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Home My WebLink About160 23RD ST - Building Permits CITY OF COSTA MESA t BUILDING DIVISION f ogrt F i „�.': � I DEVELOPMENT SERVICES DEPARTMENT PER T NUMBER � � PERMITgttitrvitorso 03-02042 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 160 23RD ST Status: ISSUED Suite: A Applied: 11/25/2003 Vicinity: ROOF - Issued: 11/25/2003 • Parcel Number: 43926102 Zoning: r/ Applicant ELIAS DAVILA ISSUED BY: <� ks� - Address: 19651 EDUCATION LN. Phone: (714)968-6135 HUNTINGTON BEACH,CA Zip: 92646 '. Owner: WINKLE, CHRISTOPHER AND SHANNON ' Address =160 23RD ST Phone: / COSTA MESA,CA'. - " - Zip: 92627-1754 _ , Contractor: E D ROOFING SYSTEMS CO Address: 19651 EDUCATION LN. Phone: (714)968-6135 HUNTINGTON BEACH,CA Zip: 92646 • License: 672009 Arch : Eng: Address: . Address: ' 4 Phone: • _ Phone: Zip: ' License: . License: . - - SCOPE OF PERMIT - TEAR OFF EXISTING ROOF.INSTALL1/2"OSB,30#FELT,30 YEAR PRESTIQUE ASPHALT SHINGLES. 18 SQUARES FOR UNIT A., FEE SUMMARY Plan Check: $0.00 Calc Valuation: $5,185.00 Permit: $125.25 Claim Valuation: $5,185.00 SMIP Res: $0.52 / SMIP Com: $0.00 Other: $0.00 . Inspection: $0.00 ., Total: $125.77 - • - PLANNING &ZONING " SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right - 0-0 PARKING Existing:- 0 . Required: 0 Proposed: 0 NOTES: - 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) il 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 2446.46(6/00) • DECLARATIONS; WORKERS'COMPENSATION DECLARATION: I hereby affirm'finder perttalty of perjury one of the following declarations: ., ❑ 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 perforrnance 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's'/compensation� Insuran�rrier and policy number are: -Cerifer: —�7f /y7 ! PoNoy Number, / 315 ir_(This section fired not be completed A e�t is valued of one hundred dollars($100)or less.) I ❑ 1 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•:come subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these! • I • s. Applicant Signature: _ — 1 dip _— Deter VOW 2c-03 WARNWG:FAICURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDrrON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm.thatI am license under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business aq{)Pralessios Code,and my license is in full foroe antl # effect.Uc.N - 7ji DO ' Class. jjC� Contractor's Signature: _ i.t --�� e)kLC.(IOcie :--,- AJdi/— 2- C - II 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 exempt under Sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers 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 6,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: I 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 ❑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). �.. t....._.._...t__._ _ __.._..l_...._.. 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management antl Prevention Program for acutely hazartlous meterials)7 ❑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 11 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 a ermit for such construction or modification from the South Coast Mr Quality Management District or from any other air pollution control district or agency? Yes j�No (Section 65850.2 of the California Govemment 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 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 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? 0 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 comply 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-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal ner(s) Date 4 " Al ' 1 fA r utAutA horizeeddYYCpppl�i"cant /� `h Date �'� CODE I INSPECTIONTYPF PAIS R4TITI L5 CODE# ptSPECT1ON TYPE P2IF t 1616 Fixed System Final Fire Prevention • 206 Final Mechanical 1266 Pool Spa Final _ ' 208 Final Plumbing 200 Final Re-Roof /Z—iS=01 210 Final Electrical 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 tom ' 9 CITY OF COSTA MESA ' - 4041 BUILDING DIVISION h DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER V els PERMIT J B03-02043 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.r,uuiLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 160 23RD ST Status: ISSUED Suite: B Applied: 11/25/2003 Vicinity: ROOF Issued: 11/25/2003 Parcel Number: 43926102 Zoning: Applicant: ELIAS DAVILA ISSUED BY: Address: 19651 EDUCATION LN. , - Phone: (714)968-6135 • HUNTINGTON BEACH,CA Zip: 92646 • Owner: WINKLE, CHRISTOPHER AND SHANNON Address 160 23RD ST Phone: - -COSTA MESA,CA - - Zip: 92627-1754 Contractor: E D ROOFING SYSTEMS CO Address: 19651 EDUCATION LN. Phone: (714)968-6135 HUNTINGTON BEACH,CA • Zip: 92646 License: 672009 Arch : Eng: Address: - Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF.INSTALL 1/Y OSB,30#FELT,30 YEAR PRESTIQUE ASPHALT SHINGLES.7 SQUARES FOR UNIT B. FEE SUMMARY Plan Check: $0.00 Calc Valuation: 51,400.00 Permit: $50.95 -- Claim Valuation: $1,400.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 • Total: $51.45 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0.0 Left 0-0 Right ci:0" ' PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: 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 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 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 2046-06(WOO) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 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. �J-3 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: p ,CaFde` tG7 1 A/�- /Policy Number. ?y.s 4'- O (This'section neednot be completed if thepermit is valued et one hundred dollars($100)or less.) (�-� ❑ 1 teddy that in the performance of the work for which this permit is issued,1 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,t shall forthwith comply with these pr .Appllc&M Slg'nature: �i �,9 `�'7/J ' (bate: Aid)? 62-,5 a 3 WARMNOTFAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UMAWFUL MD SHALL SUBJECT M EMPLOYER TO CRIMINAL PENALTIES MD CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division lathe and Professions Code,and my license is in full 'foice`and effect.Li&Nc7-�•�_ � h7%049 — [Class It t✓3a/ - 1contractor's signature'` '77'7 90.14-c Moate:— N 1 7Y• • 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: Lenders 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 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 exempt under Sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers 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,faisework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomla 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 CaliforniaHealth 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 Califomla 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 requited,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No .._ ....._._ _.__. _..._ .i_ ._._�.._ .._o 5 Does thee will the coast ou present or n buildingso from at y other for toe work ontch districtis the subject of this U estion aggertnii for such construction or motliflcetion from South Caasi Air Quality Management District or Irom any other air pollution control or agency? LJ Yes L1 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? ❑Yes ❑No (if yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomla Health and Safety Cale). Ar.__ual Quality District _. .__.__ 7 a a permit from the South Coast Air Quacri ed by Heor other airtpollution control district3 or agency is requiredsfor the work which is the subject of this application,have all of the disclosures prescribed by CaliforniaCalfoHealth 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 comply 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-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Legal Owner(s) Date r,--And/Or A orized plicant i Date SgpE-L PISPECTION TIDE PATE lI gggFS INSPECTION TYPE PATE )SLS 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1268 Pool Spa Final �_'` - 208 Final Plumbing 200 Final Re-Roof /— 210 Final Electrical 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 COUNTY OF ORANGE 9A... I UILDING DEPT. Permit No ..... .. 636 No.Broadway ISanta Ana,California Application for Building Permit Phone:Kl 2-6211 - AND FOR A Certificate of Use and Occupancy a / \ Date `� .,,?-! � I 1. OWNER'S NAME.--- ...... .22dn,✓ (2-(6,,,,--4,-,ii) ` i . ��PHOOE: g..C.::x.I N - ..tP.l.6�. VI 1. MAILING ADDRES ... .� p - .2,.t CITY<.lrDD� A, 727,,c...,. Name Pan( V Name (Architect or ka ti a....„..........._ ,' 9`� t ` (Contractor) Address .........................-... Address City • City ..-. State Cute '" Lic. No Phone Lic. No Phone ' ' r PROPOSED USE:--t �1;c:;,4- `a`' c -:C-rxc f l x -i-- 'JJ .--i0 &A, ' _r. 11•-f yy a 2. JOB LOCATION---��..i� i� - .2 3 (House No.) (Name of Street) (Town or School District) 3. LEGAL DESCRIPTION: Lot.-_- f Block Tract 30 Q (Metes and Bounds Description—Use reverse side of form) 4. CORNER LOT ( ) 1NT RIOR LOT ( ✓) a T 69UspH LOT ( ) SLOPE OF LOT ( ) 5. SIZE OF BLDG•.S !'� AREA:.-3 SIZE OF LOT- (n o AREA• I v -2-- 6. 6. HEIGHT OF BLDG 5CEILING HEIGHT• 8 NO. OF STORIES ., 7. NO. FAMILIES ) Size of Smallest Bedroom- Size of Kitchen . . 8. EXTERIOR WALL CONSTRUCTION--Cea'ntE t I o,t'J6 INTERIOR WALL COVERING PLA taT. (Frame, Stucco, Etc.) / (Plaster-Drywall, Etc.) 9. SETBACKS: Front Yard From Center Line of Street LP a r &,t 2 — 6S/ Nearest Side Yard Rear Yard A Distance in Feet Between Bldgs. on Same Lot 1..Q 10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. r, 11. For (a) Footing:' Width 141 Depth in Ground I 2-11 r Accessory Width of Wall � - Bldgs. and I' Similar (b) Size of Studs:..-2 x 4 Spacing l to "CC Material of Floor C6 tt ' Structures: (c) Size of Floor Joists- ? ' to Spacing I b "CC (d) Size of Rafiers• Z o- 4 Spacing 2 q "CC 12. VALUATION OF P O OeSyEDl-�W919C- Including all labor, plumbing, electrical wiring, heating, fire sprinklers, painting and sewage disposal 5 yg- ,---_ _ 13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO. Signed cr - (Owner) Plans Filed -s‘../[..- / ' By' (Authorized Agent) FOR DEPARTMENTAL USE ONLY FEES: 0.0 �a. CHECKING BY Bldg. Permit • $ GROUP APPLICA 10-r 1- .7 HEALTH Plan Check $ �. �� TYPE FIRE COr�' ZONING Total - • / CO DIST. 5/ PLANS AND n�MARSHAL Receipt No. �C .... .7 .,ZMAP......._.... SPEC'S...._ rJ�_ STATE Paid to _Si.)/ SHEET NO CORRE(IiTIOIVS9• ENGINEER Date ,-e*��.1.,,1,t`0 VERIFIE -an"CAL PER ED : : DATE6.2,-;,/,5_7" , e„-z.ai G METES AND BOUNDS DESCItIPt](.. .: 110 30 30 90 • SIO . ,6p NI_INNEN • o - -I' 1 _,_. ............. __ _II Ormlnimr1 IIIIIIIIIIIIII il IIIIIIIIIIIIMII