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HomeMy WebLinkAbout2505 ELDEN AVE - Building Permits ADDRESS OF BUILDING: 2505 ELDEN AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT OWNERS NAMEIPIOIOWN: VON HERZEN, KURT PERM NO: E 07481 ADDBE& SHEARER, RHONDA A 2505 ELDEN AVE PERMIT NO: E 074819 PLAN CHECK NO: N GOVT: N SUPP: N CAPLS § ,CA 92627642-3287 • CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: ALT ARCHOECT ORENGNEER: UC.NO.: JOB DESCRIPTION : INSTALL NEW FAU UNIT /ELECTRICAL SQ FT: ARCH.OR ENG.'S ADDRESS: UNIT: CLAIM VALUE: , CALC—VALUE: GROUP OCC: R-3 /M-1 CONTRACTORS NAME: • ) • CONTRACTORS MAIUNG COMMENTS : INSTALLATION OF . NEW FURNACE/ ELECTRICAL FOR RELATED WORK M-74818 ADDRESS: LK.NO.: ******#****** *****#************************* E**********#*+E******************** UNIT: ZONING REQUIREMENTS ' LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally of perjury that I am licensed under provisions of Chapter 9 S0 E T B A C K SS (commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect. . CITY LIC.NO.: UC.CLASS: UC.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING Date ContractorFRNT: FT IN REAR: FT • IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penty Of perjury that I am exempt from the Contractors License Law for the following reason(Section 7031.5 Business and Professions Code:Any city or county whichrequires a perms to construct,atter.improve. PARKING REQPROV: PARCEL: 43917140 Z NE: REF NO: • 'modish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she : licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the PLANNING NOTES> sines,and Professions Code]or that he or she is exempt therefrom end the basis for the'albged exemption.My violation of Section > ' 7031.5 by any applicant for epermit subjects the applicant toecivil penalty of not more than/rve hundred dollars(55001) ***.**************************************************************************** 0 I,as owner of the properly or my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered for sale(Section 7044,Business and Professions Code:The Contractor,License Law does not apply to an owner of properly DEVELOPMENT SERVICES REQUIREMENTS who builds or inproves thereon.and who does such work Ivmff CPT ser herself or through he or her own employees,provided such improvements are not intended or offered for sale.II, the building or improvement is sold within one year el completion,the ZONING APPROVED BY DATE: owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale). OI.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section7044,Business and BUILDING APPROVED B Y Professions Code:The Contrmors License Law does not to an owner d who builds cc improves thereon end who — " DATE: contracts for such projects a commdor(s)licensed pursuant to the Contract e : _ ❑ lemexa un r B.a P.C.,for this n: APPLICATION ISSUED BY: r' DATE: I�'ZJ �r �� Dae: owner: // 21/ /. *********************.********************** - **********DATE: /0--' E*A***** Ido hereby candy that am aware d and understand the requirements o California Health end Sal,: Code sections 25505."ASaT,and LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N 25534,end that I or any future building occupant will/will not(circle one)need to comply with said a codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction appicmions are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 29 .0 0 • Date: v Applicant: 50% • SMIP/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: PLAN 0 I have and will maintaina certificate of consent to self-insure for workers'compensation,as provided for by Section 3700 of the Labor ISSUE FEE 15 .00 Code,fortheperfonnanceotheworkfowk<hthispenniisissued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ lhave and witmaintain workers'compensation insurance.asrequired bySedicn3100ofthe LaborCode.for the perlormanceofthe TOTALS----> 29 .00 15 .00 0 . 00 44 , 00 44 .00 ,00 work for which this permit is issued.My workers'compensation insurance carrier end policy number are: ' Carden REVENUE DIVISION TOTALS--> COLLECTED: 44. 00 OVER/SHORT: . 00 Policy Number BLDG PMT- PLUMBING ELECTRIC - MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK ,/h/s section need nor be completed a rhe prank is for one hundred dollars($100)Of less.) 4 4 . 0 0 I candy that in the perform; .of the work for which this permit is issued.1 shall not employ: y •.raon in any manner so as to "" become subj.. to the . •,rs'compensation laws o California,and -.rse . '• I . - abject to the workers' . compe0sgtio .rovisions Sectbn3100 of the Labor Code,I she) h..7 'h t,-, provisions. ****#*#***##*******#****#*****E*##**##*A#*********E*A**A*AA*****#***#T#**#*##*# �Q / ./i INDIVIDUAL F E E BREAKDOWN Date: Applicant / i //J._� Warning: -Slunslos. WO workers'compsruetloneovergrylsunlawful.end shall subject an I . tocdMnslpansltlsaand TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines rig to one hundred thousand dollars($100,000),In addition to the coat of compensa n damages as provided ler In Section 3706 oI the Labor Code,Interest,and attorney's len . ELE fj' 1 FIXTURES LIGHTING 1 ST 20 EA. - 75 . 75 • CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction lending agency for the ELE — 2 RECEPT/OUTLET 1 ST 20 EA. . 75 1 . 50 pedonmance of the work for which this permit is issued(Section 3097.Ca.C). ELE 1 RECEPT/SWITCH 1 ST 20 EA. . 75 , 75 LENDER'S NAME: / LENDER'S ADDRESS: ELE 1 .. SERVICES BELOW 600 V 6 BELOW 201 AMP 18 . 50 - 18 . 50 I certify that l have read this application and Ycorrect.ate that the above information iscorrectcity.I agree to comply with allty and county ordinances ELE 1 MOTOR/POWR APPARATUS 1 . 1 — 10.0 HP 7. 50 7. 50 and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property END OF FEES for inspection purposes. 4. ........... ' / / KURT VON • / .� • ild�4// Print / • v// Elate://f4< Signature of Owner t/Appli t/Contractor `\5151-46AP) White-Building a Safety:Green-File:Canary-Appicant:Pink-Revenue:Goldenrod-Assessor - f ADDRESS Of BUILDING: UNT: awxERswLMEIR ImowN: 2505 ELDEN AV • CITY OF COSTA MESA — BUILDING PERMIT Blp" r eaEIpnwSS VON HERZEN, KURT PERM NO: P 074820 SHEARER, RHONDA A 2505 ELDEN AVE PERMIT NO: P 074820 PLAN CHECK NO: N GOVT: N SUPP: N CTS .A,CA 92627642-3287 CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: REP ARcxOECT on,ENGINEER: UC.NO.: JOB DESCRIPTION : REPAIR/ REPIPE WATER SERVICE SQ FT: ARCH.OR ENG'5 ADDRESS: WIT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /M-1 CONTRACTORS NAME: CaNIRACTORSMNIDM COMMENTS: WATER AND GAS SERVICE INSIDE / NO BUILDING PERMIT REFERENCE ADDRESS: LIC.ND.: ***kiEdE*4BE*1E#iE***iFBkif*iE1EiE1FiE#iE**iEdEBEdE*dEBEkEiE*iEBEkE#SEkEkE*iEkkkiElELEiE*BEiE1EiFkEiEiEikkEiE#kE1EBEBEdE******db GMT: ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter B - SETBACKS (commenting with Section 7000)of Division 3 of the Business end Professions Code,and my license is In full force and ended. CITY LIC.No.: UC.CLASS: UC.No.: EXP : MAIN BUILDING ACCESSORY BUILDING Date: Contractor: FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN • LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby elfin under penalty of perjury that I am exempt from the Contractors License Law lor the following reason(Section 7031.5 Basilan and Professions Code:Any city or county whits requires a permit to construct,alter,Improve, hmd'ch,orrepsi anyato a prior to is issuance,also requires the applicant for such permit to file a signed statement that he or she PARKING REQ• PROV: PARCEL: 43917140 ZNE: REF NO: licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commenting with Section 7000)of DNhfon 3 of the PLANNING NOTES> 1. dusinesa and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section > i 7031.5 by any applicant fora permit subjects the applicant to a evil penalty of not more than fire hundred dollars[5500)). I,asowner ofthe oremployees wages ads compensation, iE1E1E#kEtEkEkE#kE4EiEif#iElE1ElE1ElEiE1E****iE1E1E#If1EiEiE1EiE1E1EiE1EiE1ElEiflfiEiEiEiE1E****iEiEihlEiElElEiEiElEiEiE#iEiE1E1EiflElEiEiE*** ❑ property my eg will do the work,and the structure is not intended or Mend for sale(Section 7044,Business and Professions Code:The Contractors License Law Bros not applyan owner of propend DEVELOPMENT S ER V I C E S(^' REQUIR EMENTS who Wide or improves thereon,and who does such work er,himselfb herself or through he or her own employees,provided that such imno+emente are not intended or offered for sale.II,however,the building or Improvement is sold within one year d completion,the owner-builder will have the bunion d proving he or she did not build or improve for the rows.Of sale). ZONING APPROVED BY i . DATE: ® I,as owner of the propend.*n exdeivehy contractbg with licensed contractors to construct the project(Section 7044.Duskiest end Professions Code:The Contractors License Law does not appy to an owner d property who builds or improves thereon and who BUILDING APPROVED BY : I. DATE: contracts for such projects with a caerwor(s)licensed pursuant to the Contractors License ). _ ❑ lame/p(�^q y/ B.APC..rorthis : APPLICATION ISSUED BY: DATE: 40-25' Date: 4J Owner iEifi@lfiki@iE1EiE#iEiEiEiEiEiE1EiE1EiEiE9E#9E1E1E1E1E##IE****#1fiE1ElEiflEifiEifiE iEiE#ifiEiliEifiElEiEiEiEiE1E iE#if141EiF 11iE1f I do hereby certify that em aware d and understand the requirements of CaliforniaHealth end Sal Sections 25505.?ASmk,and LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N 25534,and UW I or any future building occupant will/wit not(circle one)need to corn*with said codas and the requirements la a permit construction or modification Ai OuaktyMenagement District.Residential construction exempt from then BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 26 . 00 Dale: Applicant: 25% SM I P/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby eft wider penalty of perjury one of the loolbwing dedastions: PLAN ❑ I have and wmanof nanacertificate «wsnt to sell-insure for workers'compensation.n providedby tiforSection3700 of the Labor ISSUE FEE 20 .00 i Code.for the performanceoftheworkforwchthispanneisissued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ I have and veil maintab workers'compensation insurance,as required by Section 3700 of the Labor Cade.tor the pedormence d the TOTALS----> 26 . 00 20 .00 0 .00 46 . 00 46 . 00 .00 work for which this permit u issued.My woken'compensation insurance center and policy number ice: Ceder: REVENUE DIVISION TOTALS--> COLLECTED : 46 .00 OVER/SHORT: .00 Policy Number BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK (This section need not be completed I the permit is for One lusted dotter.(5700/or lest) 46 . 00 certify that in the •' Ibecome subject to the wo.ta'tion laws of Caftans,and thatfor which this pennit is issued,I shedl w employ any 4 *!M anner so as to to the waken' compensation 300 d the Labor Cob.l shell lm mm I:. � ****************w*****************************************************sese****1E*if Data: In 're., Applicant: i ( INDIVIDUAL F E E BREAKDOWN Warning:Fan to*nu workers'compensation coverage Is un/aMu(and shall*Weer an employer admnalpenarees and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines te to one hundred thousand dollars(5100,000A M wWlnon to the cost of compensation, as provided for In Section 3706 of tie Labor Code,Interest and attaomey's fns CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty or perjury that there is a construction lending agency for the PLU 1 WASH BASIN 7 .00 7 .00 mdmnanmdthe work for skid,the Fermi iissed(Swion3097,Ci,.C). PLU 1 WATER HEATER AND/OR VENT 7 . 00 7 . 00 LENDER'S NAME: PLU 1 WATER SERVICE ,4-51j& 7 .00 LENDER'S ADDRESS: PLU 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 5 5 .00 I certifylha l have reed thisappfration and state that the above ********L **isconw.I apnea to%t wth at dry and- d county ordinator END OF FEES end sore bora relating to buldmg con*uction end h reby ehnhorie represerhtelivea dthis city to coker upm the above-mentioned property for inspection purposes. KU:T ON HERZEN // OCT 2 51993 ' / .///N/ Dice: //C.t] av Signature of eh'a/ Appfimnt/Contrwor CITY OF COSTA MESA 51 d0.WP) Whte-Ouidkg A Safety:GrnmFle:Canary-Appicant:Pink-Revenue:Goldenrod-Avessa il J i ONSTRUCTION AND PLANNING x POO SPA \\ • APPROVALS Permit# Date Inspector APPROVALS - Permit # Date Inspector \, v 1 Temporary Electrical Service or Pole ' 52. Pool & Equipment Location • , ` 2. Soiipe-Undrgrnd. 53. Steel Reinforcement /' c• . _ ; tegirical Conduit Utility-Undrgrnd. , - 54. Forms . . 0_,.•.--,-, ~Electrical Conduit-Undrgrnd. 55. Electrical Bonding - - , ,. ;Vali& Reinforcement 56. Rough Plumbing & Pressure Test �•6. Electrical LIFER Grnd. 57: APPROVAL TO COVER-GUNITE ' `IIS�T. pOtings 58. Electrical Conduit-Undrgrnd. ' 9•.i-ii . dation 59. Gas Pipe, 0 Undrgrnd.,Test '94Wateea,r Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, 0 Undrgrnd. ;.i 10. Structural Floor System 61. APPROVAL TO DECK r 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final, . 12. Sewer Cap - 63. Heater & Vent-Final ' c� 13. Roof Drains •• ' • 64. Plumbing System • Final ,.... 14. Rough Plumbing . 65. Electrical-Final ;r-s 15. Rough Electrical-Conduit 0- - 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. rOugtc,Fa ory7irlprace c^ ex • 7:•• 71 . ••PPR�]V/ SiS."CPeeAit# x -•_j 21. Oucts;in $tructire:,., i •• . - a H» 70. 14h1derg1.unif Hyt_to s 22. Ducts-VeflfHating ^' ' C'•• a' •• Q1 771. Product:flip-ihg I Lias O�OiI 23. Gays Pipe- u ,hj& 'Test �' tr e -t* Underground1 `'' _ 9 C' • r c, O. -72. Flush) :k . -44 24. Rdof:Framing - 'Q* ' I- a = •' ,73mUndergrnd Storgt .D 'ankGas ❑61` - i-,4 ! -rt W '7 < 25. Roof Sheathin y �a' .'v* I. tun y ^" 9 _ P N 74!�verhead HydroC a 26. Bar.Cei T- ling (Strueiiral) & M&pGat * ,..I C' 75 Dry Chemical �,� t -4--.7:� 27. F,rameandd.Flashing�* '� ` r.1 .A . 'pip J=--` u : .ter -r, .� t Y m* 76. Dry Stanaprpe r<n� t: xm -28. Lathititj&tSiding c"' -1 tc * F S' 1 774 FIXED y,3TE:1 1NAL.Lt - - <-- n r,m r-, ,"1 8. 1 I r. r7 29. •Insulation �'* ` .-7 . rh 't 78TE-IRE PR EV. FIN, , i > r, ;-a; "S `• .. 4 '- ..•1 -•e. f‘;.:130. Drywall Najling hT Y; 1 -4. so o f,_ALTH;"DEPT#REOUIRENTEpti .-.♦ K 1 I r m 1 .r •1:• X31. Plaster Brewn Cpatnr S , IT x I Iq 79t FINALTriaeECTII V a < n: _ ae---•-- 32. Electrical Abwad Mete*-F)nal W N I •' T$O OOD CERTIFIp/CTE ISSUED ; G --33. FZaltaleckcic -.1j; n1 I v. '1 ,: • Notes: -jt:j w 1 1.-. rr .134. Final:Neating&1Air"Cbnditioningc x• * s S n:z• c S _ r:- 44. -.4. T. - n. T11- to m * > • : V H ,r., t' M 35. Fral Gas Pipe'j•'.est,- 0.- „ - ; k I ' N S "• r• .r36. Noodjor Canopy - " r-- n r- r. I F • r Kt:: r rn -- c nx n < Ir IT; t .44.MA ''j37. Final tpr $ r•7.. 1 SIT. 4' n r: ..Y � rY1 .. 1•, R ?ac Y Fireplace E_.LT < r s O:_ x-38. Final Plumbing 1-*r... -2.-: l(�Itl_ S V •r c' c- �v 1-, t> t --39. Water$ervice-Finale . I c it (: -.t1 x .. - :40. Gas Service-Final oTf . , <R-r•tr. S -, • »: "D^. C. -: 1' v* /l 4_t_ rr 0<, X: C 441. Solar Domestic-Finaj* `-• r' x - 4 - - '1- 42. Backflow Preventerz p1 . Ir _ -' _r r,: Y " x r:1 'rlrs t ,- .. LCT 6:S'S * :K ti- r1 .J - - � J r•, - 43. Backf low Irrigation t., > x 1,l, _ _4 .,, ... r t'. r_ .. - ti . LandscapeUrripatio7Aystem ^:r1S ^ s M - 7 ^) 1V 117 tz t C.. . :. - - D -,- -n * <r es't. `e 7 .1 (1 r _- •P.•t 45. Sound Attpnuatiori' M�� r k £ F x ` _pif r, mc: _ 46. HandicapReglitatiojsv .-, -, - >r =C 5 •c. '- r al,r1• __ S .. r v' , -Ty A• T r. . :r 47. F1NAt'STRUGT'URE1*,& BUIL5ING * I ', •* `1 '' * y¢� 48. FINAI.PLANNING A. I E-1 i"••• t n: I ; 'iy 71 m -t = C.; •` + • 49. Etectric Releaskito Edison y ' ' r m ' 50 Gas Release to•Southern California Gas Co I I lip o i I- _ = 5l,; CERTIFICATE OF OCCUPANCY _ a- r 5 C) rnr No. Date ADDRESS OF WILDING 2505 ELDEN AV we: CITY OF COSTA MESA — BUILDING PERMIT OWNER'S NAMEIF10lOWN: VON HERZEN, KURT / PERM NO: M 074818 ADDRESS: SHEARER, RHONDA A 2505 ELDEN AVE PERMIT NO: M 074818 PLAN CHECK NO: N GOVT: N SUPP : N CA9PtLl UggsA,CA 92627642-3287 CONSTRUCTION TYPE: V—N PERMIT TYPE: MEC PURPOSE: ALT ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : INSTALL NEW FAU UNITIN ATTIC SQ FT: ARCH.OR ENG.'S ADDRESS: UNT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /M-1 CONTRACTORS NAME: CONTRACTOR'S MUM COMMENTS: INSTALLATION OF NEW FURNACE ADDRESS: UC.NO.: dEiEdEdElEdEiEdEiEiE*1E*iE1Fk1EIE1E**#*iEdE*1FdE1E*iF#*SE1E9E1E*1ElE*1ElFlElfiERE1EIFIE*#*iE#iFdEiElESEdEfEdE1E1E1H1EdE1ElbdFdEiE1E1E1EdE*iE WIT: ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I em licensed under provisions of Chapter 9 SETBACKS (commencing with Section 7000)of Division 3 of the Business and Professions Code.and my license is in full forte and effect. cfTV UC.No.: LIC.CLASS: LIC.No.: EXP : MAIN BUILDING ACCESSORY BUILDING Date: Contractor: FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I eon exempt from the Contractors License Law for the following reason(Section 7031.5 Business and Profession Code:Any cfy or county which requires a permit to construct.altet,improve. emolish,orrepai any structure,pndn b its issuance.also requires the applicant for such permit to file a signed statement that he or she PARKING REQ: PROV: PARCEL: 43917140 ZNE: REF NO: licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING NOTES> 4ti .rusiness and Professions Code]or that he or she is exempt therefrom and the bilis for the alleged exemption.Any violation of Section > 7031.5 by any applicant fore permit subjects the applicant to a civil penalty of nor more than Tee hundred dollars]5500]1. ❑ las owner.)the propenYorcoy employees with wages eslhei sole comperaation,wit do the work,and the structure ens intended ************************************k4***************************************** or offered for sale(Section 7044.Business and Professions Code:The ContracorsLcense Law does not apply lo an owner of property DEVELOPMENT S E R'.V ICES R E Q U I R E M E N T S who bolds or inproves thereon.and who does such work himself or henel or through hs or her own employees,provided that such r� improvements are notintended or offered for sale.I,however.the building or improvement is sold within one year of L dcompletion,the f DATE: X caner-bugler will have the burden proving he or she didnd build or improve for the purpose d sale). ZONING APPROVED B Y I,as owner of the properly.ern exclusAdy contracts;with licensed contractors to construct the project(Section 7044.Business and /...,,in pp Professions Code:The Contractors License Law does not awry to an owner of property who builds or improves thereon and who BUILDING APPROVED BY : .1:4;e_ , DATE: contracts for such proj s with a radials)licensed pursuant to the Contractors License _ e) �j� (�. ❑ lam exempt B.BP.C..for Nn �^ �� / ' O-27 —9S /gyp/pre/� ` ! I APPLICATION ISSUED BY: - DATE: Date: — 26 9,C Ovmer: .****..iF.. ....E.E.E.E.E.E.FTElhi....E.E.E.E..ETF.E....E#...........E..F1E' - fEiFifiFiEiEiEiEiEiEiEiEiFiFiEififififiE#iF1EiFiFiE Ido hereby certify munderstand o at I am aw e of and uerstand the requirements California Health and Sal ode Sections 35505,25533,and LEGALIZATION:N F E E SUM MARY STRUCTURAL SEGMENT:N 25534.end that I or any future building occupant will/will not(circle one)need to comply with said a codes end the requirements ler a permit for or modification from the Ar rmilyananegement District.Residential mWrud applications ate from BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 21 . 0 0 Date:_. . Applicant: 2 5% S M I P/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following declarations: PLAN ❑ I have and will maintain a certificate of meant to self-insure for wisdom'compensation.as Pr370 Provided for by Section 0 of the labor ISSUE FEE 15 . 00 rm Code,for the performance of n theworkforwahthispermiisissued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ I have and wil maintain wakes'compensation insurance.as required by Section 37C0 ol the Labor Code.for the perforrnance of the TOTALS----> 21 .00 15 .00 0 .00 36 .00 36 . 00 .00 work for which this permit is issued.My workers'compensation insurance carder and policy number are: Carrier: REVENUE DIVISION TOTALS--> COLLECTED: 36 .00 OVER/SHORT: .00 Policy Number. BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK This section need not be completed i the perml is for one hundred dollars(Ston)or less.) 36 .00 �( I ally that in the performance of the work for which this permit is issued,I shall not employ any person in any mann'r m es to become subject to the s'compenation lawn of Calromla. end that A aha subject to l workers' *1E1f 1E 1E 1E 1E if 1F IE 1F iE 1F 1E if lF if lE lE if iF iE lE 1E iE 1F 1E lE 1E iE iE 1E 1E fE 1E 1E 9F 9E iE iE iE iE iE 1E 1F iE 1E iE 1EiEiE iE if iE lE iE 9E 3E 9E fE 1EiE 1E iE lE iE if 1E 1E 1E 1f iE 1F iE 1f iE 1E 1E 1F mmlgn��e w� ransgns Sedan 3)00 d the Labor Code I shall lanJl mm t sb Dole; /�75� Applicant ft t� INDIVIDUAL F E E BREAKDOWN Warning:Fallon los we workers'conwenabon cordage la unlawful,and shell sub/ac en ernpl to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines up b one hundred thousand dollars(5104000),In addition to fits cost of compsnsatio magas as provided for In Section 3706 of the Labor Code,Interest,and attorney,fees. CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury thatthere is a construction lending agency for the MEC 1 INST FORC—AIR/GRAV FURN <= 100 K BTU 9 .00 9 . 00 perfmenceoftheworkforwhimmepermitisissued(Section3097.CA.C). MEC 1 REPAIR/ALT HEATING UNIT/SYS W/CNTLS 9 . 00 9 . 00 m i LENDER'S NAME: MEC 1 GAS PIPING SYS 1 — 4 OUTLETS 3 . 00 3 . 00 LENDER'S ADDRESS: END OF FEES I codify that I have read this application and state that the above inlmmation is coned.I agree to compy with all city and county ordinances , and state laws relating to building construction and hereby authorize representatives of this dtylo enter upon the above-mentioned property •• for inspection purposes. KUR VON HERZEN OCT 2 51995 / ,' Print Name /� /.,•/ +...../—a...../—a � CITY. OF COSTA MESA Signore of• 11-1,g. V PplcanpCongw Dale:ect (515146.WP) White-Building 8 Safety;Green-File:Canary-Applicant:Pink-Revenue;Goldenrod-Assessor CONSTRUCTION AND PLANNING >: POO' 'Fel ' APPROVALS Permit# 11 Date Inspector APPROVALS Permit# Date N �"� 1iTetporary Electrical Service or Pole 52. Pool & Equipment Location ' 2. SoiQPipe-Undrgrnd. .'53. Steel Reinforcement - 4E.3..,..--,Electrical Conduit Utility-Undrgrnd. 1 54. Forms r. 0 45Electrical Conduit-Undrgrnd. - " 55. Electrical Bonding ". . rt,-r, , ::�St el Reinforcement - - 56. Rough Plumbing & Pressure Test ,� Ot6. Electrical UFER Grnd. 57. APPROVAL TO COVER GUNITE ) ti 7�foi3tings58. Electrical Conduit-Undrgrnd. j;.f�; Oundation 59. Gas Pipe, 0 Undrgrnd.,Test n' 1:79,ea'4er Pipe-Undrgrnd. c- 60. Backwash Lines, P-Trap, 0 Ur)drgrnd. 10. Structural Floor System 61. APPROVAL TO DECK ; 1 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final'./ 12. Setter Cap - • 63. Heater & Vent-Final - • 13. Roof Drains - 65: Plumbing System - Final. : ) ' 14. Rough Plumbing . N . ' 65.• Electrical-Final 15. Rough Electrical-Conduit n - 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 y ' pp-. .-:r: r,- ]11-4-15.--n „ 1 Z -. c. - rT� 20. Fro ugE'Fa or'fire-bace ' Cr) `�`t * _ 9 • t-•24PPRRVA�LSy"CPerMit# s y =rmr Yt 1. , qtr 2F.. * r �+* s ,.. r+E . ,( ^ jn , t--.r' „ • Y - a4 4 Z JJ d , ,, ' 21. D'ucts,.in Structure•:i* 1 •• •• - z. C F-1'' 770. �lhdergSYoir7t6)H>rdro 4; 22. DuctsrVegtilaiin r _ " `,x -1 T'-pi '�" _� [1 1 •:.;.1 gN t��; KC! q F. �.,,r y71. Product,-Piping 0Eieu Cf.,,Oil 23. o s Pipe-Rough,& Tegt . r r.; O't -(72. UndergroUhd Flust`) * c- 24. R6of=>ra4n'ng- 54 `"`" -it 1 > ,..1; 73�Undergrntl Storarg Tank.©Gas 0Or-' [[__ t-.* s [o4 t', r V i4i ,-- "r 25. Root$heat�hing <,- < . v* _ C ^- n.:t; 7400verhead Hydro:_ - 26. Bar'Ceiling (Struttralj & Man`pcpat ,** O r 751 try Chemical E'.r .�. `• ": Sm y'. F? mean Flashin- r. r 4: t.t 1- r ?)�. v.: +- s l') .�,_. ,.27. dr Sir J,m,'; x tr :l Cr* 76. Dry Standpipe Hal * B.< :-28. Lathi1'g &'Siding Z* r '-'4 •1: •'" 77' FIXED SYSfE klNA + Er. --, >"29. Insulation:'' m* O * P' * 7BZFIRE PREV. FINA1 * -> h: c,* 0. Drywall Nailing m * r l�. KALTI-FDEPT; R-EQUIREiVMENT 1 10 0 • -1 * LI is• tit•1 " G31. Plaster Brb vn Coati: . r+,-- .i: I -r79. FINAL 1t3SEECTI6t,N * . Q r r. r.. '32. Etectrical(Powe?. Mper-final ' it, ru I I ft -r80ff,FOOD CERTIFICATE lS ED Tr-' - i c k c a: ' I I It TIN t tri Cr '- I * . 533. Ftpalrtlecrr'ic ,,, .c - 7.1 y: .r - . I3 Notes: "-7 -3171 * 'i 0 ir) 1)34. Einallleat$ig BdAiirOonditioning•X 'm 0297 Q fi�/ I* a S ‘Th:-..-..t_ '* m 4/Zs?�to •," .t -, r, 1 F f r.. v- 'El.?.0 35. 4TnallGas pettest x 1 t 1 1 ' 'r- T ` r36. Hood ar Gano Py t J' . an i• •I I* i E :._> * ' „r.t-tT * i 1 I Tin ' I I I.: t'l `J:._ '1- 7, >IC- F1 7. F{nal`Pacipry Fireplace'' FF 11"--, - m I l 4 a ^:,[ --.1 _ 4 - �,�.• .t .. . X. . -_ rtf 38. Final_£lubing '4 Co ' . 4,-' 4' 1 .,c ,� .r.n . W '-39. Water-Service-Final * c i =' -t; � ;t r:o'_ o :.l r) * U. f i H ro * .ZE- ;-40. Gas Service-Final 7 to <r'' S el 1 ti-. 1,z aro ecu * ~ 0'1 r.c_� E., • C E * .^ :41. Solar Domestic•Final* 5 rrj "• * CA ) %"` o r+ a I Io- rr x r o r.t 42. Backflow Preventer *r � cti t i 4- I-v "'1r-. :x t� 1- - - r, t .-, * -tl !IC) 4- r4 43. Backf low Irrigation aS= 2 ,5:.1, T, u wa.r_, - C 44. LandscapeJrrigation-System e^i:� tr :: ttt c O p.' s• - co x0 * - - c • . 5. Sound A enuation # „ „ x. a n rl T o, _ r p - V. T. _ 46. Handicap Regulations - t a S 17.1O S t S .. r- I , .... .„-c m n 0 r - _ 47 FINAL STRUCTURE:& BUILDING * R 3 _ 48. F4.14PLANNING .. , E--t-• * r.) Di. -r 2-i <- - I ^ la --i C. Cl S 1. 49. E4ectria Release-to Edison ' ` tt E z * ,. .. .. t: 4- [ x -) .C 5D. Gas Release to-Southern Califomia;Gas Co * `',i* - .- I .171 t .1. ".O rJ _ 7 5;1. CERT-EFICATE OF OCCUPANCY * . e: ._ :a MC . - - c...:,c.....,_ No. Date mr.iiVonlomm 2904 ELLESMERE AV Mt CITY OF COSTA MESA — BUILDING PERMIT 0TExsNAMEIVIQC*7l:WEXLER, JAY I /PERM NO: B 077740 ADD WEXLER, LINDA J 2904 ELLESMERE AVE PERMIT NO: B 077740 PLAN CHECK NO: N GOVT: N SUPP : N COSTA MESA, CA 92626432-1877 APPL.MAILING ADDRESS CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT ARCHRECT OR ENGINEER: LIC,NO.: JOB DESCRIPTION : T/O REROOF W/ COMPOSITION SHINGKES SQ FT: 4, 650 ARCH OR ENG'S ADDRESS: UMT: CLAIM VALUE: 4 , 650 . 00 CALC—VALUE: 4,650 . 00 GROUP OCC : R-3 / CanRAcToxsNAME:SMOTHERMON ROOFING CO ( 714 ) 997-0255 CONTRACTORS MAIMS 568 S . GARDNER STREET COMMENTS : X Aooisss.ORANGE CA ucNo.: 308614 ##1E1tiEltltfEiklElElE1E1EiEfE1E1k1t1EfE§f#itiElEx fElElt##ltikltftfkx 1t1E1EiEiE1E##ItltrltiEitiFltiEftfEltiElEfEfE#it fFlt#!f-ififfEiEfEiElEiFi(-1EiE 92666 UMT: ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby diem under penally of perjury that I am licensed under provisions of Chapter 9 SETBACKS (commenting with Section 7000)of Division 3 of the Business and Professions Code,end my license is In full force and effect. CITY UC. uc.cuss:C3g UC.NO.:308614 EXP: 10/96 MAIN BUILDING ACCESSORY BUILDING Dee: 5=�o - 9LA Contractor FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN ER BUILDER DECLARATION:I hereby affirm under penally of perjury that I am exempt from the Contractors License Law for the following reason(Section 7031.5 Business and Professions Code:Any city or county which requires a permit to construct,alter,improve. PARKING REQ: PROV: PARCEL: 13927214 Z N E: REF NO: § demolish,or repair any structure.prier he r to is issuance.also requires the applicant for such permit to file a signed statement or she (�� of the is licensed pursuant to the provisionsContractors License Law(Chapter 9(commencing with Section 7030)of Di.bimt 3 of the PLANNING NOTES> .,Business end Professions Code(or that he or she is exempt therefrom and the basis for the alleged exemption.My volalion of Section > 7031.5 by any applicant for e permit subjects this applicant to a civil penalty of not n mothan Pm hundred dollars MOOD. ***************)******************************************************it.********* ❑ I.as owner of the properly or my employees with wages as their sole compensation.will do the work.and the structure b not intended D E V E-'L OP MENT SERVICES R E Q U I R E M E N T,' S or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to en owner of property who bulds a improves thereon.end who does such work himself or hersel or through his or her own employees.provided that such a �, impovementsere mtwended"feted fasale'e'beeeewr,the building«inpraemenn wbwtho aryeee ammpbmn.the ZONING APPROVED;.BYDATE: ovmer.builder wig have the burden a poring he or she did nal Gull Cr improve for the purpose of sale). ❑ I.as ower of thepopeny.emexchnhelyoxtradg sic Ecerned canunaclas aconseuct the Pmied(Seaon Deaths. Bns: a end BUILDING APPROVED BY : DATE: Professions Code:The Contractors Licensenot Law does napply to an owner of property who builds or improves thereon and who ' contracts for such project,with a conlractor(s)licensed pursuant.this to the Contractors License Law). 1, �� ❑ I am exempt under Section: B.BP.C.,for reaso : APPLICATION ISSUED BY: DATE: fpfEfEfsfefafEfE§L1EiEiEkiElElEiEiE1E+ ***IEiFiflfiEiE****iE******* iE7EiE iE****1E#iEiElEiEifiE§FiEiE*** #fit Date: Owner: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y I do hereby cenfy that I am aware of and understand the requirements of Caliama Health and Safety Code Sections 25505,25533,and 25534,and that laany Man buileinp occupant will/veil not(circle one)need to comply with said state coves end the requirement fa BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING a permit for°onryy.an etmction or modification from the Aagen,enl District.Residential construction eppical'ons are exempt from these PERMIT 99 . 75 . 50 provision Date: Applicant: SMIP/NON—RES PLAN WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: ISSUE FEE ❑ I ham and wil maintain a cendicate of consent to selbinsure for worker,'compensation.as provided for by Section 3700 of the Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE Code,for the ped«maneeofthe work for which this permit isissued. TOTALS-- —> 100 . 25 0 .00 0 . 00 100 . 25 100 . 25 00 I have and veil maintain workers'compensation insurance,ea required by Section 3700 of the Labor Code.ler the performance of the work for which this permit is issued.My workers'compensation insurance under and policy number are: n caer: STATE FUND EXPIRES REVENUE DIVISION TOTALS— > COLLECTED : 100 , 25 OVER/SHORT: 00 Policy Number. 041/911-95 09/01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC IRE SMIP/TOT GRADING PLAN—CHECK (This section need not be completed I the pent is for one hundred dollars($f00)or less.) 99 . 75 . 50 • ❑ I coney that in the performance of the work for which this permit is issued.I shall not employ any pram n any manner so as to become subjed to the workers'compensation laws o California.and agree the a I should became subject to the workers' ****9hfb9E********df9E**ib************fblbfb**fib***************************************** compensation provisions ci Section 3700 d the labor Code,I dad forthwith� �)campy with dress ron.im.. INDIVIDUAL F E E BREAKDOWN 2—.9 —J/ APdi : I�/— amino:Failure to secure workers'compensation coverage Is unlawful,and shall stalest an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil lines up to one hundred thousand dollars($100000).In addition to the coat of compensefIon,damages as Provided for In Section 3706 of the Labor Code,Intent,andattomey's few. SFR 4650 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 4 , 650 . 00 CONSTRUCTION LENDING AGENCY:I hereby affirm ceder penalty of penjvy that there is e c nstrWbn lending mono/to the END OF FEES performance of the work for which this Fermi is issued(Section 3097,Cie.C). LENDER'S NAME: LENDER'S ADDRESS: I candy that I have read this application and dale the the above information is correct.I agree to comply with all city end county ordinances and sure laws relating to building construction end hereby authorise repesenteives of this city to enter upon the above-mentioned popery �^ :'c r_.. w 7 Cr-t- s for inspection pumnseaBOBBY SMOTHERMON 'ATE: 05 /1)/U n7INE- L!,'::71 n11em9-- L)— 4Qi�Jt _ Date: �yql gnams of OwnerlAgent/Appican trader I (5151.46 WP) White-Building 8 Safely:Green-Rle:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor itCONSTRUCTION AND PLANNING i ,P.00L ei SPA T APPROVALS Permit# Date Inspector APPROVALS Permit# s / Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement -. 'a• .,'-IjrEle:4trical Conddt�rU?yiity-Undcgrnd. 54. Forms ' r.•. _ r :4^Electrical Conduct Undrgrnd. 55. Electrical Bonding • 5.-Steel Reinforcement 56. Rough Plumbing & Pressure Test 6.• 1ectrical UFERGrnd. 57. APPROVAL TO COVER-GUNITE -5 - , 7.'Fptitings ' r ti.. 58. Electrical Conduit=Undrgrnd. , ,: 8-Foundation -4. y 59. Gas Pipe, 0 Unilr;grnd.,Test ` 9. Water Pipe-Undcgrnd. coo. 60. Backwash LinerrSP-Trap, 0 Undrgrnd. .- • 10. Structural Floor;SV.stem TV' 61. APPROVAL I8-ECK 11. Property Sewer Linef& House?Corinection 62. Backwash & Receptor-Final 12. Sewer Cap . 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& Ait Conditioning: rc• V - .,,r - _• FtRb,DEPT. REQUIREMENT • _ _ _- - r . '- x,.. - • s. 20. Rougfi FactoryFicadlace - - - K -- ! r•' ' ErAPPROVALS,Z . Permit# , 21. Ducts in,Stru• `cture _ r* :� --1• r'' 70. rUndergrountl fipdro 22, Ducts, Ventilating' - - r r' ' 71. Product'Plpin O.Gas ❑Oil 23. Gas Pipe•�1?ou9h & Test r. r. l��'; . 7 n a r' 72. Underground Etush r 24. Roof Framing '~ r^ -'.. ` 71 Undergrnd.Stohage_Tank-.O Gas ❑Oil 25. .Roog:Sheathing _ f--21.? 6(c4' 7C Overhead Hydro •- 26. 1-Ba;Ceiling (Structural) & Mondcoat = •- - 7B",-Ory Cher cal r _ 27. frame arta FI32,hing - ^.0 r• .- 1 -, 76. Dry Standpipe + . . - -- E 28. Lathing & Siding i: ., :ME- C3, 4. 77; FIXED SYSTEM'FINAI: . 7 . . 29. Insulatioh _- - _ - 78: FIRE PREY. FINAL e 30. Drywall Nailing * - - HEALTH DEPT. REQUIREMENT 31. Plaster Brown�Coat L k 79. FINAL fNSPECTdON • -. _ it. ' 32. Electrical Power Meter-Ftnal ' * 80:, FOOD CERTIFICATE ISSUED' _t 33. finacElectric'e- J. m , "r.., x n• ! « Notes: ,, =-; ,. 14. 34. Final eating:& Air Conditioning i _ o ^. - �- - • 35. Final GafPipe=Test :' C -' ' " t 7. "D r•� .r - & 36. Hooor Canopy - - a , '- r: r r - v. - _:r r .1- 37. Final Factory Fireplace.. :, , „ x - •38. Final)'lumbing- k rt: - r u ' - .. ., , ,.. 39. Water Sercice-Final - - a "t - c - 40. Gas Service-Final r. x _-t- x ' - . - 41. Solar Domestic-Finalei �k ,. - ,.t r-. Z 4 42. Backflow Preventer .. '.7 0� r- --t r - 43. Backflow Irrigation '* cs-- • - Y 1rig 4. -Landscape Iration,Systemc5r r r• t%1 r re,t _ • a _- 4, a i_ Y / _.r . r. 45. Sound Attenuation '' - ' • _ r tr! •- - _ , 46. Handicap liegtilations x - [nr 47. FINAL STRUCTURE& BUILDING s 7File -- ,/1 P-I ' 48. NQL PLANNING , * .. ,, n, - 49. Electric Release to Edison , '�t` - • 50. Gas Release to Southern California Gas Co F - - 5t. CERTIFICATE OF OCCUPANCY No. Date °Ni` _ _ _ _ _ CITY OF COSTA MESA - BUILDING PERMIT ,� ADDRESS OF BUILDNO: 2505 ELDEN AV OWNER'S S NIF IOIO/IN: VON HERZEN, KURT _ . . - PERM NO: E 074819 ADDRESS: SHEARER, RHONDA A 2505 ELDEN AVE PERMIT NO: E 074819 PLAN CHECK NO: N GOVT: N SUPP: N fi CcpSA,CA 92627642-3287 CONSTRUCTION TYPE: V-N PERMIT TYPE: ELE PURPOSE: ALT ARCHITECT OR ENGINEER: ARM OR ENG.'S ADDRESS: UC.NO: UM: JOB DESCRIPTION INSTALL NEW FAU UNIT /ELECTRICAL SQ FT: CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /M-1 CONTRACTORS NAME CONTRACTORS MMLINO COMMENTS: INSTALLATION OF NEW FURNACE/ ELECTRICAL FOR RELATED WORK M-74818 ADDRESS: LIC.NO.: ******************************************************************************* Wit ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally or perjury that I am licensed under provisions of Chapter 9 SETBACKS (c n,mendng with Section 7000)of Division 3 of the Business and Professions Code,and my license is in lull loom end effect. CrTY LIC.No.: UC.CLASS: LIC.No.: EXP: MAIN .BUILDING ACCESSORY BUILDING Date: Contractor: . FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT- IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby Siam under penalty of perjury that I em exempt from the Contractors License Law for the Idbwng reason 7031.5 Busiest;and Professions Coda:Any city«e«aywhich requires a pensee to construct.abet,improve, PARKING REQ: PROV: PARCEL: 43917140 ZNE: REF NO: demolish,or repair any structure.our to its issuance,also requires the applicant for such permit to file a signed statement that he or she r licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commenting with Section 7000)or Division 3 of the PLANNING NOTES> Juaineaa 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 a y applicant Planet ter a Peasubjectshundred the applicant to a ciMT penalty of notmore than five dollars[$500)). > ..,. ❑ '. owner alhe propemv«my employees With wages other sole compensation.utas the wok.and heawdurelsna intended ******************************************************************************* Of offered for sale(Section 70u,Business and Professions Code:The Contrrdom license Law does not applytoanOwner ofproperty DEVELOPMENT S E '.R V IC ES REQUIREMENTS who bolds«improves thereon,and who does such work lensed or herself or through his or her own employees.provided the such improvements ments are not 4uanded or aired for sale.D,however,the building or improvement is sold within one year of completion,the owner.buildrwmhavethe brofp denrovingheorshedidnothaldorimproveforthe Putpd osasale/. ZONING APPROVED BY DATE: ,N I,as owner of the property.am exclusively contracting with licensed Contractors to co stud the project(Section 7044,Business end - Prelessore Code:The Co rade°License Law does not apply b n owner of gayety who bunds or improves thereon and who BUILDING APPROVED BY : DATE: contracts for such prgects 'h a contrauo(s)licensed pursuant to the Contract. DATE: IC;LE6 V _ r ❑ lamer ,/ B.&P.C.,lorthis, -•n: ' APPLICATION ISSUED BY: Date: /v �-3 fS Owner: /a..,/—A/- **********************************fit******** ***************************** Ido hereby c illy that em aware of and aundemndlhe requirements of California Health and Red4 Code Sections 25505,25533.and LEGALIZATION:N F Et 'SUMMARY STRUCTURAL SEGMENT:N 2553s.and that I ex any Mure building occupant will/all not(dale one)need to comply with said .e codes and the requirements for t e permit for m'eUucion o modification from the Afr UMy an 1agemenl District.ResormrWrmore Residential are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 29 :00 Date: Applicant: 5 0% SM I P/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally d perjury one of the following declarations: PLAN R, o I havecaddie/deb and will maintain a caddie/de of consent eeff'insure for workers' rcompensation,as provided by Section 3700 the LaborISSUE FEE 15 .00 Code,fortheperformaeofthewrktowhchthispemitlel®ued. dBUILDING-DIV-> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ I have and rrill maintaii workers'compensation insurance.as required by Section 3733 of the Later Code.kr gee performance of the TOTALS > 29 . 00 15 . 00 ;A1 0 .00 44 . 00 44 . 00 . 00 work for which this permit h issued.My workers'compensation insurance ismer and policy number are: • Carder _ - REVENUE DIVISION TOTALS--> COLLECTED: 44 . 00 OVER/SHORT: . 00 Poky Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK This section need not be completed ll the panne is for one hundred dollen/5IMI or les.) 44 . 00 , g1 coney that in Lha performs e of the work for which this permit is issued,I shall not employ y•. .• in any manner to as to . become au•'•• to the • 'compensation laws of California,and ..tee .. ' I • - subject to the workers' woe°�'an ':ion Section ]GOdlM labor Cada.!ahatl h. /, t. :�:. ..es ******************************************************************************* Date: '" - Applicant: / / , �/j 0/l I N D I V I D U A L" F E E BREAKDOWN warring: - gun to we workers'conupesedoncovragelaunlawful,and shall srblectan tocdmnlpenamesand TYPE QTY D E S C R I P T I O•- N UNIT COST TOTAL COST civil fins w to one hundred thousand dollars(5/04000),b addition to the coat of comports: damages as provided for In Section 3706 of he Labor Code,Intend,and attorney's lees. CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty d perjury that there a=nitwlendingr1 lending wart?for the ELE 1 FIXTURES LIGHTING 1' ST 20 EA. . 75 . 75 pedomanceof the wwbrwhich this permit isisued(Secion3097,Ci.C). ELE 2 RECEPT/OfJTLET 1 ST 20 EA. 7S 1 . 50 LENDER'S NAME: ELE 1 RECEPT/SWITCH11 ST 20 EA. . 75 . 75 LENDER'S ADDRESS: ELE 1 SERVICES BELOW 600 V .6 BELOW 201 AMP 18 . 50 18 . 50 ELE 1 MOTOR/POWR APPARATUS 1 . 1 10.0 HP 7 . 50 �� 7. 50 en icemthat!have read thisthisapdueoM sadism.,nedthe the above information eod.lw�mcomply with all ar l cry om ay ordinances END OFFFEES and state laws relating to butdbg construction and hereby authorize representatives of this city to enter upon the above-mentioned proper itfor inspection pure ses. �KURT VON RZEN /PalmN / i // Date t z�/� OCT 2 5 1995 Signature a L/Appk tractor (515t.46.WP) White-Building&Safety:Green-Ale:Canary-Applicant Pink-Reese»:Oaldruod-As»m CITY, OF COSTA MESA I 1 • r,� � Imo, ' CONSTRUCTION AND PLANNING >-Date POOL .,PA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole '52. Pool & Equipment Location I . ' 2. Soil Pipe-Undrgrnd. - - -53. Steel Reinforcement - , ;r3 lectrical Conduit UtilltyUndrgrnd. 54. Forms i E' ? 4^Electrical Conduit-Undrgrnd. 55. Electrical Bonding r'• . tt-C�.5teel Reinforcement 56. Rough Plumbing Si Pressure Test CJ L6. F,fEectrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE t,,. ``- j=fodhtings 58. Electrical Conduit-Undrgrnd. c' ,. , 8_Foundation • 59. Gas Pipe, 0 Undrgrnd-,Test r EJNater Pipe-Undrgrnd. 2/ 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 .' I 63. Heater& Vent-Final . 13. Roof Drains - - • 14. Plumbing System - Final " 14. Rough Plumbing ,m 65. Electrical-Final I. ' . 15. Rough Electrical-Conduit T , 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. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning arrF cp it,D�,ELPT. REQUIREMENT b1K C.tgtrl 20. Roug6'FaCtory'Firepl'ace '• Qm Q` ;.` I.`- °rt APPRDVAl! 55 Perptit# "21--�� .r - 9.�' 61 21. Dects;in Structure:4 ::..- •• •• •,--_ r 0� -7' '70. lndergid`up'-d Hydro I • * 22. Ouctr • Venula }ng`* 1 ',r, y a, K r 71. Produq Pipingbas E')Oil 23. Gas Pipe-Rougfb& Test ^ i m r .c- "•`' • 72. Underground Ftash' t , 24. R3of-Fre-Fretting id : r `^ * '. ..- . _. 9 _T tir • m * - ,_-� ;.73. Undergrnd.Storagz•Tank,tOGas OOif 4 25. Roof rShea`thing cr C 1 `• C ,i1 r74..Overhead Hydro r i - - 'r �,._ ter* 26. T-Bar-Leiling (Structural) & rotbat * V r C' Ej " C�"'I n .. 4,m * 0 7* 75i. Dry Chemical ,.-,r-,:atdtt 27. Famerand-Jlashin9,,* Or♦S _ x tr' >1 wa' 76. Dry Stan ee 'Lc • , F- rn "I'>CC C- - _ . -rte - <I-, - .r.i-.2 1-28. Lathing &'Siding St C1 'ids er +, E "' " .' 77T FIXED SXSTE 'FINAL, ; o'"ice' 29. Insulation tri‘ s •• _ tI- w _ _ j .- ' 78T FIRE PREV. FINAL Y -it-n c30. Drywall Nailing ^X ; 1, , it HEALTPDEP7* REOT11Rk11AEK1 K r I n- rt" I b r 17131. Plaster Brown Goat * S I Iran 1- 1 k r79. FINAL INSPECTI-ON• 4 .. - s°- tG• : .-.•> a •_ - h' t 32. Electrical Mk-tel.-Final i Gu I r+ '80:�FOOD CERTIF`CAT-E IS�SUED1i " :,,ItIll -••a 1 m c:� Tr I- t ,: r 33. FinalElecfric ; s r C Notes: r•: n-34. Final_Heating&IAirrOonditioning. i-, x 1 `^ ��,'/ n' O • ., r �r6y �Oli�t3�7 •' ate 35. FihalGas'PipetTesti,.: , •. t1, It : ^o r'.-, r ':uvNit,4--4r. c36- Hood or CanoPY cl+ D : tr M * r, r Ta i. -37. Final Eact ry Fire4laFe~ , „E " r i ' ,•FL * 3 - ^38. Final'Plur ibing ,- -7. _PJ ` ^ t ' J' c • ,.y cf .,, . "} . . y v .-, -39. WaterService-Finaln 2 C t,. •;; .rr , ' R.: r .z `,r 5", -40. Gas Service-Final Or c: ri*,r-r ' 4: O- 0.cc. • • •rr't; z. n�,G- . k* --41. Solar Domestic-Final*. s p. __/ _ }� Jr rr -7.•c r r r 42. Backflow Preventer+" ,i, 4 - r r G 43. Backflow lrriga;ior(�r. QSS % r I. .- t- i• -.I Tr - vn 44. Landscape irrigation System ":+1". o• t: m t: c: r . r t" - "- " - 45. Sound Attenuatiori`' 'J ^ r-• t { r- F -_ r ^ r ' • r` . t . Tj t' - 46. Handicap Regulations r. '- _ a -- 71 __ - 'r, .. t r _ a) 'k .- 47,- FINAL STRUCTUREt& BUILDING r. l f _ H 48. FINAL PLANNING * E• r "- = -n cr r •- 49. EI'ectrr'e Releas(to'Edson ` - ° "�- - z 50. Gas Release to-Southern California'Gas Co r ' i - - �1 x 51. CERTIFICATE OF OCCUPANCY * No. Date / \ Applicant to.fill in all spaces except those within heavy border lines and.sign all appropriate declarations. 7156, 1 1/13/86 39 50 TI F COSTA MESA CONSTRUCTION PER �Tt PERMIj�EO. TRACT NO. LOT NO. UNIT NO.. . • . o oleo Address ZS OS � G ,n _ �J . Applicant's Mailing Address 6951 'NEruT'N C. 4. . TYPE OF CONSTRUCTION ❑ NEW ❑ ADD ❑ ALTERATION ❑ REPAIR 1#73-12•02-112—,L 7 /fir—_Try' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone Owner's Name h�IvSbN Phone YO LLLL7I�m DE CRIPTIONO WORK/USE OFBLIG. C•r e •'//its-Oft rtis)s Address "- a-2" IIbbbe", Ave. • C'N7• 4 h".. - W �� 11 L „ L - - ,m, p . ."a .L_ S Main Building: Accessory Building: \S TYPE OF PERMIT . GRADING M FOUNDATION M STRUCTURAL E Front _ • Z R�cEv -nn0 Arch/Eng. License No. ❑ TENANT ❑ ELECTRICAL IE PLUMBING ❑ MECHANICAL g - :I I ED 1`�Q 1 ' !1 '`Re N Cw 72-P106-, sem�. ,, 69 !� RearC Address 1 SF�v 72- t X , 6-a."--0 ❑ ,OTHER L7 vi-i1.171-1.0(, • A — Contractor's NamePhoneC Right N Address lm.ili PROJECT DESCRIPTION SQ. FT. .z� 00 OCCUPANC�Y _ K • G .- CON STRUCTION TYPE VALUATION$ :7/�O g A Left R • ^ City License No�J - ,_ ZONE GRADING CU.YDS. ACRESE I-. LICENSED CONT - • R'B•' Ping. Ref.# Parking Req./Provided I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Plannin4 EIVED 4OV 5 1988 • M with section 7000) of Division 3 of the Business and Professions Code, and .1 my license is in full force 0• -.d effect. • T \� ( License lass _ - y s J Lice S• •-nas • Date - -41. Signature 4�.. PLUMBING • FEES t WORKERS' COMPENSATION DECLARATION ,gar Sink Showers ELECTRICAL t FEES I hereby affirm that I have a certificate of consent to self-insure or a certificate - C -if Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 1800, Lab. C ^7••� r Automatic Washer Transformer 0 15.50-KW Policy No. //-4- Cony •�/R - Backflow Irrigation Sewer Cap Construction Pole Sub. ❑ 50+ KW liedcopy is hereby furnls •• '! j , / Certs}ed copylss filed with - city - Ip h. gra i• Bathtubs Sewer Connection • Cooking Unit Meter ❑up to 100 amps Date / 1l1ly A••Ilcant I"C ' • a' — EXEMPTION FROM WORKE- - Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps (This section need not be completed if the permit is for one hundred($100) or less). Dishwasher Solar Piping Dryers ❑Gas DElectric Sub Panel , 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 Drinking Fountains Solar Tank FanMotors 00.1 HP 011/2•-8'- Worker5' Compensation Laws of California. r . Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9.15 HP ❑16-15+ '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 Fixtures • Microwave comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet I hereby affirm that there is a construction lending agency for the performance Device Boxes Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors • Water Heater Outlets •Range • Lender's Name •_ Lender's Address Kitchen Sink Water Service .'Switches Sign OWNER BUILDER DECLARATION - • - I hereby affirm that I am exempt from the Contractor's License Law for the • Lavatories Auto-Wash Garbage Disposal - following reason (Section 7031.5 Business and Professional Code: Any city or - ;Standing Sections . • county which requires a permit to construct,alter,improve,demolish or repair P-Trap - Laundry Trays • Generator ❑0-5 KW❑5-15 KW any structure, prior to Its issuance, also requires the'applicant for such permit Trash Compactor 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 - therefrom and the basis for the alleged exemption. Any violation of Section • - - - '031.5 by any applicant for a permit subjects the applicant-to a civil aenalty of not more than five hundred dollars($500)., LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee '$15 Issue Fee $ 3 1 compensation, will do the work,and the structure is not Intended or offered `- Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's • MECHANICAL FEES • License Law 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 DEVELOPMENT SERVICES REQUIREMENTS: • employees, provided that such improvements are not intended or offered'for Boiler -1. Hood or Type I • 0 • , sale. If, however, the building or improvement Is sold within one year of corn- Canopy Type II 0 - Zoning Approved By Date provef the owner will have the burden of proving h¢/she did not build or im- Duct-Under Ground Building Approved By 'Date 1 prove for the purpose the he of sale). - tl_ ❑ t as owner construct t project am t 7 44, contracting ing with licensed con- Duct-Structural Refrigeration System Application By • Dat Thethe (Section sContractor's License Law does not apply to an owner je property who Duct-Ventilating 001 00.000 BTU 0100,000 BTU - SUMMARY OF FEES builds or improves thereorsuantgawho contracts force such projects I as with a that tractor(s) licenseeiorker's to the Contractor's insurance License be ov aware that Exhaust System 0 Multiple 0 System Repair/Alteration I BUILDING PERMIT '$ 9•G� SMIP $ Sat- proof l of their nderr's Compensation insurance should. P.C.for dedthis to me. PLAN CHECK $ PERMIT • ❑ I am exempt under Section B.6 . .for chit reason Firepl/Fac[.Blt. ICBO# Fire Dampers • ISSUANCE $ - PLUMBING $ Date owner Heating'System& Ducting Registers 'PLAN CHECK 25% $ ENERGY P.C. $ ' I hereby certify that I have read this application and state that the above 0o-i 00,000 BTU 0100,000 BT ' - - ELECTRICAL $ . GRADING $ information is correct. I agree to comply with all city and county ordinances and state law,Gating to bullring co .-ruction :ntl hereby authorize 'rote- i PLAN •CHECK 50°� $ MICROFILM $ sentatives ofI c'i1 to ee// e p., the a“, --mentioned r pert or inspection pers. `Y / / /' i MECHANICAL $ . TOTAL FEE �$ �•Sy Signature G- I • _ Date Drivers' License or SS' �>��( Pink -Accounting; Goldenrod - Assessor JONSTRUCTION AND PLANNING POOL .. SPA Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit# 1. Temporary Electrical Service or Pole52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. . • i . - 53. Steel Reinforcement 1. Electrical Conduit Utility-Undrgrnd. - 54. Forms • 44. Electrical Conduit-Undrgrnd. 55. Electrical Bonding .5, Steel Reinforcements 56. Rough Plumbing&Pressure Test- 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE „7y Footings , - ! 58: Electrical Conduit-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 , 11: Property Sewer Line & House Connection 62. Backwash & Receptor-Final '12. Sewer Cap • . - 63.-Heater & Vent-Final 13. Roof'Drains64. 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 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 BFown 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 - • • I.,' 36. Hood or Canopy rf{ 37. Final Factory Fireplace i jT1 . 38. Final Plumbing -- ' 39. Water Service-Final "-' 40. Gas Service_Final ri 41. Solar Domestic-Final _ - • - - 42. Backflow Pr¢Henter ry . • 43. Backflow Irrigation `ex) , 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 026LP �A 48. Special Requirements Completed, 0 /� , 49. Electric Releas�to Edison - ' , 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ' ' 17163 • F E RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENTMAY 2 8 1969 P. O. BOX 917 COSTA MESA. CALIFORNIA SI FINANCE DEPT. For A licant to Fill In Completely CITY COSTA MESA PP P Y APPLICATION FOR PERMIT TYPE OR PRINT BUILDING 2go.s 2 O� BUILDING ADDRESS,J��C/OST�A MESA. �CALIFORNIA For Office Use Only OWNER ✓?-.C.• -'•'^_/•W�-0. I RECEIPT NO. IP7/ 6,NO. • MAIL RE VH BY DATE RECEIVED/ DATE 188/U l ADDRESS ....5 uZ p e. ,57.-a,/+ '!O CITY NO.A5/10 SO BUILDING ( `o r e// e c ARCHITECT - �/�a TEL COSTA MESA. CALIFORNIA OR ENGINEER / '�4/ NO. ADDRESS.S�/ O Itwl0�4.Q//J,.-� -.11, ZONE I G' , ZONE --// TYPE GROUP .J CONTRACTORL�,e,�PO. � APPROV P BY - ADDRESS/4t.C.'c ..# J di-7,..... ZONING . CITY�D <4 G /JOOGC• / ZON I NO.OP I UEE OP NEW f (,414.1-, Z PLANE 2- BUILDING fin ATE LIC.NO.///Afl •p NO. %EiL /S� DEESCRIFTION 7oet ,z 7-41 3 7 SIZE / I NO. OF SLOGS. p o 'J 3 OF LOT /j i }L /6 i NOW ON LOT A p NO Ii / - -c -_ 3 R `� USE OF {{��//77 ��//ff YARDS EVES EXISTING BLDG ALU�.V..14• - APPROVED ALLOWED SETBACK LINE FROM / �y"� (CENTER LINE ST.) /J,�� CENTER OF STREET 6 REAR YARD± " FRONT /0,�[1 FT. /�..-c te.. IN. SIDE YARD LEFT /0 / I RIGHT S/�P, R.SIDE �' �FT. l IN. DESCRIPTION OF WORK L.SIDE /D' -FT. N. ,II1� NEW 4--- I II ALTERATION I_•'��"III'ILADDITION I • REAR ._5" FT. IN. REPAIR I----II MOVING I- IIDEMOLISH I .--- APPROVED /vie „BY ic 0-. DATE /w/6 2- BUILDING r L7 NO. OF SIZE S 7N ROOMS STORIES EXTERIOR WALL ~_ ROOF COVERING COVERING USE OF BUILDING AND WORK TO BE PERFORMED . PO-1-4 tea-/. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION TH8 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 - BUILDING CONSTRUCTION. VALUATION .{ J SIGNATURE OF / / ..�� PERMIT FEE $ /A (� PERMITTEF J ' e $ `-I Jb PLAN CHECK $ b ---- AUTHORIZED AUTHORIZED AGENT , ti c TOTAL FEE ' n