HomeMy WebLinkAbout3257 NEBRASKA LN - Building Permits�
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Job Address: 3257 NEBRASKA LN
Suite:
Vicinity: ROOF
Parcel Number: 13906410
Applicant: JONES, BILLY
Address: 2040 N SACRAMENTO
ORANGE,CA
Owner: STALLINGS, JON A
Address 3257 NEBRASKA LN
COSTA MESA, CA
Contractor: B & J ROOFING
Address: 2040 n. sacramento
ORANGE,CA
Zip: 92867
Arch :
Address:
Status: ISSUED
Applied: 10/03/2002
Issued: 10/03/2002
Zoning:
�
� : �►y�
Phone: 714-637-5609
Zip: 92867
Phone: `,�
Zip: 92626 �� y �
�'� I p
�p.R�
Phone: 714-637-5609
License: 366956
Eng:
Address:
Phane:
Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 1/2 CDX PLYWOOD, APPLY 30# ASTM FELT, 30 YR, CLASS A COMPOSITION SHINGLES. 2,800 S.F.
INCLUDES ATTACHED GARAGE.
Plan Check: $0.00
Permit: $125.25
SMIP Res: $0.60
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $125.85
ry
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existin : 0
Rear 0-0
Rear 0- 0
Re uired: 0
FEE SUMMARY
PLANNING & ZONING
LeR 0- 0
Lek 0- 0
Pro�osed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
ss,000.ao
ss,000.00
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, § t, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspendetl or abandoned
tor a period of 1 BO days.
INSPECTIONS: In order for the work au[honzed under this permi� to be considered legal, such work must comply with all applicable codes, and all
requlretl inspeetions and final epproval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (774) 7545626
?44F4fi (6/00)
WORKEAS' COf�'ENSATION DECLARATION:� � �
C 1
I hereby eflirtn untler penalry of perjury one ot Ihe following tleclarations: ,
❑ I have entl will maintain a cetlificate of consent to self-Insure tor workers' compensetion, as provitlea for by section 3700 ot ihe Lebor Cotle, tor the peAormance of the
work for which Ihis permit is issued.
❑ I have enC will malntain workers' compensation insurence, es reqWreO 6y section 3700 0l the LeDor Code, for tha pertortnance of [he work For which Ihis pertnit is issued.
My workers' compansation Insurance cerrier antl policy num6er are:
Carrier: Policy Number:
(This secfion need not be complefed il the permit is valued at one hundretl dollars ($100) or less.)
certify �ha� in �hgperfommncg o� �he work for
THOUSAND OOLLAPE ($100,000), IN ADDITION
LICENSED CONTRACTORS DECLARATION:
I shall not employ any person In any manner so es to become subJect lo the workers'
� to ihe workers' compensation provisions oi Section 3700 of the Labor Code, I shall forthwllh
�_ �Date. �a � O 3 — d �
IS UNLAW FUL AND SHALL SU9IECT AN EMPIOYER TO CRIMINAL PENALTIES ANO CIVIL FINES UP TO ONE HUNORED
\iION, DAMAGES AS PROVIDED FOR IN SECTIQV 3]O6 OF THE L4BOR CADE, INiEREST, AND ATTOPNEV'S FEES.
Section 7000) of Division
.-
and my licensa is in lull
CONSTRUCTION LENDING AGENCV: �
❑ I hereby aflirm that there is a consiruction lending egency for ihe pertormance of ihe work for which ihis permit is issuetl. (Sec. 3097, Civil Cotle).
Lentlefs Neme: Lender's Address:
Signe�ure:
Date:
OWNER-BUILDER DECLARA710N5:
� ��'�,
I hereby ettlrm tha[ under penalry of perjury that I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5, Business end Professions
Code: Any city or�county which requires e permit to constmct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant tor such permit
to tile e signed stetemenf Ihat he"or she is licensed pursuant to the provisions of the Conirectors License Law (Chapler 9(commencing with Sectlon 7000) of Division 3 of ihe
Business and Professions�Coda)'or�thaLhe or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by eny applicanl br e permi[
subjacts tha applicant to a civil panalry oi not more ihan five hundretl dollars ($500).):
� •, it
❑ I, as owner of Ihe propeny, or my amployees with wages es their sole compensetion, WILL DO TME WORK, antl the strudure Is not Intendetl or oHeretl for sale (Sec.
7044, Business and Professions Code: Tha Comractors License Law does noi apply to an owner of property who builds or improves Ihereon, and who tloes such work
himseN or herseN or thwugh his'or her own employaes, provitled ihat such impmvements ere not intendetl or oMeretl tor sale. If, however, Ihe building or improvement is
sold within one year of completion, the owner-builder will have the burden oi provinq that he or she did not build or improve for purpose of sele.).
❑ I, as owner of the property, am EXCIUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct ihe prolect (Sec. 7044, Business and Protessions
Cotle: The contrectors License Lew tloes not epply to en owner ol pmperty who builtls or improves Ihereon, antl who contracts for such prolect with e contractor(s)
license pursuant to ihe Coniractors License Laws.).
❑ I am e:empt under sea Business and Pmfessions Code br this reeson:
SiqneWre: Date:
Owner ID veniietl by tlriver's license. ❑ Yes ❑ No Dnvels License No.
Verilication ot Ownership by pype of dwument, i.e. - property tex bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
Expires:
❑ I hereby certity that no excavation five (5) or more feet in depih into which e person Is required to descend, wiil be made in connection wit� work authodzed by Ihis
permit, and that no building simcWre, scaflolding, talsework, or demolition or dismantling thereof, will6e more ihan thirry-six (36) faet high. (Chap. 32, Grp 2, Art 2, Sec.
341, T�le 8, Califomia Admini5lretive Code).
❑ As owner-builder, I will not employ anyone to tlo work which would requlre e permit from the Division of Industrial Selety, es noted abova, unless such person hes e
partnit to do such work irom the division.
Signature: Date:
Division ot Industrial Safery Permit Number.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATON OF ENTAV: I certity under penalty of perjury that I have read ihis ep0�ication and stale Ihat the informatlon given is
correct I egree to comply with ail stete laws entl city ordinances relating to builtling consiruction, and authonze representatives of the Clty ot Costa Mesa to enter upon the
ebove-described property for inspection purposes. I egree not to occupy or allow occupancy of any builtling euthorized by ihis permit until final inspection.
COOE Y.
1616
1266
Fiaed System Final Fire Prevention
Pool Spe Final
200 Finel Re-Root
201 Finel Block/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
- �. 204 Final Demolition
Q� INTRIALS
LO�E♦ INSPECTIONTYPE
206 Final Mechanical
20B Final Plumbing
210 Finel Elecincal
212 Flnal Fire Prevention
220 Final Planning Approval
222 Final Site
250 FinelBuiiding/OCcupancy
�
PdiE II�ELB
Property Profile
- Property Profile
O 2003 DntaQuick InCortna[ion Systems
"fhis intormation is compiled 0'om public documcn[s and is mt gua�nn[ecd.
Property Giaracteristics
Bedrooms: 4
Bathrooms: 2.0
Total Rooms: 7
Zoning:
Heating/Cooling:
Sale & Loan Liforneatio�i
Transfer Date: 01-14-1997
Transfer Value: $191,500
First Loan Amr. $197,200
Loan Type:
Primary Owner: STALLINGS,JON A& KAREN T
Secondary Owner.
Mail Address: 3257 NEBRASKA LN
COSTA MESA, CA 92626
Sitc Address: 3257 NEBRASKA LN
COSTA MESA, CA 92626
Telephone Number: (714) 424-0773
APN: 139-064-10
Reference APN:
Census 7'racr 638.052
Housing Tract Number: 3722
Lot Number: 11
Page Grid Old: 27-C2
Page Grid New: 858-H4
Legal Description: N TR 3722 LOT 11
Subdivision:
Year Built: 1960
Garage:
Fireplace:
Pool/View:
Seller:
CosUSq Feet: $ t 2029
Lender. All Pacific Mtg
Interest Rate Type: F
AssesseJ & Tax /nformation
Assessed Value: $211,124
Land Value: $139,236
Improvement Value: $71,888
Percent Improvement: 34.05
"I'ax Amount: $2,393
Tax Statur. curren[
Square Feet: 1,592
Lot Size: 6,500 sq ft/ 0.15 acres
Number of Units: 1
Use Code: Single Family Residence
Document 0000020253
Title Co.: Fidelity National Title
I_ast Trans W/O$:
Last Trans W/O$ Doc:
Homeowner Exemption: Y
Tax Rate Area: 15045
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PflOJECTFDO8E5S: 3ZS% NEBRASKA LN
OWNEfl'S NAMF: BARNES HETTY I
aoonEss: 3257 N�BRASKA LN
� COSTA MESA,CA 92626
ANCHIENGINEEfl:
aooness:
NEG.NO.:
UNIT:
uxir:
PEflMITTEE: GRAHAM BROTHERS ( 714 ) 546-1653
anoeess: 2952 CENTIIRY
COSTA MESA CA 92626
LICENSEO CONTBACTOB OECLABATION: I hereby a��irm ��a� I am Iicen5e0 under D�ovisions oi Chapter 9(cammencing wi�� Sec�ion
7000) ot Division 9 of l�e Business an0 P�otessions Cotle, antl license is in tNltoice antl efl�
ciTruc.: 05963 STATELIC.:24S q ciass: C_z
Dale: Signature _
WOflNEflS' COMPENS TtON OECUMTION: I �ereEy aifirm t at I luve a ce�ilicate of consent m selbinsurt or a cenilicate ol Workers'
ComDensation Insurance. or a cenilied copY �hereol (Sectbn 3800, Lab. C�.
�roucrNo.: WC7161030226 EXP.DATE: OB�OSI9Z
caMvaxr: LIBERTY M�UAL
❑ Cenilie0 cooY �s hereby lumisnetl. Cenified c is ble 'in ihe city Builtling D/iy�6f0'�
Oaie: 1_T -`Z� '- 1 l Npplica ' "� j� / \Cl
EllEMPTIONFflOMWOBI(Efl5'fAMPENSRTI0N0EClABRT10N: (ThissectionneeAnolhecompleteGdthepermilisloronehunOretl(5100�orless�.
1 reriiiy �hat in Ine pedormance oi I�¢ wofk �or which ��is permil is i55ue0, I shall nol em0loy any Derson in any manner sa as to become
sublecl Io IAe Workert' fAmpensaiion L7K's ol California.
Date: Signamre:
NOTICE: II, aller making ihis OeclarAlion, you shoulC beCome sublect to t�e Workers' CAmpenSation pmnsions of ihe Labor
Co6e, you musi tonhvnih rompry wiih Suc� Wovisions a ttris permit shall Oe 0¢emed tevoke0.
CONSTflI1CTI0N LENOING AGENCY: I pere0y aifirm tha� Ihere is a canslmction lentlinp agency �or the pedormante ol t�e work fo�
wAicn inis permit is issuea (Seciion 3091. Civ. CI.
lFNOEP:
RDDflE55:
OWNEB BUILOEfl DECLFflATION: I �ere�y aifirm ihat I am exempt irom t�e Coniractors' State License Law lor roe lollowing reason
(Seclion 7031.5 Business antl Prolessional COAe: Any city of county which requires a permit to construct, aller, impmve, demolish, or
r¢pair any 51mClure. prior lo i�5 issuante. al5o reqUires Ihe apDlitan� bf Suth permit �o fil¢ a Signe� 5tatemenl ��al �e/5he is litensed
pursuam lo Ihe provisians oi IAe CanVaclOrs' Slate License Law (Chapler 9(commencinq wi�h Section 7000) of Oivision 3 of ihe Business
ana Profesvans COOe� ar ihat he/she is eKempt theretmm ana �ne basis lor the allepeU exemption. My vioWtion al Section 70.i1.5 oy
any ap0�icanl for a permit 5u01��s I�e aD�liwnl �a a civil penaltY al noi rtqre Ihan five hunCred dollars (SSfq�.
I. as owner of ihe o�ace�Y er rtry emyloyees wiln wages as ineir sole compensation, vn0 Oo IAe wdlt, aM the
� simcture is nol in�enaep or olle�e0 �or ule (Section 70aa. Busmess anG Pmfeuional Cotle: The Contractori State License �aw
Ooes nol aODty to an ownei ol a propeny wlw huilds or impmves t�ereon, an0 w�o does such woA himsell/Aerself or t�mugA
his or her own emD�oyees, OmviOeU ��at such imDmvemenis are not inlentletl or otteretl lor sale. II, however t�e huilaing or
improvemenl is 5010 wilhin one year oi complelion, th¢ owner will Aave Ihe 6ur0en of proving �e/she dia nol huild or impmve
lor Ihe DurpOse ol Sale�.
I, a5 owner o� Ihe pmperiy, am exclusively conVading with IicenSeA conlraciors lo cons�mct the project ($eclion 7044, Business
❑ anG Prolessions Code: The Cantractors' State Licenu Law Ooes not apply to an owner of Pmperty who bwl0s or impmves ihereon
an0 who cantracts for such O�oiecis wilh a conlraclar�5) license pursuan� lo Ihe Cantr2clors Sla�e LitenSe Law). I am awar¢
I�al proof of their Workei s ComDenu�ion insurance shoultl Ge pmnGeO �o me.
� I am exempt unaer Section: B. 8 P. C.
lae Ihis reason:
Date: Ownec
I eo nereey cenily Ihat I am aware ol ane unaerstanA t�e repuiremenis of Caiifomia Healih anC Satery Code Sections 255Q5, 25533, ana
25534 an0lnat I or any tu�ure Duildmg a4upant wilVwill not (circle one) nee0 �a comply wiih said s�a�e wees antl ��e re0uiremen�s lor a
permit lor con5imtlion or motlilicalion IrOm I�e Air Ouabty Managem¢nt DiSiricl. peSiGeniial conSVuction apDlicaiions are exempi �mm
these provisions.
�a�e: ApPlicanP.
I hereby cerlily Iha� I have reaa IhiS appliCalion and Slaie Iha� Ihe abOve inlorma�i0n is torretl. I agr¢e t0 tomply wilh all ciry antl couniy
or0inancesanCstatelawsrelalingtoUuil4in9�onslmc�ionanG am�onzerepresemalivesoflAisci emeruponl�eaGove-memioneG
p�op¢hY foi im,peclion pwpos¢5.
Date:� 2' ZT -� � _ Sigremre. ��t
Driver'S License or Social Seturiry r: �
lfiaba6 W�pe—Butldma', Green—Coda EnlorcemenC Canarv—Aoolican�; Rnk—Revenue: Go�tlenrotl—Assessor
CITY OF COSTA MESA - BUILDING PERMIT
PERMIT NO: M 055623 PLAN CHECK NO: N
CONSTRUCTION TYPE; PERMIT TYPE: MEC
JOB DESCRIPTION ; FAU CHANGE OUT
CLAIM VALUE; CALC—VALUE:
PERM NO: M 05562
GOVT; N SUPP; N
PURPOSE; OTH
SQ FT;
GROUP OCC; R-3 /
COMMENTS: NO HLDG. PERMZT INVOLVED
****�***+��*+�*+��***�***��e�****�**��c***�e�*�******��*��r�**��r*�r**�r**+�*x�*+��*+�***�***
Z 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
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN 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; 13906910 ZNE: REF NO:
PLANNING NfSTES>
i
***�*�r�**�*********�r*�+��**+��*��*���*i���*��*��**�******��*���+��**�*�*+�**�***�***
D E V E L O P M E N T S E R;'V 2 C E S R E Q U I R E M E N T S
lr'
ZONING APPROVED BY "1 DATE;
BUILDING APPROVED BY ;
DATE;
APPLICATION ISSUED BY; ,= / DATE: �2��7�r�
iF3f1EiFlFifkiEkkiFititMiffflf�FM1EiF3E *{E*aF3E*k*{F{E **
ififlfiEiflflfikifiFiE�f�EiEkiEifkIFlFlFiFiEjfMitMiFkifiklFlFlflE3fkit1ElFifif If�fififiFlFafiEilkliififif3ElE�FIFIfikiElEiEififiFiEiFiEiFiEiElFiFif
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:N
PERMIT BLDG PMT PLUMBING ELECTRIC MECH9N00
ZSY
ISSUE FEE ',. 15,00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 9,00 15.00 0.00
FIRE SMIP/RES GRADING
SMIP/NON—RES
TOTAL PAID DUE
24.00 24,00 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 24,00 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECR
� 24.00
�1
if if 1E if if ik if �f 1E �f 3f iE iF iE �f iF 1f IF iE iF jf IE iE if k�t k If If k if jF If ik if if iF iE ik iE If iE 1E if iF iE 1F k iE 3f iF If M 1f IF ff iE iFif iF iF iF If ik if 1E �E af If iE iE 1E �f iE iF iE IE * iF
I N D I V I D U A tI. F E E B R E A K D O W N
TYPE QTY D E S C R I P T 2�0 N UNIT COST TOTAL COST
MEC 1 INST FORC—AIR/GRAV�FURN <= 100 R BTU 9,00 9,00
.END OF FEES
r. - ' _. ...�i , � .
� H . �.. �_ � ' �. .
CdNSTRUCTION AND PLANNING F �& SPA
APPROVALS Permit# Date Inspector qppROVAIS Permit# Date Inspector
, 1. `Temporary Elec[rical Servic� or Pole., . 52. Pool & Equipment Location
2: Soil Pipe�Undrgrnd. _ 1�� �-� . 53. Steel Reinforcement �
;- 3: EI¢ctrical Conduit Utility-Undrgrnd. I 54. Forms
_ 4: EI¢Ctrical Conduit-Undrgrnd. 55. Electriwl Bonding
�5. StEel Reinforcement' , 56. Rough Plumbing & Pressure Test
-� ElaitricalUFEq�Grnd. ' 57. APPROVALTOCOVER�GUNITE
:T. Footings - ' 58. Electrical Conduit�Undrgrnd.
� 8. Foundation , � �� 59. Gas Pipe, � Undrgrnd., Test ,•
'�9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undr9rnd.
10. Structural Floor System � 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Finat
12. Sewer Cap � � - ' 63. Heater & VenrFinal '
13. Roof Dreins ' 64. Plumbing System � Final �
14. Rough Plumbing ' 65. Electrical�Finai
15. Rough Electrical-Conduit 66. Solar SYstem•Final
16. Rough ElearicWiring � 67. Fencing & Access Approval
17. Rou9h Wirin9 Sign 68. APPROVED FOR PLASTERING �
18. Rough Elettriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. fiough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
- - - i - -
20. Rough Facto� Fireplace � x '� � � ' - APPROVA4S Permit # ' '
- �_ - a:
. . r - ., '_' - 1
21. Ducts, in•Strustur'e . , .. j .. � - . 70. Underground:Hydro �
22. DuctS, Ventilatin9 � " � _ - �77. Product�iping OGas L7Uil
23.'6as Pipe�Rough &'7est , , - ,�. �. 7z, Underground Flush . ' �
24. Roof Freming _. � i � �'R -�73. Undergrnd: Storage Tank O Gas ❑ Oil
25. Roof_Sheathin9 � r -� �� 74.'�Overhead Hydro
26. T�Bar Ceiling iStructurall & Monowat - 75r ry Chemical '�
27. Frame and Flashing- `.� _ � ' . 76. bry Standpipe �� ` � ''
28. 'lathing & Siding'� . _ ` • •�* - 77.' FIXED SYSTEM-FINA� _
29. Insulation . - � �� . .°, ' 78. FIRE PREV. FINA�1+ A � ^
�c'i0. Drywall NaiGn9 � � � � � �� � HEALTH DEPT. REQUIREfv1ENT
�
37. PlasterBrownCoat� , ,., ° � ,79. FINALINSP.ECTI�N -
32. �Electricai Power ty9eterF�nal � � %-,� . .$O..FOOD CERTIFICATE ISSUED �
33. Final Electric - - � � �Nofes: j(2�QZ �`(C,pf-lrG(-kOM�Q-(.��prj GQldD-• (�F.G
�34. Final•Heating & Air.Conditioning, �iq/i'ir . G�� , ". -` � : � '
{( T �
35. Final Gas Pipe-Test . " - ' '� - �� ' .� �
i �
36. HooSi or Canopy ' � _ � • �� a �� .
37. Final Factory Fireplace > • ` � � ' -
. _
38. FinaJ;Plumbing . � . �� � �� ' V'� - � �
39. Water Service-Final � - � ' � • '� '
� ti
.40. Gas Service-Final ' ., r ' ' , - � ' _�
41. Solar pomesticFinal ' ' - = ' "
42. Backfiow Preventer " - - . - . . .
43. Backflow Irrigation� - � _ - ` .
,�.
44. Landscape Icripatioo System, �� � � �� . . � � ' _ �_
�45. Sound Atte2Uation ' - " � -�
46. Handicap flegulations � ' • ', � , �
�47. FINAL STRUCTURE & BUILDING , � • �. �
48. FINALPLANNING ' -' : � '
49. Electric Release to Ediso� ., _ �� � � � .
50. ,Gas Release to Southern California Gas Co '�' .. = y - -. '
.,
'S1. CEF�TIFICATE OF OCCUPANCY� , , ; _ ' "
No. Date
Lor 11
TR 37ZZ . 1J�.N�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. p, gOX 917 C08TA MEBA, CALIPORNIA
For Applicanf fo Fill In Complefely
TYPE OR PRINT -
BUILDING 32r�7 NEBRASKA LANE
ADDRES9 I
GOSTA MESA. CALIFORNIA
owNER K B� E DEVELOPMENT CO.�INC.
MAIL ___ _
TEL.
■STATE . .__ TEL.
65X t oo � N°w��N ,�oa.
USE OP
EXIBTING BLDG
BHTBACK LINH PPOM C�O � ZO �
CENiaR OP BTRB� l REAR YARD
/ /
SIDE YARD I EFf RIGHT
D�SCRIPTION OF WORK
EXTERIOR WA4L ROOP ���� `!^ �
GOVERING iTll[f(1 COVERING
USE OP BUILDING AND WORK TO BH PHRFORMED
FIRE
ZONE
APPROVED
ZONe
R-1
L86AL
FEE RECEIVED
�-OCT 241960
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Ofiice Use Only
aEceirr no. . PaRM�TiN4.
BY DATH H 1 ED DA1! 18SUED
- ///=��,Gd ��� z ; �sFa
COSTA MESA.
ZONING
NO.OP U88 OP NEW
PLANB 2 GVILDING
LIHe BT.1
MPROVED
EVES
I HBPEBY ACKNOWLEDGE TXAT 1 HAVH RBAD TH�B MPLIWTION THg .�MOUM BHOWN UNOEP V�LUAT�ON IB POR TXE
ANO BTATE THAT TH¢ A90VE IB GORREGT AND A6RE6 TO COM- pYPP09E OP EBTABLIBNINO A PEPMIT FEE ONLV.
PLY WITX ALL CITY ONUINANCEe BTAT •LAW9 RBGULATN6
aULLo1Na CONB�tu oN. �. VALU� I��h � PERMIT FEE $<i�V� '�
SIGNATURE OP ��,///
PERMI7TE 1' , V �( y/�
S J � PLAN CHECK $ ��/ �
'AUTHORIZED PGENT I J J-� I�
TOTAL FEE $