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Home My WebLink About420 BERNARD ST - Building PermitsAPDlicant lo till In ail s0aees eacept those within heavy Eortler lines ana sl9n a11 apo�eD�iate tleelaratio�s. C17Y OF COSTA MESA - • ' CONSTRUCTION PERMIT _ � . .. ProjectAddress'_ �-'%Z Cl,' "'OS !i 1r "e _ s' Applicant's Maili1n�g Addreu� n'p �'� c� � � Owner'sName +VQNV t-Q N�hone�.��/e-4.o/ 9 Adtlreu o2e� �"� SA:J %eC Sp N A tV �(�E71 Arch/Eng.- . , License No. Adtlress Contractor's Nam Phone Adtlress (meilingl � City License No. . LICENSED CONTRA R D TION � I nCreby affirm that I am li<0 sea unaer provisions of Cnar[er 9(commencing . �+��h section 7000) of Divislon 3 of the gusiness antl Professlons Cotle, antl my license is in full torce anC eHecf. . . U�ense Class Licensa No. Jate Signature WORKERS'COMPENSATION DECLARATION • ' 1 h@reby af8rm lhat I have a certiflcate oi consent ro sali-insure or a tertlficate of Workers' Compensation InSurance, or d cerlifietl cOpy tnereof (Section 36Q0. Lab. C.I ' . . � Poqcy No. Company � BCertitietl copy is hereby tumishea. ; � " . � Certi(letl copy is (iletl with the <ity Builtling Divlsion. Date ' � Applican[ � � E%EMPTION FROM WORKERS' COMPENSATION DECLARATION ' (Thg section neetl no[ De conlpietetl it tha permit Is tor one huntlratl (5300) or less�, I c0rtity tha[ In the Performanca of the worl Qr which this perm�t I5 issuetl, I shall not employ any person in any ma i5o as [o becom � ject to Ihe Workers' Cunpe�cgt'�L}�a ws ot Califor ( v Date � « � �"o�5ignature NOItCE: It,'a(ter making this tleclaration, you sboultl bero e subje<t e Workers' Compenution provislons of the Labor Cotle, you muit for with comply with suc� provisions or t�is permit shall Ee tleemetl revoketl. CONSTRUCTION LENDING�AGENCV -' - ' I hgreby at(irm that there is a conztructlon lentlin9 agency for the performance of the work ior which this permit is Is5ue0 (Section 309] Civ. C.) Loqtler's Nam> � � � L.entler's Atldress OWNER BUILOER DECLARATION - ' " ' I hereby affirm that I am exempt trom the Ctintractor's License Law tBr the following reason (Section 7031.5 Business antl Protessional Cotle: Any city or -o�nty wnich requlres a permi[ lo constru<t, alter, improve, tlemolish or repair ' ny structure, p�lor to its issuance, also requires the applicant for 5u<h permit .o tile a sianetl statement that h¢/she is licenutl oursuant to tM1e o.ovisions of ��31.5 oy. any appucani ior a perm¢ suo�e<cs [be appilcant to a crvu ��ylty of not mor¢ than (ive huntlretl tlollar5 (E500). - Ly�, -az owner of the property or my employees with wages as their sole rompenzation, wi11 do the work, antl the, structura Is mt intentletl or offeretl (or �le (Section 7044, BuSinnss anG Professional Cotle: The Contractor's LiCenSe Law aoes not apply to,an owner ot a properry who builtls or ImOroves thQ�eon, antl who Uoes suc� wo�k'hlm5¢If/he�selt or throu9h his or her own employee5, provitletl that suoh ImprOverpent5 are nOt intentletl or o(feretl�(or sale. It, howover, [he building o� Imp�ovement Is soltl within one year ot cOm- plBtlon, tne owper wlll hav¢ the burtlen of proving h0/she tlitl not builtl o� im- �Ove for the purpose of sale). I, a5 own¢r 01 the property, am exClUz(vely Cont�acting with IlcenS¢tl Con- tractors to mnstruct the project (Settion 7044, Business antl Protessions Cotle: The Contractor`s'License-LSw tloes not appty [o an owner of property who builtls or Impwves tnereon, antl who contracts for such projecls with a con- traclor(5)license pursuant to [he Contractor's License LawJ: • ❑ I am exemp[ untler Section B. & 7. C. for this reason Da�e Owner! I hereby cer[Hy that I have reatl this appllcaUon antl stata that th aEove intormation iz <orrect. I agree lo comply with all tlty antl�county ortlinances and state laws relatlna to builtlino constructlon. antl herebv authorize reore- to �5� -/o d 8' 3 I ` ' "-='' I < � � I TVPEOFCONSTRUCTION� NEW ADD AiTERATION R�PAIR ❑ CONVERSION ❑ DEM1ppLLISH ❑ OT�>HER �OESCRIPTIONOFWORK�yC rBCY /l�� TVPE OF PERMIi GRADING FOUfYDAT10fY STRUCTURAL ❑ TENANT d ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER . PROJECT DESCRIPTION 5(i.PT.� I� �' OCCUPANGy CONSTRVCTION TYPE VALUATION $ ZONE GRADINGCU.VDS. ACRES Remarki: � ) Bar $ink Backflow Preventer ' Backflow irrigation � Bathtubs Clarifiers ' Dishwasher - - Drinking Fountains Floor Drains � � . � Floor Sinks Gas$ervice Outlets ' Interceptor5 _ Kitchen Sink •� Lavatories ' P—Trap Roof Drains Reinspection Fea •, ' $25 Boiler - ' "' Duct - Under Ground � Duct - Structural Duct - Ventilatin9 • Exhaust System ❑ Multiple ❑ Firepl/Fact. BIL ICBO�# Heating System & Ducting � ❑0.100,000 BTU � 100,000 BTI inapecuon purpo c/ S�gnature � _ oate �� % � Reinspection Fee Dr��ers' License or 55 # CMF 0865-46 rev. ]/B3 - White - Builtling; Canary - Applicant; Pink - Actounting; Goltlenrotl - Assessor � $25 Showers Service Sink Sewer Cap Sewer Connection Solar Collectbrs Solar Pipin9 � Solar Tank Swimming Pool w/Spa �Water Closet Water Heatec Water Service �- � Issue Fee . � Hood or' Type I' �� 'Canopy Typ¢ I I ❑ � � Refrigeration System � • � ❑aioo,000eru ❑ioo.000er� Sys[em Repair/AI[eration ' A.P. ;W S Main euiltling: E T Front � Reai _ _ t g L, ` . f. # Parkiilg R `.L ro � Use of Quilding; K �nning Nvtes: ,<J� .�o Ts....n �� , :.� �� Cookin9 Unit Dishwasher Dryers ❑Ga� Fan F.A.U. �7UL. - � � � ( �'.J �'�. ' , r Accessory Park.Fees $ `� !/ ELECTRICAL ' � ' �''+ Transformer ❑ 15-50 KW Suh, �' ❑50+KW i ,i Meter �up to 100 amps ' "':`�� ' Meter ❑over 100 amps . � Device Boxes ' - ' Outlets Switches Garbage Dispoul ' ' Generator �U5 KW � FEES laue Fee ' ' , I $ 3 5KW .�'e'� _ Z O N � N R E . Q I R E N E N �� T S FEES Sub Panel Motors �0�.i HP [)i K- 8 t Inc.Solan�9-15 HP �16-15+ Microwave Pole Light � Range ' . Sign Standing Sections Trash Compactor ' I Reinspection Fee i I gp5 I Issue Fee I $ 3 I PUBLICSERVICESRE�UIREMENTS: , � ' ' 2oninp Approved By � Date ' � Appliwtion Approved By • Date APPlimtion Issued By ,.. i��lJ � . . Datw /� � � . SUM M�ARV �OF� FEES ' T . BUILDING�PERMIT , $ ��t_2.,(2 SMIP $ i S�C� PLAN �CHECK $ PERMIT � � ' PLUM9ING ' � $ �. ISSUANCE � $ • PLAN CHECK $ � ENERGY�P,C. $ ELECTRICAL $ GRADING $ PLAN CHECK $ MICROFILM $ � MECHANICAL . ' $ � TOTAL FEE $ / �- d � PLAN CHECK $ � . CONSTRUCTION AND PLANNING� �- JL & SPA APPROVALS' Permit# � Date Inspector AppROVALS Pe�mit# Date Inspector ' 1. �Te�porarY Electrical Service or Pole �52. Pool & Equipment Location 2., Soil Pipe-Undrgrnd. � � . � . .53. Steel Reinforcement _ . ,. 3. E�ctrical 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, O 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. Root Drains - � 64. Plumbing System - Final .� 14. Rough Plumbing . 65. Electrical-Final 15. Rough Electrical-Conduit -� � " 66. Solar System-Final i 6. 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 OGas ❑Oil •23! Gas Pipe-Rough & Test 72. Underground Flush � L4. Roof� Framing . - - 73. Undergmd. Smrage Tank O Gas ❑ Oil 25. floof Sheathing � . � 74. Overhead Hydro 26. T-Bar Ceiling (Structurall�& Monornat - 75. Dry Chemical 27. Frame and Flashing - 76. Dry Standpipe 28: Lathing &'Siding 77. FIXED SYSTEM FINAL 29. �nsulation - � • • 78. FIRE PREV. FINAL 30. Drywall Nailing � !, _ • , HEALTH 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 Conrlitioning � 35. Final Gas Pipe-Test�, ,, � ' � 36. Hood or Canopy ' . � . ' . � 37. Final Factory Fireplace . � 38. Final Plumbing . � • . 39. Water Service-Final - y 40. Gas Service-Final � � . � - � � � � 41. Solarpomestic-Final . "� , . 42. Backflow Preventer � � 43. Backflow Iriigation ' - � 44. .Landscape Irrigation System ' � ' � - � 45. Sound Attenuation ' . � � 46. Handicap Regulations' , ' � , 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed � . . . . � - 49. Electric Release to Edison � � 50. Gas Release to Southern California Gas Co � � � . 51. CERTIFICATE OF OCCUPANCY _ _ . - No Date ' F QOSTA\IESA � � fRUCT10N PERMIT. AVPlicanl to fill in all spaces exceDt those witnin heavy Eortler IinaS anE Si9n all app�opr(ate Eeclarations. I � • � . � � i P MIT NO. ' � TRACT NO. LOT NO. • BLD . . - - . -' --, - - , � `' _ �'- �oo� �. . _ . : ProjeCt Addre55. � ✓ � n ' L TYPE OF CONSTRUCTION.' NEW A�D ALTERATION REPAIR� — AppliCant'SMaili Add �O��SLC,� �/�S/� ❑ CONVERSION -O DEMOLISH ❑ OTHER � , q,p'�! OWner'S Name �� 7� -�5- Phone' , DESCRIPTION OF WORK , . S Main Bui�ding Address; y�O �+iv9h - . ' TVPEOFPERMIT' '. GRAOING � FOUNDA71oN STRVCTURAL. T Front ' ' Afch/Eng: y licenSE NO. ',❑ TENANT ❑ ELECTRICAI� PLUMBING' � MECHANICAL . B Rear � Address �� '� • � ' � ��❑9THER ' : � - ' ' A . � �'Ys.l�/C/1-�. �S � Qi/ PROJECT DESCRIPTION 5a. FT. � OCCUaANCv � - C Right Contractor's Namr ,/) � P}hone �y�.+ . , . . . , K � Addre55lmailing) � ��`�`r��^� ��'- �_�"' �� -' � CONSTRUCTION TVPE VALUATION $ g Left ' �!� (�/ 9 . ZONE ' GRADING CU. VDS. ACRES p�ng. Ref. #� Ciry License No. / LICENSED CONTRACTOR DECLARATION ' ' Remarks: ' • � � P2rking Req./P�ov' i. hereby'affirm that I am licansetl untlar provisions of Charter 9(commencin9 " with se<tion ]000) of Divislon 3 of lhe Business antl orofesiionz Cotle, antl ' . � � Use of Building: my license is in (ull fofrc an$ e}f �cL � �7��' � - Licen e Ci ` �+ O �icense No. �y�v� ' ' PLUMeING - . FEES P�anning Notes: oate ��`� ignatura �� - ✓VORKERS' COMVENSATION DECLARATION ' I heteby afti�m that I have a ce�tlticate of <Onsent to self-inzure o� a ce�tlficate � of Workerz' Compensatlon Insurante, o� 5"certHiea copy'thereof'(SecHon' 3800, Lab. C.) . �� Policy No.�S�4�935% { Company �a->� � Cer j ptl c py JS �p,withrthehcltY Builtl 9 Divisi .� . . Date /f-/Y'8"S APPlicant � EXEMPTION!FROM WORKERS'�COMPENSATION OECIARATION � (Tnis section neetl not be completetl It fhe permit 6 for one huntlrea ($300) or � lessl. � � � i I certify }hat ln the pertormanca oi the work for.which thls perm�t is �Issuetl, I shalP no[ employ any person in any manner so as t6 becoma subject to the Workars' Compensadon' Laws of CalitorNa.i � �ate � Signature NOTICE:, If, atter making thls tleclaratlpn, you slioultl become subject to the Workers! Compansatlon prbvisions o� the" Labor Cotle; you must forthwith i wmpry with such provl5ions� or thls�;permit shall be�tleemetl, ievokeC. CONSTRVCTION�LENOING AGENCV' ' ' " t I hereby affirm tha[ [here is a�construcBon lentling agency for the performance of the wbrk lor which t�is_permlt.is•Issuetl•(SecHon�:3097 Civ. C.) Lentler'sl Name' Lentle�'s AtltlreSS. OWNER BUILDER DECLARATION - - ' � � 1 hereby,affirm�lhat I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Buslness antl Profe55ional Cotle: Any city or courity which requires a permit to construct, alter, improve, tlemolish or.reoair any st�ucture, prlo� to it5955Uance, also �eqW�as the applicdnt (or Suth permit ao file a signetl statement�tnat he/she is Iicensetl pursuant to the provlsions o! °he Con[ractor's'License Law (Chapter 9(commencing with Sectlon 7000) of �Division 3 of the Business antl Professions Cotle),or that ne/she'Is exempt ,t�eretrom antl the basis for the allegeC exemption. Any violation oC Section 7031:5 by any applicant for a permlt'subjects_[ne applicant co a civil �enalty of not more than five huntlretl tlollars (E500). ' � ' � I; as'owner o( the property or my emPloyees with wages as their sole romnenution. will tlo the work. antl the structure is not Intantletl or ofteretl a o�onertv'wno bWltlso� saie. u, nowever, tne ouumng or improvemen[ is sma wi[nin one year or com- pletion, the owner will have the burtlen of proving he/sha tlltl not builtl or im- . �rova for the pur0ase o( selo). I, as owner of the properry, am ezclusively conlrac[in9 wiN Iicensetl con- tractors to construct the project (Sectlon 7044, Business antl Professions Cotle: The Contractor's License law does not apply to an owner ot property who - builtls or improves tnereon, antl who mntracts tor such oro7ects witn a con- tractor(5)licensa pursuantto the Contractor's License Law). . , ❑�?am exempt untler Sectlon ' B. & P. C. for this reaton Date Owner; . I hereby certity t�at I have reatl tbis application antl state that the aEove intormation is correct. I agrea lo comply with all dty antl county ortlinanres - antl-state laws relating'to bulltling construction, antl hereby auNorize repre- sentatives of'thls city to enter upon the above-mentlonetl property �for I inspectlon purpo5 5. ' . � • Date�� 5� nature Sink Irr.gation I i Drinking Fou Floor Drains� Floor Sinks � Gas Service InterCeptor5, Showers .` Service Sink � � Sewer Cap Sewer Connection� � Solar Collectars �' Solar Piping' � Solar Tank � Swimming Pool w/Spa . � Urinal : ! Kitchen Sink ; ' � � Cavarories � �, -- � P-Trep� �� - �_ � .Roof Drains� � �I�.Reinspection,Fee ; � t$25 eoiler ` Duct�- Under Ground Duct-Structural � Duct-Ventilating � � ExhaustSystem ❑ Multiple�� Firepl/Fact. BIL IC80 # Heating System & Ducting � ❑6100,000 BTU 0100,OOOBTI 9 I I Heinspec[ion Fee . I $25 Drivers'.License or 55 � � CMF 0865-46 rev. 7/83 Wnite Canary - Appliwnt; Pink - Accounqng; Gottlenrotl'- Assessor Water Heaterv � � . laue Fee , Hoodor Typel ❑ � � Canopy Typell' ❑ ' Refrigeration System ❑0.700,OOOBTU ❑100,0008 System Repaii/Alteration laue Fea , 1 ' A�utomatic Washer Construction Pole. �Cooking Unif � `� � D�ishwasher DfYCfS ❑i�id5f' ❑ Fan� � F.A:U. ': ' Fixtures � ' Device Boxes � ' Outlets ' ' �' . . 0 U727'I2/I5/�9 ; Zone Acceuory Building: - - Park:Fees $ • � . . r �h,�li , T:_ ' Z � O N I N G _ R E . ' U � R E ELECTRICAL � ' FEES . Transformer � 15-50 KW. � � � b � ❑ 50,+ KW � � , � � � - Meter ❑up to't00 amps ' ' � ' ' � � .Meter ❑over 100 amps � � � ' lectric Sub Panel� � _ . i � Ina Solar�9�15 'Pole Light � Range . ' Sign Garbage Disposal ' � , Standing Sections � - Generetor �P5 KW OS-15 KW Trash Compactor ' $,3 . � ' Reinspeaion Fee � � . $25 � �uue Fae � ' $ 3 FEES PUBLICSERVICESHEQUIREMENTS: � . � ' � , ' 2oning APProved BY � . Date ' . Application Approved By � Date—j--� Application Issued By � � � Dat�.S . . �SUMMARV OF FEES BUILDING PERMIT . $ ' - SMIP ' $ . PLAN CHECK � $ —� PERMIT PLUMBING , � $ .5 • G v ;ISSUANCE � $ PLAN CHECK � $ ' ENERGV P.C. : $ ELECTRICAL $ • GRADING $ PLANCHECK � $ MICROFILM • $ • MECHANICAL , ; $ ' TOTALFEE $ .rir�- $ 3 PLAN CHECK ' $ . _�'_"�_' ' . . .. ; CONSTRUCTION AND PLANNING - � � PL�-� & SPA , �` APPROVALS Permit # Date Inspector qppROVALS Permit # Date � Inspector 1. Temporary Electriral Service or Pole . 52. Pool & Equipment Location- - . i � 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement "3. Elect.ical 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. APPROVALTO COVER-GUNITE 7: Footings' �.� 58. Electrical Conduit-Undrgrnd._ 8. Foundation � 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. � 60.=Backwash Lines, P-Trap, O 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 WiSing .' ' 67. �Fencing & Access Approval � 17. Rough Wiring Sign � . 68. APPROVED FOR PLASTERING 18. Rough Electrica�-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL � 19. Rough Heating & Air Conditionin9 FIRE DEPT�. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# � 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating ' � 71. Product Piping O Gas ❑ Oil '._^3. Gas Pipe-Rough & Test 72. Underground Flush �- 24. Roof Framing " 73. Undergrnd.StorageTank OGas ❑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. Drywall Nailing � - HEALTH 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 � � C� 36. Hood or Canopy . ' ' 37. Final.Factory Fireplace � ' _ ' � 38. Final Plumbing � � ' � � - 39. Water Service-F.inal '�, 40. Gas Service-Final ' � ' • . 41. Solar pomestic-Final 42. Backflow Preventer , � 43. Backflow Irrigation - _ 44. ,Landsca,pe Irrigation System � - . � 45. Sound Attenuation � � . 46. Handica�p Regulations ' � � 47. FINALSTRUCTURE & BUILDING ' 48. Special Requirements�Completed � � , . 49. Electric Release to Edison �- • 50. Gas Release to Southern California Gas Co ', � 51. CERTIFICATEOFOCCUPANCY . No. Date • � � . ' 221�6 COSTA MESA BUILDINCrSAFFfY DEPARTMENT P.O. BOX 120� COSTA ME9A� CALIFORNIA 92EtD Por AppUcaM ro FOl In ComplN�ly TYPE OR PRINT CO3TA MESA, CALIFORNIA 8TAT2 UeE OP EXI6TIN6 BLDO.� BHTpACK tJN6 fRO� DE4CRIPTIOPI OF WORK ll � f FEE RECEIVE� 1 4 1904 FI�1�(VCE DEPT. CITY OF COSTA MESA MPLIGTION FOR PERMR SUILDINO FOI OHICO UH OIIIj� nic��►r „o. �� r YAROi MPROV CC � MAIN BUIlO1N0 fFROM C/ � rR IiT 11.� ID `�= . L SID l�PT. � RBAR FR. DI@TANC6 B6T. - MAIN BLD06. . VM.�F 1 H6R60Y �CRNOWI.fDOt T11AT.1 MAV6 IWD T111t IVILIGTON AND 8TAT6 T11AT iMt Ap01/�,�D GOAq[G} AND AOII[t TO COY. PLY WITN �LL'CITY OqDINAMCt� A�10 RAT[ lA1M� RiYYtATINO eu�tc�Ho coxernut/T}o/y ��J //// BIONATURL� Or A//7 DO �I /K / n /�//OA wuTHonizco �a�rrr ' f�L(hn.ti�w � . � � / ! BMALL EB L688 THAN YARDBAPPROVHD ACCH880RY BUILDINO � BLT. I ACCB DATB .\ M� � �� G DATi � M Pl / u/ 8 BC. Ff. � n�i �rouxr �Howx uHcen v�tu�noH ie ►oa n�e � ►UNIOC[ O! ifiMY0XIN0 A P6pY1T I66 ONLY. � VALUATION a PBRMIT R68 S � s �✓ C/ w � �� BRADLEY. DALE H. JOB ADDRESS � BUILDING I'ER vai.uE S 72c INE 3 DLSCRIPT[ON OF UP I TYPE �J SUBCONTRACTOR � �y nni I,L