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HomeMy WebLinkAbout1625 BAKER ST - Building Permits 1111) CITY OF COSTA MESA ,TpMF BUILDING DIVISION fray, FI � I a 77 FAIR DRIVE,COSTA MESA,CA 92626 • (7,14)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us w• ^� FOR INSPECTIONS CALL: (714)754-5626 `"^ tooss PERMIT NUMBER: B11-00152 k/ PERMIT TYPE B_ROOF2 STATUS: ISSUED APN: 13919308 DATE ISSUED: 05/11/2011 ISSUED BY: KJB JOB ADDRESS: 1625 BAKER ST CM • Suite/Unit: Vicinity: Squares: 2800 Valuation: $4,000.00 SCOPE OF WORK: TEAR OFF EXISTING ROOF.REPAIR AND REPLACE SHEATHING AS NECESSARY.COVER WITH 40 YEAR COMP SHINGLES. ROOF PITCH IS 4:12.APPROX 2800 SQ FT. NOTE:RESIDENTIAL RE-ROOF: Final approval of permit shall not be granted until access to dwelling unit(s) is provided for verification of the installation of smoke and carbon monoxide alarms by the City Inspector. See Attachment w/Inspection Card OWNER: COMSTOCK,CHARLES AND ROBIN Address: 1625 BAKER ST Unit: PHONE: 949413-4070 City/State/Zip: COSTA MESA,CA APPLICANT: COMSTOCK,WARREN Address: 1625 BAKER ST Unit: : PHONE: 949-413-4070 City/State/Zip: COSTA MESA,CA CONTRACTOR: OWNER-BUILDER License No. 000000 Address: Unit: PHONE: City/State/Zip: CELL: ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: FEE SUMMARY ••Reroof Plan Check: $0.00 Reroof Permit Fee: $97.25 Reinspection Fee: $0.00 Bldg Std Admin Fund $1.00 TOTAL FEES $98.25 HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010-PER CMMC Sec. 13-279 Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm.Prohibitied all hours-Sundays and the following Federal holidays New Years Day,Memorial Day, Independence Day, Labor Day,Thanksgiving Day and Christmas Day NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE S. INSPECTION TYPE DATE INTITIALS LODES INSPECTION TYPE DATE INTITIAL$ 1616 Fixed System Final Fire Prevention 3 II206 Final Mechanical 1266 Pool Spa Final / 208 Final Plumbing /•r 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 . Final Factory Fire Place .1,- `, 220 Final Planning Approval 203 Final Sign 222 Final Site • 204 Final Demolition 250 Final Building/Occupancy 10. WORKERS'COMPENSATION DECLARAT Owner ID verified by rivers license. ❑Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: ' Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy El I hereby certify that no excavation five(5)or more feet in depth into which a number are: 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 Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This seam need not be completed dthe and is vaWed at one ono ars(Ston)«less.) 2,Art 2,Sec.341,Title 8,California Administrative Code). licy Number: 1n.Jy// 1 0 As owner-builder, I will not employ anyone to do work which would edify that in the pert ante of the Ark for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issu I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to t - irkers' compensation laws of California, and agree that if I should b: one •.'ect to the workers' compensation provisions of Section 3700 of t 4 bor C.• I shall forthwith comply with these provisions. Applicants Signature Dale V _ �` -_-'11 — Division of Industrial Safety Permit Number: [l�-LL HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes ❑No Lic.# Class# (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 Contractor's Signature Dale 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 undred dollars($500).): of the California Health and Safety Code). I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation. WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the fiv -offeierf for sale(Sec77044TBusiness-and-Professions-Code:-The•Contractors—subject-of-this-application,have•all.ol-the.disclosures.prescribed-by.California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes ❑No thereon,and who does such work himself or herself or through his or her own 8. (If yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and CII, as owner of the properly, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupan of an building scced by this permit until final inspection.irliS �/ alurelolLetAldwn4rTs , -+r 3057.46(TIM And/or Authorized Applicant Dale 9TPP Tnhn t 7-12-76 JOB ADDRESS ' 1625 Baker Street BUILDING PERMIT NO. 42267 GENERAL CONTRACTOR Vi J arreal Masonry,Tnc. DESCRIPTION of WORK Blockwall t)AP No. 139-193-08 LOT TRACT FIRE ZONE VALUE $ 2,600.00 RINSPECTIONS Signature Date TYPE V GROUP J ZONE R-1 501E SUBCONTRACTOR PERMITS ISSUED • , ) GAS Date I Number Signatu S WATER Plumbing ROUGH PLUMBING - PROP. SWR. LINE❑ HOUSE CON. 0 c SPRINKLING SYSTEM . ‘‘,MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING . TEMPORARY SERVICE OR POLE UNDERGROUND 0 POWER ❑ ROUGH WIRINGrn �q �r ` Heating and Vent. . TRENCHES 93 FORMS L1 STEEL REINF. go `�/'-) 4/x FLOOR SYSTEM BOND BEAM 0 STEEL REINFORCE in SHEATHING FRAME AND FLASHING LATHING — IN in OUT in PLASTER. BROWN COAT STRUCTURAL, FINAL Electric HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST in ELECTRIC, FINAL BUILDING ocnFINAL oc.C.cue/c t ?/(r )&40 ', e+ '1 eagle nOte. rf/144/R/JiG. OWNER COMESA, INC. • DATE 6-3-59 JOB ADDRESS 1625 Baker St. BUILDING PERMIT NO. 9510 • GENERAL CONTRACTOR pike & Colegrove VALUE $ 15,5(1.0 AP.No. LOT 98 TRACT 2822 FIRE ZONE DESCRIPTION OF WORK ReS.W/att.Gar. INSPECTIONS 49p.532 DATE I GROUP 1 & J TYPE V ZONE H r Underground Soil/pfric U.G. Water/i4+$ 6-/1-,121_ SUBCONTRACTOR PERMITS ISSUED Underground Gas DATE NUMBER Overhead Water and Gas Rough Heating 7 �Jy/_1.a'fr ' nel E-"y_e4). '/.;L/-�9 .2) a. se Rough Plumbing / ^' );.,(-(nti •- -k-.^ / 4-`/-.-C % /%V=t;9 IP t-- + Miscellaneous ' / Prop. Swr.LLine 116(s Con. St. Swr. )/5-4'/17 ., -a . r > alt r)d(, / i A Sprinkling System W' Heating, Final 41fl 9-.22--4-9 A✓5 Plumbing Fixtures ,j �S 9 r- 1Q! Final Gas Test/b - �/�1 _ Construction Pole Underground Power Rough Wiring , /72 /1-5Y->,L ,fez nn.�l/imi-liin, 7-/c•-:5-7 r6 , O TrenchesYIZLForms' SteelC'X"/y-- b// 19'S) Floor System __UU Steel Reinforce Chimney Re-Rod Bond Beam Sheathing Frame and Flashing R#71- 9--3-5'9' Lathing, In Out Fr1ISC. -1P->9 Plaster, brown coat it el,- 9-J--if Plumbing Fixtures, Final /HIS 9--`26--6y Electric Fixtures, Final /75 'o' 3.9Y _ Building, Final fl 10.4• Ice I _ OCCUPANCY I Form 210-3M-4-59 - OWNER REPP, John DATE 4-18-63 JOB ADDRESS 1625 Baker St. BUILDING PERMIT NO. 19307 GENERAL CONTRACTOR Royal Pools VALUE $ 2,500.00 AP No.139_193-0$ LOT TRACT FIRE ZONE DESCRIPTION OF WORK Pvt.Swim Pool INSPECTIONS Signature DATE GROUP J TYPE III ZONE R-1 cv Soil PERMITS ISSUED Gay SUBCONTRACTOR DATE NUMBER Water Rough Corn. Refrig. 0 Air Cond. 0 Rough Heating Rough Plumbin , a—/ j ,gyp Miscellaneous i/r / 3 Prop.Swr.Line ❑ H e Con. ❑ St.Swr. ❑ / Sprinkling System Construction Pole Underground 0 Power El Rough Wiring ec L)-78-G3 Trenches @� Forms 0 Steel Reinf. gie fr„ _,47i-dr.) Floor System I Bond Beam r Steel Reinforce a' 3-1-‘25 �` Sheathing ,�N Frame and Flashing 1j' Lathing — In 0 Out 0 `C�`j' "� Plaster, brown coat �1 � Refrig. 0 Air Cond. 0 Final Heating, Final Plumbing Fixtures, Final a//! /••77-t: Final Gas Test 4fr .- _fear— Electric Fixtures, Final SeA7— \ Building, Final . ✓f�1 J-2 7— L� OCCUPANCY , FORM Rab.5M — 7.61 H(1Tf 'MP PPFY`T AT. P rTITRVMFTPPR la/(17 nib 42267 In 1?_ 75c, 001203'+ ****36.50 • . . COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 For Applicant to Fill in Completely —Use Ink Only L4TI N FOR STRUCTURAL PERMIT 16 5 6 k h' 5---,2r— ADDRESS R E D DLv7E,WIZ� nY`ISSUED� BUILDING ([// IJ (/J'//J /� �(� �J 4 /y7 �Tq��i/r/1^�I� n OWNER , 0H/ RI /� P A.P. NO.I3r —I/ 3—o r �i f-0 / MAIL BUILDING ' 6�ss f e^ 34,_ ADDRETESS ADDRESS gy�lpp.. /(`�' CITY CO c74 m E s A NO. TRACT,Tgli LOT 9.S. BLOCK CONSTRUCTION NEW ADD,ALTER REPAIR MOVING DFMOLJSH LENDER ,`J(`/' BRANCH 34„1,..., k:OWNER ADDRESS hit( / ARCHITECT TEL. 1 ' L4- LcJall A D$fav nir OR ENGINEER NO. FIRE �'/t /� ADDRESS ZONE TYPE 51-GROUP �) CONTRACTOR ViaL4aaggt �1 y ^— BYPR1JIL l //J1 /VJ SIDN2 'BV DATE �( / ADDRESS 9&4/ ,s A. ASS/I/ TEL. 96 NO.OF q USE OF�pL�w/ / CITY 5.44/7-4A A/9- NO•S3h ‘,6 f9 ,i\ I PLANS / BUILD!t .. t wa 1 — STATE C CITY YARDS APPROVED YARDS APPROVED LIC. NO. dy q$ / )/ p Li LIC. NO. /0 zf 3 S` MAIN BUILDING ACCESSORY BUIJQ ING 14 SIZE NO.OF SLOGS. (FROM C/L STREET) �,r//� (jy�. 0. OF LOT NOW ON LOT FRONT FT. Q�t JFT. Q USE OF N EXISTING BLDG. R.SIDE FT. ©FT, CO F Separate permits are required for L.SIDE FT. O}FT. Q electric,plumbing and heating work. REAR FT. �T. ul US BUILDING AND WORK TO BE PERFORMED r F I-m C DISTANCEAINSLOGS. BET. BET.MAIN& ¢� (/�/iQ4G Awe E MAIN BLDGS. ACCESS.BLOCS. VAR.# DATE Q 3D,��;1. C.U.P.# APPROVED _ APPROVE o 7 / CC VA 0 I hereby acknowledge that I have read this application and state r N BC that the above information Is correct and agree to comply with 0. all laws regulating building construction, and I shall not employ m Z any person in violation of the workman's compensation laws of m SW the State of California. ,....�s„ I hereby certify that I am properly licensed as a contractor under V " FT. N //�//�!W�/' the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT E LY: e am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ < and Professions Code, Division 3,Chapter 9. xi athAe — m PLAN CHECK $ ^ Signature of o Permittee i - 'r/ , s tyr-- TAX $ -a u. 2 satyr-- ST U Authorized Agent ',LSD— , Q V _ ` TOTAL PAID $ �7L,S . 9510 .W :tr Q�.: . �_ . eve JUN 3 1969 COSTA MESA BUILDING-SAFETY DEPARTMENT 7 •r;1lnr `1r-pi P.O.BOX 317 COSTA MESA. CALIFORNIA C:. FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING ADDRESS 1625 Baker St. COSTA MESA. CALIFORNIA MR OFFICE USE ONLY RECEIPT NO. I F�@MSIT j O OWNER Comesa, Inc. CV MAIL 419 E( . 17th St. RECEIVED. /RATE RECEIVED DATE ISSUED ADDRESS -- li--og -.,. / I --_J _5 ,./'v CITY GOs ' Mesa TNLO.LI81159 BUILDING ADDRESS ARCHITECT Carlson & LIC. OR ENGINEER NO. COSTA MESA, CALIFORNIA Middle brook FIRE T �/ _ / (�/ ADDRESS rnrd.an Grove ZONE Type Group 7-J\,J tae ,Q� Cole rove Inc. STATE 167293 APPROVED CONMhL`fOR ,'l g LIC.NO. BY DATE ADDRESS a9 E. 17th St. , Costa Mesa ZONING LEGAL LOT �npn�2 ZONE �/] NO.OP USE OP NEW �J� DESCRIPTION I NO. 98 I BLOCK I TRACT /?i I PLANS I BUILDING /• /22,e A.P.NO. APPROVED ley5/42 DATE (e/>JO SIZE I OF LOT 60 R 103 No,OF BLOCS. �7 EVES NOW ON LOT non REQUIRED ALLOWED USE OF (CENTER LINE STA EXISTING BLDG. •).- FRONT (/ FT. IN. SETBACK LINE FROM CENTER OF STREET AAI REAR YARD I R.SIDE �-. FT. IN. • •SIDE YARD I LEFT 51; IRIGHT 51 • L.SIDE 3--- FT. IN. DESCRIPTION OF WORK 4q REAR /. 6 FT. IN. NEW I p ALTERATIONI II ADDITION I REPAIR I II MOVING I II DEMOLISH I BUILDING 1560 NO.OF ROOMS 7 STORIES 1 EXTERIOR WA L I ROOF COVERING St11CCn COVERING Shirt ]„A USE OF BUILDING AND WORK TO BE PERFORME Single family residence with attached double garage. Plan 120 B R I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUCTION.�^� VALUATION SIGNATURE OF„,19e/ PERMIT FEE $ 36 00 I PERMITTEE OF„, ff ``�� �t� PLAN CHECK $ 18.00 AUTHORIZED AGENT De / rOve,oInc $ 15,571 TOTAL FEE S 54.°C) 19307 FE 6 ��Id� ® J 911 1s 1963 CPSTA 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 BUILDING ^�1 /�/�'J1 For Office Use Only ADDRESS a G( S -/ k/4 RECEIPT NO. PER. I��.O COSTA MESA. CALIFORNIA J C4920/ RE D2�yT/yR�[yC1[I /fG 3 : OWNER O• ///!/ G6 �/ -3 4i% BUILDINGitt/ 2 ' ADDRESS MAILADDRES8 //p S" T / FIRE I �.,�tt ry��' /� TEL. ZONE TYPE 1 GROUP CITY t (i0./ ./� V NO. ARCHITECT /�/ � -` 1 �EL BYPROV DATE // OR ARCHITECT ER.w_td.1'-�V O 7 �� �� ) n ZONING /1�`',(, bMt/ ADDRESS g7 D ..'b'"A/a.LLGII/ �OLLPTJ•E� ZN� _ (I KO.OF PUNS y' I BUILDINGUSE BWV • CONTRACTOR ���i�/ .AP /i r (I �J I LEGAL . DESCRIPTION ♦ /AC -I t ADDRESS n 7d -G..f-p-.�.Ei -�A1 ,/e ) ^ , A.P.NO. —o V CITY.--' �'(�jti/ / NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE n �1 �1 TEL 90'TO SIDE 8 REAR p.L. LIC.NO.I7 37rK Ol NO. .!����� U.' EAVES SIZE // No.Op BLDGB. ALLOWED (U.B.C.REQUIREMENT) C OF LOT k'7 ® xOW ON LOT YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING 'a EXISTING BLDG. a (FROM C/L STREET) C W SETBACK LINE PROM • FRONT FT. FT. Ce CENTER OP STREET REAR YARD L r ". 4 ',,YARD I LEFT I •RIGHT S R.SIDE FT. !lam FT• wt d �D/ESSCCRIPTION OF WORK L.SIDE FT. ILLI NEW ! ALTERATION ADDITION REAR FT. 14: DISTANCE BET. BET.MAIN S C REPAIR MOVING DEMOLISH MAIN BLOCS. ACCESS.BLDGB. U. - VAR.# DATE C SIZE ./.6.--X 3(]ROOMS '� STORIES C.U.P.# APPROVED ///NO.OF '3 EXTERIOR WALL ROOF �. APPROVED tap D J / / -/ T COVERING �- I COVERING BY `l I/ C7 USE OF BUILDING AND WORK TO BE PER RMED 01/7 N SQ.FT. I HEREBY ACKNOWLEDGE THAT AVE READ dip L�II([CCAATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOV- ORRECT AN PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDI� AND BT, E EO TING BUILDING CONSTRUCTI•- 1 VALUATION A p PERMIT FEE /f/ N SIGNATURE OF L^I — C PERMITTEE Ham ' $ 4so l _ T - Y V is, Eo AUTHORIZED AGEC. /1( • TOTAL FEE $ O