HomeMy WebLinkAbout2756 MENDOZA DR - Building PermitsI
0
PflOJECT AOOFESS: Z'� S 6 MENDOZA DR �
owNeesxame: STANSFIELD JAMES J
aooeess: Z�56 MENDO�LA DR
COSTA MESA,CA 92626
AflCH/ENGINEEH:
AODflE55:
UNIT:
nEc.xo.: "
UN1T:
�, PEPMITTEE: RPS ROOFING ( 213 ) 633-9528
aooeess: 13516 LAKEWOOD BL " ' H
BELLFLOWER CA 90216
UCENSE� CON7BACTOB OECIAHpTION: I here�y affir al I am censetl under pmvisions apter 'c encing with Sec�ion
7000� of Division 3 of the 6usiness antl Pmfessions e. anA license is in tull �orc eflect.
c�rruc.:054389 STATELIC.:4 43 cuss: 39 `
�ale'. —/r��4=� 5' naiure' _ _ _ . _ _ �
WOflKEflS' COMPENSATION �ECIAHFTION: her afh Ihal I have ehi�i a sent �o setl�insure or a certilica�e of WOMers'
Compensziion Insurance. or a cenilietl coOY he , t(Section 3800. La . C�-
POLICYNO.: SOS89S%-91 , E%P.OAT. IOLI9Z
IcomvnNr: STATE FUND
❑ Wrtifietl copy is hereby lu�nishea. � CeRrtie py rs fil, ii�h IAe ciry Buiidin on.
,ale: _�Q ^ �� �� A IiCanC
EXEMPTIONFNOMWOHNENS'COMPENSNTIONO ION: Qhissec�ion edna UecompeleAiftAepeimi�isforonehundrea(5lqqarless).
I cetlity I�al in ��e pedormance o� Ihe work lo ich this permii is iss . I shall nol employ any person in any manner 5o as �o hecome
subleci lo Ihe Workers' Compensa�ion Laws o� Califomia.
Oaie: � ` Signature: "
NOTICE: I�, aiter making Ihis aeclara�ion. you 5hou10 Uecome su�ject �o Ihe Workers' Compensation pmvisions ot �he Labor
Code, you must forthwith comply wi�h such pmvisions or this permi� shall �e tleemed revake0.
CONSTNUCTION LENOING AGENCY: I hereq� aflirm Ihai I�ere is a conSlmc�ion lending agenty �or �Ae pedormance a� �he work tor
which ihis permil is i=suetl (Sectian 3097. Ci¢ C�.
lENOEfl:
noosess: , --
OWNEF BUILOEN OECIABATION: I hereby atlirm Ihai I am exempl �rom I�e Contrac�Ors' State License Law �or Ihe lollowing reason
(Section 7031.5 Business antl Pmlessional Cotle'. Any ciiy o� counry which reQuires a petmi� lo cons�mcl, alier, improve. tlemolish, or
reoair any s�mclure, prior lo ils issuance. also requires �he applicant lor such permii �o �ile a signetl sta�emen� Iha� helsM1e is licensetl
pursuanl to the piovisions of t�e Conlractors' State License Law (Chapter 9(commencing wit� Section 7000) of Oivision 3 of the Business
and Pmlessions Coae) or Ihat he/she is exemp� �herelmm ana Ihe basis lor Ihe allegetl exemption. Any violalion ol Section 7031.5 by
any applicant �or a permi� 5u�lecis Ihe applicanl ro a civil penalry oi no� more �han five hundre0 Oollars ($500).
I. as owner al the pmperty or my employees wilh wages' as IAeir sole compensation, will tlo the work, antl the
❑ S�mcWre is not in�entletl or o�fered lor sale (Section 7044, Business ana Pmiessional Cotle; T�e Con�racbrs' State License Law
Ooes nol apDly Io an owner ol a properiy who �uiltls or impmves thereon, an0 who does suc� work �imseif/herseli or t�rou9M1
nis or �er own employees. pmvided �hat such impmveinems are not intentled or ottered for sale. If. however the builUing ar
impmvemen� is 5010 within one year ol compleiion, I�e owner will have I�e bur0en o� pmving he/she tlid no� build o� improve
lar Ihe purpose of sale�. , . .
� I. as owner ol Ihe property, am exclusively contrac�ing wi�h licensed conVactors to conslmct t�e pmiec� �Section 7044, Business
I❑ antl Prolessions Code: The Contracbrs' S�ate License Law tloes nol a001y �o an owner of pmperty who Dm105 or impmves I�ereon
antl who conlrac�s �or such proleds wil� a conVac�or(5)license pursuan�lo �he Contractors' Sta�e License Law),I am aware
Ihat pmof a� iheir Worker'S Compensation insurance shaultl �e pmvitled �o'me. -
� I am exempt untler Section: B. 8 P. C.
lor Ihis reason. '
Dale'. Ownec
I do hereby cetlity �hat I am aware ol antl unders�and �he reQuiremenis ol Cahbmia Healih and Safery Code Sections 255Q5. 25533, antl
2553a and Ihat I or any lulure building ocaDant witl/will nol (circle one) need lo camply wilh SaiA Slale co0e5 and the requiremenis for a
permii for conslmclion or matlilicaiion tmm the Air��uali�y Managemen� DisVic�. flesi0eniial cons�mction applicaiions are exemp� �rom
ihese pmvisions.
�alo- ApPlicant
I herehy ceriify I�at I �ave reatl �hls appbcalion and slat
ortlmances antl sta�e laws relating Io huilding Wns�mdio
pmUeriy br inspection purposes.
�ale'. �O� � ��{ ' Si aWre
�river'S License oi Sor,ial Secunly n.�
1641�46 W�ne—Bmltlinq_Gr¢¢n—Cotl_e nbrcemE
wi�� all city and county
onlhe above�mentioned
CITY OF COSTA MESA —, BUILDING PERMIT ' PERM NO: B 059272 ;
PERMIT NO: H 054272 PLAN CHECK NO: . N GOVT: N SUPP: N
CONSTRUCTION TYPE: S—N ' PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION :.T/O SHAKE/RE—ROOF W/25YR COMP SHINGLE SQ FT: • 6,800
CLAIM VALUE: 6,800.00 CALC-VALUE: 6,800.00 GROUP:OCC: R-3. /M=1
COMMENTS; SMOKE. DETECTOR(S) RE�UIRED 3N HOME. Clh�uc�p ,R�,�P S�'IP�zJ`ii�y
�r**�r�r*�r*�r***�r**�r�*�r�r**��r�r�e*�r*�r �r+��r�*+��r+�+�x�r�e*�r*****�e��*+r�e+�+�r�������g*����
2 O N I N G R E Q U I R E M E N T"S
S E T B A C K S ����j���
------------ MAIN BUILDING ---------- '--------- ACCESSORY BUILDING ---------
FRNT; FT ZN REAR; ' FT IN FRNT; FT IN REAR; FT � IN
LEFT:� FT IN RGHT; ' FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ• PROV; PARCEL: 14168104 ZNE; REF NO;
PLANNING NtSTES>
. �
kiliF3t�tiEitlt3FitiFiFififiFiFkikafitaEiEkiFfF1lltititififiFklf3titit�titiFikiFkjfltk3lkiFklF3fiffklFifilkat�FififMiF3titriF3EitiEaE�lt3f�1t3F3t3Fkif �
� D E V E L O P M E N T' S E R V I C E S, R E Q U I R E M E�N;�T S
,r„
20NING APPROVED BY DATE::,`'
BUILDING APPROVED BY : DATE:, :
APPLICATION ISSUED BY: � DATE; ��v �
itif3fiFikiFifififififjfif�fif�fit3E�E1E1EiEiFiF7 iFkif�lFiFikMiFiFiF FififiF
iFif�fiEikitifif�EiFiEiEjEiEiEiEjf3E�E1EiE�E�iiFiliE�fjF�fk�E�lkiElEifiEikiFikiF iFifif ififififiEfEkiE1E1F1F3f�Fif3f#iFiFjFiFiFiEkiFifiFiFifjFiF�FiE
LEGALIZATION;N F E E S U M M A R Y STRUCTURAli,�SEGMENT;Y
BLDG PMT PLUMBING �ELECTRIC MECHANIC FIRE SMIP%RES GRApING
PERHIT 90,00 • 68
PLAN SMIP/NON—RES
ISSUE FEE ' ' �
HUZLDING—DIV—> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE •
TOTALS----> 90.68 0.00. 0,00 90,68 90,68 ,00
RfiVENUE DIVISION TOTALS--> COLLECTED: 90,68 OVER/SHORT: 00
HLD90P00 pLUMBING ELECTRIC MECHANIC FIRE SMIP/T68 GRADING PLAN—CHECK
� kiF�EiEifiFikiElF3FkifiEifikiFiFiFiliEifiEiEififiFiFiFiEiFiF�FiF�E1FjF�t1E�Flf*fEjEiFiiiF�EifiFkfEiflfiFifiFifif*iEif:EifiFifiEiEifiE3E#�iEiFifiEiEiEiEiE �
Z N D I V.I D U A L F E E �B R E A R D O W N '
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 6800 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 6,800,00
. . END OF FEES
�
CONSTRUCTION ANDPLANNING POOL� a�
Date Inspector Date Ilnspector I
APPROVALS Permit # APPROVALS Permit # -
�
: 1. Temporary Electrical Servic�e or Polery� , � 52. Pool & Equipment location
� r
2. Soil Pipe-Undrgrnd. ' ���� w� i% 53. Steel Reinforcement
n•. ,!- ., d^
�7��( 1 Y•u' .. � l Q:�tj
,3 .Qlectrical Conduit,_,U�lity-l�ndrgrnd�, 54. Forms .
-c4� El�trical Conduit�t�drgrnd.�� ✓ � . 55. E�ectrical Bonding �
.�
�n��.��'teel Reinforceme�t� ��. , 56. Rough Plumbing & Pressure Test
vf�%Electrical UFE8;6f�ii. � �� ���' S7. APPROVAL TO COVER�GUNITE
'�%7.'F'o��tings �d 4/ � 58. Electrical Conduit-Undrgmd.
�
i_�;Foundation `- ;��/`�_ . j� ,, 59. Gas Pipe, O Undrgrnd., Test
9% Water Pipe-Undrgiad.' �. • Y 60. Backwash Lines, P�Trap, O Undrgmd.
10 Structural Floor System -�� � i�- 67. APPROVAL TO�DECK '
11. Pcaperty Sewer Lin�& Hotis�`Connection �,� . 62..Backwash & Receptor�Final
2 � i i
12. Seiver Cap a. � 1 � j ;� ,/ i',r 63. Heater & Vent�Final
13. Roof Drains ui �'; V v �. 64. Plumbing System - Final
14. Rough Plumbir�g� 'O� ��� .� .�� � � 65. Electrical-Final
15. Rough Electrica%CAnduit "; �� j% � 66. Solar System-Final
16. Rough Electric�iWiring ' t 67. Fencing & Access Approval
77. Rough Wiring �jgn � 68. APPROVED FOii PLASTERING
19. Rough Elettric9ol.,�T Bar Ceiling 69. �POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning " FIRE DEPT. REQUIREMENT '
_ _ _ tT G!-+ V:-� S%: * F N
20.��oi73h ictdr� Fu�place i�.C:TS �i � � tj � C�%� i iqPpROVACS���Perrriit # Y �:r
5 <z m 4: Y' :S :-! C^x'k .^, ��>X (VhiH �r i± C'
21.�Duct's, i �Stru��'ctu �' i�~ �-+s a :S v �x a�0. Uadergeq�id:Hy,m�ro :R «7
22.�Duc3E, Vc�ntitatin�-� � :: 5 �k V S �C:+� x. ��, Produc(�`Pr�ing �s �il
- i i n :� r. .r n .�
�- •• r^ �- 1 lK 7: �' Na �r r-. ;Tt 1 06 * {;p ro
23. ,�('ias'Pipe��p ough &��;est S � � �� �. �7Z, Under ro � d FI �
-f' I rr, :k � iT� 9 �. li5!2..n� :R r� cy
V t•� �J�/ J
24..�to�'Fr�ming• �� � i-�F •�n �'..� C� TM _*� S/3'x,lJndergrnd?Stor~t� ank �Gas ❑�ii
.� r� x
^� Ya'� � 1'i i�ii M �;. lU]c't s- L' )...i�0 a
25. RonrSh�athing ���x � � ,y. r r, � .y. .•_ ''7q•�.yerhead �lydro;� �
26.rT�Bar Ceiling (Sttaaural) &,Monocoat '� ��' _ v;� * 75.GDry Chemical V"� x i-�+ G Q
�^r r+ s, � �- rn
27.�Fra�e an,d FI�shPr�gx r�`; .�` � :` * [`• �T�;y, � x � S to �
:� � i,* J��bC X � >- cy .� :.. 76. Dfy Stan`+K'Lie Ftn M C
1 / : �-. �"�L i:J .. •.. .. V LV V
�28.yLatEUn9� Siding;-r � "2�:t tr: w 2'. .•'!' .R 77!^FIXED SA`3tTENP9NAL* r'•
-r--v � r� v �•1 { r..... r� i .- _ n
•'29. Insulatioii G x'� � ~"" � 'k �r I "� 7g?FIRE PREV. FINFF * rq j.
�,,, �:K S x :a S �- y. �
�� `-�� � �%� I �r �� HEALTHdilEPT:KR�EQUIREMENT
[ 30. Drywall;NaiFiAg � �; `�'�
\ hi /� y
r31. Plaster B'own Cox '� � � �' ` 9"FINAL IN� .ECTI n� N �* C �7 `�
:. � : 3 4'� 5 I[r�n � .x i*� ��. zs, x p
u i,� - i r r �.. I# �T� � � - � - r � ,
i-32:_Electricad Pov¢er (c3:tel;;Final i ,yc n; �(� �tx x t+80.[¢OOD CEFiTIFICF�fE IS&UED
..33.`�in`a�`1Electri� tS* ' � C :rrn j I li.:>.��^ �r. CT •��': :e [•^,
5_ S � [sl?' r7 I '2 � �.�` < 'Notes: ' �j:i :K'7 1� �Z,t�
i� R� ,\ �' 1 i- t- �, x t� ' J+. .T t-� v. � n. ..
R34.rFin. ,: Heating & Air.�Conditio�ie19� �; .* f � � y. .� S r�x ti y- CyC
�i !.. ! M
35 �`.Finat Gas PiP�-TeF[�° •. � �' * •., F � �` �` �: �o ��i-S- i !+' :SO
i : � �� � . r- ./ � :. . ' [-r,.
�36." Foosl or,-`�,EanoPv j > : t^ -� •• i. ±� � �,� �'-r a tl:� • • i � �
_ .�• i ;d�'.
;�7.�in� Factory Fir�' ceF i N� � � �'� ' /� � :� >: � K � tn
P�� � ,, ;� N
r-38. Finab PlCmbing p�- ��„ �.• •• � y: � I q�!j� S H 1. �D ;j
� � �
+'39. Wat€� Service-�Fjnal� � �i .-' f i /' k. �l at*5 �: t� O
n� �u :.r � i +� I �':� :r » o a. s
�40. Gas Ser CB-� B�� � , fr� c� �r ! }�* :1, r � � � �
,.J' .� ia G. i s x.� ' `� ra ,er�� t
F11. Solar pomest5c-Fi al S : �` •• r� �� �n :Lro ; �.�.
�-s r, , m a� ' � �. .v �r � :•b yC^ '1: T. J
c f• z. [�s n} ;Y. :.�.. � � . a :-1 � •i .[
' 42.`Backflo�v Preventer.�_ tu - � ; � ,e :a �r, jF-. • . •;, �-,
43. Backflow Irr ✓a[(tanr � �SS :k � �»: .t tSt�o;. .� p � .-,
� . � y :'r. :r; � v ;v N � .� - ?. ;1 •
44. Landsc e I�!; atio? System `�� �' � � ^ '� `- �
�:; ?A C^9 � ArT7!J l:: :fnp. r t:� C7.r.:: ir N O: � `:1:.-� �. ii� .n
SAS.;=�ound Atteiw s tt� ��FE- C .�� ��e-� c- HT. �� i-� ��� - 7G �0.��t �` -
> rt ta .:k r c' o"�. 'st :-�:�. �
x ' M' .
„ .. ..
�6.�.HandicaP.R�ul�io,{�s .� � .k:n ' ':*.r.• � •.S . :c;� ��'�T':' �:
47.�FINAL STRtICTURE &�BUILDING � �� O 4. � . � "z s ., . � _ � :R . � ,
r , i c.s z �
46.�INAL PLANNINC� ' � t�F �� p, � �� x�e i? - rTi ,.� �: x i- ,v
rA9.r£leixric Releasr�,io Edisbn � � �_ - 1 � /�r� 5 �� ' � i rc . w
.r, T ✓ .� - x ' �',.b. r �r. � � •Cl r ��
�
,`50.•�Gasfielease to"Soufhern Calit,o[nia. Gas Co � I � �s_ .Y, ;� _ - p , ppj '�� �j
�51. CERTIFICATE OF.;OCCUPqNCY' y :: �. '� i��, ;t jc �. ,�
No. Date
�
�.' I
�' cn
! l��
J.�
�si �
' � r�
,' `' /
OWNER
� JOB AD
� GENER
� t >_
pppIN�rEC
� SOII
GAS
W PTER
ROUGH PLUMBING
MISCELLANEOUS
ROUGH HEATING ANO AIR CONOITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUNO � POWER �
kOUGH WIRING
TRENCHES FORMS � STEEL REINF.
FLOOR SVSTEM
FRAME AND FLASHING
LATHING — IN �
Pl'-�ER,BROWN COA
5 �URAL, FINAL
HEniiNG, VENT., REFF
PLUMBING. FINAL AN❑
ELECTRIC, FINAL
BUIL�ING, F �'INAL /'�,�
DATE
FIRE ZONE VALUE
GROUP TYPE
, SUeCONTRACTOR
.:
Room to
Z .
dU
Z
Z Q
O v~i
C p]
J �
J N
UN
Za
W �
d W
J �
m Z
J �
W ly�
O=
zF
W �
� �
�"'
z
Q
U
J
�
H
h
z
0
H
U
�
�
H
N
z
29��0
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626
' PAIU
DEC —5-66cry5100 334x ****17.i)C
APPLICATION FOR BUILDING PERMIT
ForApplicant to Fillin Completely RECEIVED BV DATE RECEIVED
, . DAJ� 16SS1ED �
BUILDING � (Q
ADDRESS ' s'
PER T NO ;l
OWNER A, _4 A.P. NO. ' - V
MAIL . BUILDING �
ADORESS y)'S -NU�+ R� />DDRESS
TEL. TRACT b LOT BLOCK
c�rv No.ryr—ozv
CON5TRUCTION W A' A P
LENDEF n _
BPANCH
OWNER
ADDRESS VALVE
ARCHITECT TEL. SE 3
OR ENGINEEIi N .
FIRE
ADDRESS ZONE TVPE GROUP
APPROVED fj /
CONTRACTOR � ut BV ATE� �b
AD�FESS E1 ,- �. p � � ZONE NO.OF USE OF NEW
TEL. � PLANS BUILDING
cirv No. _ .G �-
STATE CITV �'ARDSAPPFOVED VAq�SAPPFOVED
LIC. NO. S- Q LIC. NO. MAIN BUILDING ACCESSORY BUILDING
SIZE NO.OF BLDCS. (FROM C/L STgEET)
OF LOT NOW ON LOT FRONT yFT FT. '
�
USE OF '
EXISTINGeLDG. Q�^/y�; LL FT. FT.
SIZE OF �C" �s'NO. OF
NEW BLDG. 'LH " i""-POOMS STORIES L. SIDE FT. FT.
E%TERIOR WALL ROOF n
COVERING COVEFING REAR d FT. FT.
USE OF BUILDING AND WORK TO BE PERFORM / DISTANCE BET. BET. MAIN &
o - �.,i.t,. C� MAIN BLDGS. ACCESS. BLDGS.
VAIi.# DATE
' C.U.P.#-` qPPROVED
APPROVED
I hereby acknowletlga that I have reatl this application antl stata
that the above information is correci antl a0ree to comply wkh
all laws regulating builtlinB cons[ruction,'antl I shall not employ
any person in violation of the workman's compensation laws of
ihe State ot California. , � �, W
i SQ. FT. �
I hereby certify thax I am properly licensatl as a contracior untler �
the State of California Business antl Professions Code, �ivisicn 3, THE AMOUNT SHOWN UNOER VALUATION IS FOR �
Chapter 9, antl ffiat such� licenses are !n full force and eHect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: m
am exempt trom the provisions of the Siat¢ of CalifOrnia Business ¢
antl Professions Cotle, �ivision 3, Chapter 9. VALVATION /�� �
.wl PERMIT FEE $ �
U ��
Signature ot �J ,^
Petmittee � Us . �s .. �li.. $ �VD PLAN CHECK $ � E
/ `o
AuthorizetlAgent � �^ LL
TOTAL FEE $
�.. `.� I9506 �`L4 �.�;aW_��,' ��
COSTA MESA BUILDING-SAFEfY DEPARTMENT ��AY? ° 1963
P. O. BOX 917 C09TA M66A. CALIFORNIA j�
� fINP,10E DEPT..
For ApplicaN to Fill In Completely APPLICATION FORCPERMIT�ES�
TYpE OR PRINT � BUILDING �
for OHice Use Only
BUILDING � . � '
� ADDRESB 2756 Mendoza Dr. - necB�'in0. p�����_
� COSTA MESA, � CALIFORNIA � �
, P[CC� [D �Y OA C[C61V/�D DATEIS9UEO
OWNER Macco Realt Co. � o�/_ MAY 2 8 1963
' � BUILDING �
ADDRH49 3800 E, Coast Hi t1W8y ADDRfiBH
FIRE
��Ty Corona del Mar� Calif. No � OR 3422 ZONE TYPE GROU
wrrrtureu
ORENGINEER Macco Realt Co.�NE�'OR 3422 BY DATE�'
ZONINf; �
w ss �Same as above zon r+o.or I �seorwa �n.
./ �u emloiH' •
CONTRACTOR MaCco Realt CO.
L80AL
aooRcss
Same as above o��a�mor, Lot 38 Tract 4784
A. P. NO.
CITY
N07E: NO EAVE OVERHAN6 SHALL BE LESS iHAN
ucTNo. 207343- - 1 neL� OR 4 90' T031Dfi @ REAR P. L. .
EAVE9
SIZE 72 x� 93 I NOW ON tAT�one '�'LLOWED �U. B. C. REQUIRHM6NT)
OF LOT .
YAR�BAPPROVED YARD3APPROVED
USEOF MAINBUILDING AGCESSORVBUILDINB
EXISTING BL�G. � RORE
, /FROM C/L9TREET] '
HETBACK LINB PROM /, H� REAiI YARD33' �6" PRONT FT.
C6NT8R OF 8TP661' Y
SID6YARDI LEPT 9� - ' I RIQHT J� R.81D6 C FT. Rf.
DESCRIPTION OF WORK �. sme C Fr./ Fr.
NF' X ALTERATIpN ADDITION REAR� � FT. ` ` �7�
. DISTANCE BHT. BET. MAIN 8
R• M VINO DfiMOLIBH MAIN BLOGB. ACCE85. B1.O68.
BUILDIN6 NO OF ' VAR.�j DATE -
512E S�i �X�il �^(��� ROOMS � RIES� pZ C. . P. APPROVE/D
EXTERIOR WALL � ROOP . `���//�1 -= APPRO D ,� .1 �� G
COVERING gtUCC COVERIN6 a" BY DATE
U8E OF BUILDINB ANp WONK TO B PERFORMBD
Single fam, res. w�att, gar.
Plan No. 500-B
Dwe��in' sc.Fr. Gar, 460 S.F. �
m
1 HEHEBY ACKNOWLGOOp TNAT I HAVE P6AD TNIB APPLIC�TION TXE AMOUNT 9HOWN UNOBR V�I.pAT10N 18 FOR THH �
AND 6TATE THAT TH6 ApOV6 1� CORRECT ANO AOR6[ TO COM. PUFP09H OF iBTABLI8HIN0 A PEHMIT FEE ONLY. �
r w�rn w�� c�rr onoinwwcro wno erwn uwa R[oui.�nno yqLUAT10N
BOILOINa CON9TPUC}IOry, H
� PERMIT FEE $ �,Sr' p
SIGNATURE OF
PERMITTE �j
$ 23,925.�0 A HECK ~ ��� p
AUTHORIZED AGEfiT � LL
' TOTAL FEE S //��,�d