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Home My WebLink About1303 BAKER ST - Building Permits 4 4` 41114 CITY OF COSTA MESA - BUILDING DIVISION > • ., , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4t —4 r PERMIT 4%ftunto IP J601-01908 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.usNG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDIJob Address: 1303 BAKER ST Status: ISSUED Suite: • Applied: 12/04/2001 Vicinity: WHOLE ROOF Issued: 12/04/2001 Parcel Number: 14119125 Zoning: R3 R3 Applicant: BOWER, DAMIEN __ ,_ __ . ISSUED BY: _ Address: 1303 BAKER ST UNIT B /—7"9' _ - -Phone: (714)850-0611 ---___ COSTA MESA;'CA: �---\I,_, • Zip: 92626 --:----H1----,-::',- ` ' . / / Owner BOWER JOSEPH - 1 A / `. �., A\ Address ,1413 E GROVEMONT ST -• - `,- / : -i t — �i/'�N'V ` ' . , Phone. ,_� -•�,i , �. ��,� .. ,SANTA ANA,CA Zip: 92705 _ '��, \\\,�'C �" ,/ \ � ,,,,,,--.',1,-,- "^ ,,N,, _iii /\�.::. , Contractor: `OWNERBUILDE .-'�--��.�j 7 i'-' �� Address: - /' ' \ ; - Phone:-,-- . • ," �_. 'License:4,0 _ - A / .Arch : - / �, :i'"�.�- Eng: , Address: i� / Address:4 �I r _ _ g .P.hone:- �r .� _ A / _ ", . ,'Zip: �'/ , .-License: _ License: , , :.� •:' SCOPE OF PERMIT /REROOF EXISTING TRIPLEX(30 SO).TEAR OFF,EXISTING ROOFING, INSTALL15#ASTM-FELT UNDERLAYMENT,& • ' REROOF WITH 20 YEAR GAF COMPOSITION SHINGLES. - - •;- ' FEE SUMMARY„, /,Plan Check: $0.00 -- - .-- - /, -Calc Valuation' j, ' _ $4500 00, .Permit: $111.25 ' " - ' - - -Claim Valuation ,/ $4,500.00 ', SMIP-Res: ' $0.50 '' SMIP Corn: - $0.00 - __ - Other: $0.00 Inspection: . '.$0.00 ;?.i � . r` - - y� _ � -, t- ; ",- /'\Total: - -.$111.75', " . • �, ,� n ,:z,. /2/ � � ' V,� , O , a- ' / // �� NomV PLANNING-8i ZONING -----,,,,,i/77- -/, / , / SETBACKS - MAIN STRUCTURE Front / 0-0 Rear 0-0-0 :Left 0-0 '- Right' 0-0 ", ACCESSORY Front 0-0 v ` , Rear 0-0 Left 0-0 - v, Right-.-0-0'1 / 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 2448-46(6/00) f c1, a DECLARATIONS 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. ❑ 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 icared. My workers'compensation Insurance carrier and policy number are: Cartier: r Policy Number: (This section need not be completed it the permit Is valued at one hundred dollars($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 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,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE 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,C00),IN ADDmON 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 that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: 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 subj - ects the applicant to a civil penalty of not more than five hundred dollars($500).): )rel'/ 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 em exempt unider sec. usiness and Professions Code for this reason: Sig ture:• //Lrni i.".......- GDate:_ -19 - ti- 7A�) (Owner ID ve�by driver's license. 0 Yes 0 No ,-Driver's License No. C.—Expires: G'6-0 Z. Verification of Ownership by(type of document,i.e.-property tax bill or deed):�r - l 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 8,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: 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 ❑No (Section 25505 of the California Health end 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 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). 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 en RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? 0 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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes U 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? 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? ❑Yes ❑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. cif-1.4....A..----i.---,--- /tr 4.----•---- /Z- L/ " 7_ Oa/ Signature Of Legal Owner(s) Date LAY Md/Or Authorized Applicant Date CODE t INSPECTION TYPE all N{i1DAI5 POE It INSPEC1I0NTYPt DATE !EMU 1616 Fixed System Final Fire Prevention 206 Final Mechanical • 1266 Pool Spa Final y208 Final Plumbing 200 Final Re-Roof 1` ? 64•461., 210 Final Electrical 201 Final BlocWRetaining 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 'PROJECT ADDRESS: 1303 BAMC$R ST UNIT.: B CITY OF COSTA MESA - BUILDING PERMIT PERM NO: P 047086 OWNER'S NAME: DAMIEN BOWER- . ADDRESS: SAME PERMIT NO: P 047086 PLAN CHECK NO: N ' GOVT: N SUPP : N .. . ' CONSTRUCTION TYPE; PERMIT TYPE: PLU PURPOSE: OTH ARCH/ENGINEER: REO.NO.: JOB DESCRIPTION ; REPIPE GAS SYSTEM SQ FT: ADDRESS: UNIT: • CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 / PERMITTEE: A-1SUP EAIOR PLUMBING CO. ( 714 ) 645-3130 ADDRESS: BOX 1769 COMMENTS: RED TAG REPIPE CM CA 92628 ******************aa+t*****Ba*ar*******al*9E*It**as*at*ae*9rBr9a+tBt+t9a**9t********9a*****9tBtlt**** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS an uc.: fj STATE uc.:4 3 9 9� /$1 n Date:_�fm�/p/_ signature: /rQ /t{�Q. a� MAIN BUILDING ACCESSORY BUILDING G O FART: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN WORKERS' OMPE T NDECLARATION: Ihere affir that l have a certificate of consent to self-insure or acrtificate workers' LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT : FT IN Compensationc died copy thereof Section 3800,Lab. ). POLICY ND.: I- EXP.DATE: 4 /0 3/91 COMPANY: FREMONT PARKING REQ: PROV: PARCEL : 14119125 ZNE: REF NO: Certified copy is hereby furnished. Certified copy is 'ed with the city Budding Division. PLANNING N TES> �(,/� / 11,A— ��r > Pilo M �� Applicant: �./3./�rl /�h � ***************************************it,************************* • *****,, ******* ��Date: EAEM N FRO WO KERS'COMPENSATION DECLARATION: (This section nem not be completed if the permit is for one red MOO)or less). D E V E L O P M E N T S E R V'•rI C E 5" R E Q U I R E M E -N T S 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 .r• subject to the Workers'Compensation Laws of California. ZONING APPROVED BY . 'i •• DATE: Date: signature: BUILDING APPROVED BY : DATE: NOTICE:If,atter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor ' Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. —® i CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: �`�� _ __‘......---'---i- DATE: which this permit is issued(Section 3097.Civ.C). ********************** t. iak ias. ********** * f* ** LENDER: ****************.************** ** **************************************** ADDRESS: - • LEGALIZATION:Y - FEE tUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECT' IC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,Improve,demolish,or PERMIT 4 . 00 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she Is licensed 25% SMIP/NON-RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN _ and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by ISSUE FEE 3 .00 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 BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK - TOTAL PAID DUE ❑ propertystructure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTAL S----> 4 . 0 O 3 • O O 0 , 0 0 7 , 0 0 7 . 00 • . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED : 7 . 00 OVER/SHORT: 00 Improvement ose of sle).• one year of completion,the owner will have the burden of proving he/she did not build or Improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose O1 Sale). , I,as owner of the propertyam exclusively contracting with licensed contractors to construct the project(Section 7044,Business 7 . 00 OO • ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or Improves thereon r and who contracts for such projects with a contractors)license pursuant to the Contractors'State License Law).I am aware *'*****'***'N'***'*'N'*****'***************'if'lf**********'**************'I *****'1E***'**'****** that proof of their Worker's Compensation insurance should be provided to me. IND IV IDUAL F E E BR EAKDOWN ' o I.am exempt under Section: B.8 P.C. , ' for this reason: TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST • Date: Owner: PLU 1. GAS PIPING SYS OF 1 TO 4 OUTLETS 2 . 00 2 . 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 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 111717iiry 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 building construction and by authorize representatives of this city to enter upon the above-mentioned - propery for cT. purposes. Q�� Date: , / signature: km' /04�7 01 00059405-00059405 TOT 7.00 Drive sLitt* •orSocial Security#: .41 ' DATE: 04/24/90 TIfiE: 15:46 164146 V.nite—Building;Green—Cade Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor 1 ! POO SPA • CONSTRUCTION AND PLANNING - ;Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit # 1. Temporary Electrical Service.or Pole- - 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd, - :2: - 53. Steel Reinforcement - =3: EGPctrical Conduit Utility-Undigrndc>> 54. Forms -' 4. Electrical Conddit-Undrgrnd. 55. Electrical Bonding v.5. Steel Reinforcement - _ - 56. Rough Plumbing & Pressure Test • 6. Electrical UFER_Grnd. : 57. APPROVAL TO.COVER-GUNITE .>7. Footings . 58. Electrical Condult-Undrgrnd. 8. Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. - • _ 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System ' "' 61. APPROVAL TO DECK J 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 Plumbing65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final , 16. Rough Electric!Niring - �.- 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 r .- , .-,„ a -APPROVALS Permit # - ~ - 21: Ducts, in'Structufe - = If y 1,70. Underground Hydro `. ' 22:Ducts, Ventilating . ''• .i = X 71. Product.Piping ❑Gas ❑Oil 23.•Gas_Pipe-,Rough & Test• _ " _ ;r _ ; -,72. Underground Flush 24. -Roof Framing ' ; > .' -. :.73. Undergrnd.StorageTank-0Gas 0 Oil 25. Roof Sheathing - v x y _� • x 74-0verhead Hydro: 26. T-Bar Ceilin (Structural) & Monocoat ., - 9 -_ ,c -j A r 75_Dry Chemical s 1 27: Frame and Flashing -- : 76. Dry Standpipe -„ - '28. Lathing & Siding. --, 77c; FIXED SY'TEM.F_INAL. -, , _29. Insulation _, .1 i '" 78._;F.IREPREV. FINAL ,. 30. Drywall Nailing „ 1: c. rK * �oZ p.I EALTHTDEPT. REQUIREMENT 31. Plaster Brown Coat, - '.'T i ? ^79. FINAL INSPECTION • _ -t .. , .. � - r- .'32.-. Electrical Power Meter-Final: n "' , , t'K ,, '80..FOOD CERTIFICATE ISSUED . c., 33: Final Electric _ 'C a f�} •w Notes: 'Z T._ .. 1-, .1 • 34. ,Final Heating•& Air:Conditioning' r - �. ,e " �-' S ;_ - ` ; J. 35.-Final Gas Pipe-Test '-•• if e 'i « _ _ - - _?^ .36. Hood or Canopy • _ r - '` M '37.•Final Factory Fireplace , •. m ' - �_ x -_• '38. Final Plumbing rift* c_ .: " 39. Water Service-Final . ' ' _ -. i. 4 _ ' b - 0. Gas Service-Final - T; ` .i t - ' 14 "41. Solar Domestic-Final" `' n, . , ,_ P. - 42. Backflow Preventer • J - 4 , 'C 43. Backflow Irrigation �.� , - 4 i„ ..44..Landscape Irrigation System= •••!,--•: -- . i r. _ _. _ 1' -- - '45.-Sound Attenuation. .. .. r r ,t . , ., -. 46.-Handicap Regulations - .. , r' _ 1 . 47. FINAL STRUCTURE & BUILDING •; > ' I- 48. FINAL PLANNING ; • , Ir ; _ T t `' 49. Electric Release to Edison " • 50. Gas:Release to Southern California Gas Co ` - -; - • _ - .� . . - - - - . 51. CERTIFICATE OF OCCUPANCY - - - No. Date -v V , . • 899: FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT R / 5-5 c"'` P.O.BOX 317 COSTA MESA, CALIFORNIA ANA CE 1 DEPT. FOR APPLICANT TO FILL /N COMPLETELY APPLICATION COSTA PERMIT TYPE OR PRINT e� BUILDING BUILDING ADDRESS 1303 A. B. C Baker St. COSTA MESA. CALIFORNIA FOR OFF/CE USE ONLY ' I RECEIPT NO. I PERMIT ' OWNER Kendon Homes, Inc. . C///!�9 MAIL 1555 'Placentia, Newport Beach RECEIVED BY TE RECEIV-EyD�` DATE ISSUED ADDRESS ' - .s y, I- P •J 7 I 94../3 -S- CITY Ni 6-3227TNO. BUILDING" ADDRESS • ARCHITECT OR ENGINEER NO. NE same O. COSTA MESA. CALIFORNIA ADDRESS same FIRE, type g'ollp t� f 11ZONE // K. W. Koll Const. Co. STATE 61195 APPROVED �/ CONTRACTOR LIC.NO. BY 4� DATE / O ADDRESS same ZONING LEGAL e1 "Z" 1644. ZONE I NO.OF I USE OF NEW - DESCRIPTION NO. I BLOCK I TRACT PLANS BUILDING J'{/.//� A.P.NO. [� } BYPROV ED /� „� DATE '/ 1!-J SIZE 60 x.130 . I NO.OF SLOGS. 0 YARDS ( EVES OF LOT NOW ON LOT REQUIRED ALLOWED USE OF (CENTER LINE ST.) - EXISTING BLDG. FRONT .4—'0 Fr. IN. SETBACK LINE FROMII CENTER OF STREET A63'-2 REAR YARD 05 R.SIDE SFT. IN. ,SIDE YARD I LEFT 18 I RIGHT 5 L.SIDE CT. IN. DESCRIPTION OF WORK REAR c Cr. IN. NEW I X II ALTERATION I II ADDITION I % REPAIR I II MOVING I II DEMOLISH I S ZIE DING 2710 NO.OF ROOMS 12 STORIES 2 EXTERIOR WAI ftucco I ROOF hot-mop �B 11.• COVERING LL p USE OF BUILDING AND WORK TO BE PERFORMED Tri pl ex re&dance and garage 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 19 FOR THE PLY WITH • CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING TRUCTION. SIGN /t� ,//l ,, / VALUATION PERMITTEE ••/ T YL-Cq, -v PERMIT FEE s 43.00 C// PLAN CHECK $ s 23,060.00 21.50 AUTHORIZED AGENT TOTAL FEE $ 64.50