF COSTA MESA PERMIT NO. TRACT NO. LOt NO. BLDG.NO. 4756 4/ 16/82 64.02 IL
CONSTRUCTION PERMIT A 3 30 -f008 89 -
Project Address 20 _ _ , It At TTY/PE OF CONSTRUCTION '
Owner �•� ! Phone '/ /KEW 0 ADD ❑ ALTERATION (�/h/L
Address,vet t tt o P�. dm. 'is /0�REPAIR 0 CONVERSION ❑DEMOLISH 1 /
/`JG( L ZONING REGULATIONS •
Arch/Eng. License No. 0 OTHER , / A•P # Zai
—Address - DES RI•TION •F WORK • /0 I co /. �2--J. ^/e5
/ y ' r // r ZONE PLNG. REF.$
a.
Contractor -QzetA4i Phone/&f/ TYPE OF PERMIT - • B' • - TO Bt1ILDING ,
Address yJ/ SETBACK C/LST.' PROPERTY LINE
P(7r 1J({Q ,�(� y2 tam_ GRADING �Q FOUNDATION STRUCTURAL -SIDE YARD so; ce q
LICENSED 'CONTRA[ OR D RATION /E LEFT 71 r V
I hereby affirm that I am licensed under provisions of Charter 9 (corn- TENANT LECTRICAL ❑PLUMBING ❑MECHANIC AV SIDE YARD �•7 I
t RIGHT /�Q n A'I�O•� P�.
mencingofessiwith section 7000)myof elvisio in 3 it the Business and 0 OTHER �i'OR l�'T n--
Professions Co d my license is in full force rid ffect. REAR YARD(TO P/L) •
/dam{ PROJECT DESCRIPTION
License�Class - Licen4/4/D , PKG.SPACE REQ. PROVIDED -
DateJ�AfL 1g19.92Signature /C-• ,t'**7 Ofili '-SQ.FT. - STREET WIDTH • PARK FEE$
WORKERS'COMPENSATION D CLA RATION - OCCUPANCY /3a tONE N TYPE ZONING APPROVED BY DKr,/,/ •r DATF�4e0/Bz_ .
I hereby affirm that I have a certificate of consent to self-insure or,a ',VALUATION,"
certificate of Workers' Compensation Insurance, or a certified copy
thereof(Section_3800, La•b.C.). r GRADING CU.YDS. - -- ACRES SPECIAL CONDITIONS: '
PoI" No. Company p"1 e � /S[iO4t.-s_ - _
Certified copy is hereby furnished. - -REMARKS: - - - - - -
-
❑ certified copy is filed with the city Building Division. - , ,
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION . . • -- - - -
(This-section need not be completed if.the.permit is for one hundred - --_ .. _ _ . -- . . - -
($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•be Come •PLUMBING- .PLAN _ _CHECK ELECTRICAL PLAN CHECK -
subject to•the Workers'Compensation Laws of California. -
LP/YELLING GARAGE-
Date Signature BATHTUBS SHOWERS SO.FT SO FT - •
NOTICE: If after making this declaration, you should become subject TOILETS . , URINALS - - -GENERATOR 0.1 KVJ_1-10 KW , '
to the Workers' Compensation provisions of the Labor Code,you must 'TRANSFORMER , -
forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAYS 'APPLIANCE 30-SO KW 50+ KW, . .
revoked. - • -- - • .• - - --- .-
CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS 1. ' MOTORS - 0-1 HP_1-10 _HP - `
I hereby affirm that there Is a construction lending agency for the per- SERVICE SINKS t ' .' SUMPS - - (INC:SOLAR) 10-50 HP + HP - -
formance of the work for which this permit is Issued (Section 3097 . -
Civ. CJ' FLOOR SINKS FLOOR DRAINS FIXTURES' - OUTLETS SWITCHES- -
Lender's Name __ _ _
Lender's Address DRINKING FOTAINS - - GAS TUBE SIGNS • ' - -
UN - ' • 1
OWNER BUILDERDECLARATION '- INTERCEPTORS CLARIFIERS POLE LIGHTS
I hereby affirm that I am exempt from the Contractor's License Law for I , r .-i
the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL P TRAP - ' • LUNSI HUL I ION _ _ _ _ - -
Any city or county which requires a permit to construct, alter, POLES METERED SUB -
improve,demolish or repair any structure, prior to its'issuance,also re- WATER SERVICE ALTERATION -I - PAN ELS MAIN SUB - -- •
quires the apklicant for such permit to file a signed statement that he _ '• - ••-
is licensed pursuant to the provisions of the Contractor's License'law - GAS SERVICE OUTLETS '
(Chapter 9 (commencing with Section 7000) of Division 3 of the , 'SERVICE AMP
Business and'Professions Code) or that he is eicempt therefrom and the' WATER HEATERS BTU OUTPUT
basis for the alleged exemption. Any violation of Section 7031.5 by I • '•' - - I
any applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS ' ' - ' -' - - -of not more than five_hundred dollars ($500). • - -
❑ _I, as owner of the property,or my employees with wages as their - SOLAR TANK COLLECTORS ' -- .' - - - . . " - -- -
sole compensation,-will do the work,-and the structure is not Intended ' r ' -
or offered for sale, (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. • - - ISSUE FEE '- - -- _ - -
Contractor's-License Law does not-apply-to an owner.of a.property APPLICATION APPROVED BY -
who builds or improves thereon, and who does such work himself or ISSUE FEE -- -' ' �'--DATE' -
through his own employees, provided that such improvements are not --
intended or offered for sale. It, however, the building or improvement MECHANICAL PLAN CHECK SUMMARY OF FEES
Is sold within one year of-completion, the owner.will have the burden --s
of proving he did not build or improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTU _ , 'BUILDING - -- 3 O S� ' - -' STS.
❑ I,' as -owner -of the property, am--exclusively- contracting•with - _ - --- - ,'PERMIT $ O_ '$MIP 'f•� $
licensed contractors to construct the project (Section 7044, Business AND DUCTING 100,000+ BTU PLAN CHECK $ 4141_5..• O " .PERMIT s. '•, -
and Professions Code: The Contractor's-License Law does not'apply to - t• - -- --- - — - ISSUANCE $ I ,
an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU I PLUMBING $
tracts from such 'projects with a contractor(s) licesned pursuant-to SYSTEM -i- - - --- GRADING ' $ s
the Contractor's License Law). 100,000 +BTU I - (. ,•-, PLAN CHECK S. • .. - , ,
❑ I am exempt under Section ars, P.C.for this BOILERS BTU ELECTRICAL $ - $
reason --- - - ' - - - PLAN CHECK S
MICROFILM $
SYSTEM REPAIR,ALTERATION
Date Owner - - - - TOTAL FEE$
I hereby certify t at I have read this application and state that the above EXHAUST SYSTEM MULTIPLE MECHANICAL $
information i orrect. I agr e t om 1 with all cityand county -PLAN CHECK $ - LESS A D- ' -
PY VANCE PC $_
ordinances a state rel in o rstupon and hereby authorize • '
groper nta of this ci ter upon the above mentioned G 'I �Z
properly inspection ur os /,�A ..�� 51-1)-2
Signature O'er Datekt"L/fen/ FINAL FEE $
Drivers' icense or SS* /# 'ISSUE FEE - - -
CMF 0865-46 White-Building:Canary-Applicant; Pink-Accounting;Goldenrod-Assessor
V •
CONSTRUCTION AND PLANNI G - POOL& SPA ;,
APPROVALS Permit # Date Inspector APPROVALS Permit# - - Date :_ Inspector
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location • - - - - . .
_ 2. Soil Pipe-Undrgrn - 44. Steel Reinforcement • _ . _ _. .
3. Electrical Conduit Utility-Undrgrn _ - ' - 45. Forms
4. Electrical Conduit-Undrgrn _
s-7 46. Electrical Bonding '
5. Steel Reinforce p .Q y 4- x-6-` D � r-ag,� 47. Rough Plumbing & Pressure Test , _ ._ _ _ .
6._ Electrical UFER Grn sizaB33a$ • - 48. APPROVAL TO COVER-GUNITE- - - - • - .. _ . .. __ _ .
7. Footings - ' S q•a(_ g.L _ 49. Electrical Conduit-Undrqrn . .
8. Foundation. _ - 50. Gas Pipe, ElUndrgrn,Test
9. Water.Pipe-Undrgrn _ _ 51. Backwash Lines, P-Trap. El Undrerri' • "
10. - Structural Floor System 52. APPROVAL TO DECK - -- - -• --- - - -
.11. Property Sewer Line & House Connection 53. Backwash & Receptor-Final -
12. Street Sewer Connection _ 54. Heater & Vent-Final
13. Rough Plumbing 55 -Plumbing System -Final •
14. Rough Electric-Conduit - - -- -56. Electrical-Final . • • ,
15. Rough Electric=Wiring - - - - - - 57. Solar System-Final - - -
16. Rough Heating & Air Conditioning - - - 58. Fencing &.Access Approval
17. Ducts, in Structure, _ - - 59. APPROVED-FOR PLASTERING ,
18. .Ducts, Ventilating • - _
19. Gas Pipe-Rough &Test . • . _ . 60. POOL/SPA SYSTEMS FINAL
20. _Roof Framing , - -
21! Roof Sheathing •' '' • . . - _ '_ - .
221 Frame and Flashing _ __ I _ NOTES: • _ '
23. - Insulation . . . .. _ - ' p
-24. Lathing& Siding _ - . _ . _ _ .._ . , - - - - -
25: Drywall Nailing -. -. . . . "
26. Plaster Brown Coat - - _ ' ' ' , - -. ' . _
, 27. Electrical Power Meter-Final . . - -
28.- Final Electric -- _ . _ _ _ _ - - •
29. Final Heating & Air Conditioning - - _ _ •
30. Final Gas Pipe-Test - - 1 • . _ _ •_ - - , .
. 31: Final Plumbing •
32; Water Service-Final _ _ _ '
33. Gas Service-Final - . . •
34. Solar Domestic-Final .
35. Landscape Sprinkling System _ - -
' 36. Sound Attenuation . _ . . - _ .. - - - .
37. Handicap Regulations • -
38. FINAL STRUCTURE & BUILDING 4_24 -74 b& • '
39. Special Requirements Completed '
40. Electric Release to Edison - -
41. Gas Release to Southern California Gas Co. '
42. CERTIFICATE OF OCCUPANCY - - _ .
No Date - 2
I 4
STRUCTURAL APPROVAL ONLY -
SEPARATE PERMITS ARE .REQUIRED A Y P -A ® U C ] i
FOR ELECTRICAL, PI II '1::;S,
HEATING, VENTiLaTI;" ANDCth' of Costa Mesa BDI1diDgl MA'
REFRIGERATION A'III( er DATA _jG
��'
THESE PLANS MUST BE ON JOB AT ALL TIMET APPROVED®�� /
MAKE NO CHANGES WITHOUT PRIOR APPROVAL IT OF COSTA MESA T,
Penult � � 3 oS OF DEPT.
THIS f\U..'."" :! C',O "PANY PLANNING DEPT.
THE ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL BULUER TO BLDG. DEPT. REG.
! ALL IP;SF"t".I;Ji: �tJ.$IS OF PLANS AND SPECIFICATIONS SHALL NOT BE CONSTRUED
_._ TO BE A PERMIT FOR, OR AN APPROVAL OF, ANY VIOLATION DY
-OF ANY OF THE PROVISION OF THIS CODE. NO PERMIT PRE- MEMO, OP DA 8-�_
I SLIMING TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE NANNM6
FOR BUILD!ifLS '.: `y_ THAT THE PROVISIONS OF THIS CODE SHALL BE VALID, EXCEPT IN SO
! BE EMPLOYED, FAR AS THE WORK OR USE WHICH IT AUTHORIZES IS LAWFUL.
STATE QF F . ...::A 0!iIS!ON OF
INDUSTRIAL SAtL + ;a: .;Q''iSULTED FOR THE ISSUANCE OF A PERMIT BASED UPON PLAN�f AND
ADDITIONAL MU REPENTS. SPECIFICATIONS SHALL NOT PREVENT THE BUILDING�FFICIAL
FROM THEREA c I m.1 _ y,,y
IN SAID PLANS AND SPECIFICATIONS fBOI1/401 rOiiti
BUILDIN 3 OPERATIONS BEING CARRIED CC.' bI4 R UNDF'R WHEN
IN V ELPTIIOON OF THIS CODE OR OF AM bTH,`ORO .yA�CE I1I�I I/`'
ar— ... ....._
t 7 �I
�'
RESIDENCE RESIDENCE RESIDENCE RESIDENCE
I-.
I-.
W W
IY I..
I-
1/I N
2
I
.167
C 0_ /f;//['p / . STREET 6 _
TYPICAL 611 CONCRETE BLOCK FENCE
a . .
Cement Coping Optional — ii �,�• •_�= im�I� GENERAL- NOTES
Channel Block With 1-3/8
0 Horizontal Top of all �.
Fences MORTAR: One Part Plastic Cement, and
Three Parts Sand
For Fences 5'or Less �' '�_','� �I'-f GROUT : One Part Cement Three and
Vert. Bars 3/8" Oat 4' -D"D.c., 0 One Half Parts Stand
cr _ nu COPING:
COPING: One Part Cement, Three
For Fences Higher Than 5' —`� " 0MI
Parts Sand
Vert. Bars 3/8"Oat 32" O.C. > w CONCRETE: Well Mixed 1:2- 1/2 : 3-1/2
ce 2 Max. of 7-1/2 Gallons ct
Fill Cells Solid With Grout 1 `>,Z " '�_' Water Per Sack of Cement
Where Steel Occurs >i- -
.4-
Reinforcing Steel Shall S� f 1 I� ■ GROUT MAY BE POURED FROM THE TOP
Conform to Sec.A-15-39 . — w o - OF THE FENCE IN CELLS WHERE STEEL
CCURS.
A.S.T.M. Z ~ CELLS AND AREAS OF HORIZONTAL REIN-
w n -'� �'-I� FORCEMENT SHALL BE CLEAR,CLEAN&
All Steel to be Lapped UI -- -
FREE OF ALL MORTAR DEBRIS,ETC.
24"or to Code ...---H ' �I. PROVIDE CLEAN-OUT HOLES AT THE OTTOMNO INSPECTION CELLS CON-
TAINING VERTICAL REINFORCEMENT.
NATURAL GRADE �I BONDS SHALL BE PROVIDED BY LAYING
. � ..I _ !iI __= u'
�' BLOCKS IN STRETCHER COURSES SO THAT
,.t:,,in, ," 0 - VERTICAL JOINTS ALTERNATE IN EACH
• ' c COURSE.
TWO 3/8"OBARS
CONTINUOUS TOP
&BOTTOM • WIDTH TO 16' 0 C. MAX.
SEE CHART `
ALL STEEL MUST BE TIED IN I 5 BELOW DEPTH OF EARTHTCOTH
PLACE AT TIME OF TRENCH • I L,1
t . E 1/3 THE HEIGTH OF FENCE
INSPECTION. P' L L. BELOW BOTTOM OF FOOTING.
1„ •
°
lo" Ii2" 2.. SCALE: 1/2" r 1'
FOOTING REQUIREMENTS CHART
WALL HEIGHT 6 ' 5' 4' 3'
WIDTH 14" 14" 12" 12"
THICKNESS 10" 10" 8 " 8
DEPTH OF EARTHTOOTH . . . 24" 20" 16" 12"
SPACING OF EARTHTOOTH. . 12' 14' 16' 16'
L
OWNERS NAME: S �'q1-t)
City of Costa Mesa, California JOBJMITDDRESS:NUMB � �L �"
Building Department SIGNATURE:
I
OWNER BEAUDREAU� KENNETH DATE OCT 2 5 1963
JOB ADDRESS 2861 Tabago Place BUILDING PERMIT NO. 20888 - -
GENERAL CONTRACTOR -Sunset Pools VALUE $ 2,500.00
AP No.139-333-10 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORKPVt• Swim Pool
INSPECTIONS Signature DATE GROUP 3' TYPE V ZONE Rl
Soil SUBCONTRACTOR PERMITS ISSUED
Gas DATE NUMBER
Water
Rough Corn. Refrig. 0 Air Cond. ❑
Rough Heating
Rough Plumbing -Q�•✓ i. -107-ii ze---..�c.c r..--,...g., "O .?✓-c 3 3 9 G /
Miscellaneous L1cz .,_, ,.d / - ' a-lco /7-..70-6.3 3 y,) se" .._
Prop. Swr. Line 0 House Con. St. Swr. ❑ // '
Sprinkling System
Construction Pole
Underground Power 0 al/ 1-, .63
Rough Wiring / w. - -63 -4 tetra .72}-f7 /' 79
Trenches Forms 0 Steel Reinf. n'' 2- c 1
Floor System
Bond Beam La— Steel Reinforce Er-^ . 0//7./ /z-V-G/ _$ V
Sheathing
Frame and Flashing { /
Lathing- In 0 Out 0 /
Plaster, brown coat , ''t vr" / /i�
Refrig.Heating, Air Con, p Final K,l,
Plumn Final
Plumbing Fixtures, Final /4W/ -ere
Final Gas Test -en.. - e
Electric Fixtures, Final ai 2 e 1 '
Building, Final /r -' ii' /
OCCUPANCY
Form BII1tiM-3-63--S-B P HnT.T1 FnR RPReTAT. RF.OTTTPlIMR.NTS onARA
20888 FEE KE�EIVEU
OCT 2 4 1963
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P. O. BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT
BUILDING
/ P BUILDING ‘ '..
ADDRESS cQ/� / �l 4ft.,.l'JO / /Q Ce/
COSTA MESA.
nCA FORNIA For Office Use Only
j. RECEIPT n G ' / M / / reL�/ RECEIPT NO. I P.pRMIT
OWNER �1' C.''�'{/ ALYl� l,.1/ "'/
MAIL RECEI eY D R2GeIVED A I68U
ADDRESS S a�T'1 �( ,(/j'/� /_ het- -43/8 kf 3
CITY 0.-0,S1-4_ / J C'-1 NO{rLQJ'-S2�1 NG
ADDRESS /
ARCHITECT / �5 e�/,/ NoQy,7 S3 7 COSTA MESA. CALIFORNIA
OR ENGINEER AA !I N '
ADDRESS 3�.(o'(U kJ./'/G/II Dd{(TCI y/J�f�CCIJO� ZONE TYPE GROUP de
Sir
3
CONTRACTOR sa' / O a�4 //�J / APPROVED .--, DAT / 4,
ADDRESS/473///�� `wN ? atl <J I✓K ZONING A,///`'/I�/(l,�„
CITY 1)V .'Jd_�-V/ may/• �//,C.[/. ZO ( I PLA/NE,/j� �T/�I BUIE LDIIING,�/�yI /�/�U/ \,{7
LIC.TNO. /sa-3S NO. �O /f / DESCRIPTION , `� ( (J 1 P - `("I/ - U
VE
�/[ I/ ) /I NO. OF BLOCS. I / // I
OF LOT (/� ^ 1.'O NOW ON LOT A.P.NO. 3 7 ??3— I ( ,
USE OFYARDS EVES
EXISTING BLDG. • APPROVED ALLOWED
SETBACK LINE FROM (CENTER LINE ST.)
CENTER OF STREET REAR YARD // `..U'
FRONT (.j FT. IN.
SIDE YARD I LEFT I RIGHT R.SIDE {) FT. IN.
DESCRIPTION OF WORK
L.SIDE ? FT.6 IN.
NEW . I K II ALTERATION I II ADDITION I ' REAR 6 FT. IN. a
REPAIR )1'I ` III/MOVING I II DEMOLISH BPPROVED / A /� ATE/0 ,.� i K 3 Z
8 ZE DING/o(.{�.1 %ACJ✓ NO. OF
ROOMS STORIES //Vil/_,,I�-/6//^V) '
EXTERIOR WALL I ROOF (V�'/ a
COVERING COVERING . o
USE OF BUILDING AND WORK TO BE PERFORMED [
a
U v
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING �y
BUILDING CONSTRUCT N. VALUATION ^LjJ`
SIGNATURE OF L-!.. Pj- 72_y_/J e-� PERMIT FEE $ /9 N 2
PERMITTEF �L /�l QU / o CI
/ ., $ 2 `OOH PLAN CHECK $ (' E U.,
AUTHORIZED AGENT --
1==t
V[ v ,/
® TOTAL FEE $ /!C/JX LL �,
. �Lot 8? 19s s - c , 1 yr
trEt hLb\L-. J L- itt
CSSTA MESA BUILDING-SAFETY DEPARTMENT 6 19B
P. O. BOX SI? COSTA MESA. CALIFORNIA % QR DEM.
FI� �,i.CE �nL 1
For Applicant to Fill In Completely APPLICATIpN(i dk CPfRMITtESN
TYPE OR PRINT
BUILDING
BUILDING cR
ADDRESS -- ''/ ` J.kU(4.y, P1.
COSTA MESA. CALIFORNIA For Office Use Only
Investors Marine Inc. I RECEIPT NO. I 1.3.x'g
OWNER a�
AMAIL DDRESS 1600 W.Coast Hi:hwa RECEIVED BY DwTH IH I^ED. A DATE ISSUED
CITY n Ann.
Newport Beach TEL .-1655 BUILDING - -r4dt-!3 !/O �`•
NO, ADDRESS tr / /
ARCHITECT �.�yP/�fOSTA MESA. CALIF NIA
Same TEL. v�
OR ENGINEER NO.
FIRE / / //n 9
ADDRESS ZONE TYPE V GROUP�IC Y"
CONTRACTOR Mesa Verde Builders, Inc. APPROVED
BY DATE
ADDRESS- 1653 Minnrna Drive ZONING CJS,:,_y -jam
Costa Mesa ZONE NO.OF �- IyUSE OF NEW re,-&-a-
CITY
CJy
CITY - M ' I PLANS 'r'BONDING i
STATEIC. TEL. _0 . LEGAL ' !! Q
NO. r•• NO. I DESCRIPTION —�`�• �'V J ki
A.P.NO.
USE OF YARDS EVES
EXISTING BLDG APPROVED ALLOWED
S ETBACK LINE FROM • I • (CENTER LINE ST.) ,�.. � //�,
CENTER OF Ermarr REAR YARD FRONT 4'OFT. 0 c -O 1 IN.
SIDE YARD I LEFT I I RIGHT 71 R.SIDE 7 FT. IN.
DESCRIPTIONOF WORK
L.SIDE FT. IN.
REAR3°FT. _IN..
REPAIR I II MOVING I Il DEMOLISH I APPROVE /p/
BY n DATE
SI▪ZE ROOMS STORIES
EXTERIOR WALk I I ROOF I:
COCOVERING IX S 61.1.0 COVERING 'IngleI
USE OF BUILDING AND woRK TO ELE.PERFORED. I/0
i
Model "%1 4'es/ v
L_ - tached garage 4.2 Sq.Ft.
I HEREBY ACKNOWI4+GE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT ITNNE A VE IS CORRECT APD AG HE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH AU. C(T11 0 NANCES D STATE.LA REGULATING
BUILDING CONSTRU/DIO1h
. VALUATION
SIGNATURE
diZn. r4
I 9 /,
PERMIITTEF D�'J ` am / I /� $ �/ 4,‘---it?
PLANCHECK $ {/150 a
AUTHORIZED AGENT ',Si) E
TOTAL FEE - .v• u