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Home My WebLink About1713 ORCAS DR - Building Permits PRO.IECTAD?KESS: 1,713 ORCAS DR UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: P 05070: OWNER'S NAME: L>•:HAN, THOMAS GEORGE ADDRESS: P 0 BOX 2523 PERMIT NO: P 050705 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA, CA 92626 CONSTRUCTION TYPE: V-N PERMIT TYPE: PLU PURPOSE: OTH 714 547-7148 ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : REPLACE WATER HEATER SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 / PERMITTEE: EARLS PLUMBING ( 714 ) 772-3470 ADDRESS: 1533 W. LINCOLN COMMENTS: INSTALLED WATER. HEATER ANANHEIM CA 92801 ***-*****4**-%#.*9f***************************'X**Ix*X''-X-X**')'X-******#*-]y•*-)F-X-* G****%X***.*3E LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SETBACKS urruc.: 09593ffl STATE LIC.:2 1 7 6 5 S: J'- Date: /7-2-1/v/ Signature:_ a -Lo'z^ - -- MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: (hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT: FT IN REAR; FT IN LEFT: FT IN RGHT: FT IN LEFT: FT .IN RGHT: FT IN Compensation Josyrdpc21 o a certified copy thereof(Section 3800.Lab.6)3/01 /91 < POLICY NO.: V`k 66 EXP.DATE: V coMPANY: BEAVER ,+,5 PARKING REQ: PROV: PARCEL: 13915217 ZNE: REF NO: I: Certified copy is hereby furnished. 'L1 Certified copy is filed with the city Building Division. PLANNING NOTES> ��q-^-'�J/ > Cate:_L/Z 3/9/ Applicant: c- ""�"`.+ **x'X'*******%**•*IE*ifXX*1E**3E*fE**X********X****X**#X****y.>E*K*IEie3E****1F***K.***X*MX**?E EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIR EMENTS I certify That in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California. ZONING APPROVED BY DATE; Date: signawre: BUILDING APPROVED BY ' NOTICE:If.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. S1. --7, / / ., . CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• c . -4 DATE: S which this permit is issued(Section 3097.Civ.C). *****'****X.************grit** c " ***** **************X-************lrlf ir+E to***- *** LENDER: ***jE********************************* tf***-)E**********************•***********34* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N • OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 2 ,00 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 25% SMIP/NON-RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 3 , 00 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS---—> 2 . 00 3 , 00 0 . 00 5 , 00 5 , 0 0 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 5 . 00 OVER/SHORT: 00 improvement is sold one year of completion,the owner will have the burden of proving he/she did not build or improve foror the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK - I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 5. 00 ❑ and Professions Code: The projects with.a License Law does not apply to an owner of properly who builds or improves thereon ******************************************************************************* and who contracts for such Contractors' with.a eLice License )license pursuant to the Contractors'State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BRE A K D OWN ❑ I am exempt under Section: B.$.P.C. for this reason: / TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Dale. /��/940. Ownery PLU 1 WATER HEATER AND/OR VENT 2 . 00 2 , 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,andEND OF FEES 25534 and that I or any future building occupant wit/wilt not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from ' these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county . ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for Inspection purposes.� /� r 01 00079129-00079129 T4 O 5,,.. Date:./414,Af Signature: . X DATE: Q1/2 /91 1'Ii1E: 1 :46 r_ Driver's License or Social Security a: 164646 White-Building.Green-Code Enforcement:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor CONSTRUCTION AND PLANNING PC & SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector Temporary Electrical Serviceor Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test . 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE '7. 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 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 & 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 0 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 I 78. FIRE PREV. FINAL 30. Drywall Nailing I ( ! r.' HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat I-' I 79. FINAL INSPECTION 32. Electrical Power Meter-Final I1/ 80. FOOD CERTIFICATE ISSUED 33. Final Electric I -:J Notes: • 34. Final Heating & Air Conditioning ( ` 35. Final Gas Pipe-Test 1 _ 36. Hood or Canopy j 37. Final Factory Fireplace 38. Final Plumbing eft Mr A 39. Water Service-Final I{ 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison :•L� 50. Gas Release to Southern California Gas Co i -i 51. CERTIFICATE OF OCCUPANCY . No. Date IPR0JECTADDAESs: 1713 ORCAS DR UNIT: • CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 051931 OWNER'S NAME: LEHAN THOMAS GEORGE ADDRESS: P O BOX 2523 PERMIT NO: B 051932 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA,CA 92626 4 CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT ( 714 ) 546-7494 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : RESTORE CONVERTED PATIO COVER & GARAGE SQ FT: 400 ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: 10, 902. 80 GROUP OCC: R-3 /M-1 PERMITTEE: THOMAS LEHAN • ( 714 ) 546-7494 ADDRESS: 2523 P.O. BOX COMMENTS: RESTORE STRUCTURES TO ORIGINAL LEGAL USE COSTA MESA CA 92628 ***************************+E*****************************RETE**+t***************** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R E Q U I R E M E N ,T S 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS CITY LIC.: STATE LIC.: CUSS: MAIN BUILDING ACCESSORY BUILDING Date: Signature: FRNT: FT IN REAR: FT IN FRNT: FT IN REAR:. FT IN WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab. C). • .POLICY COMPANY:NO.: EXP.DATE: PARKING REQ: PROV: PARCEL: 13915217 ZNE: R1 REF NO:J Certified copy is hereby furnished. El Certified copy is filed with the city Building Division. PLANNING NOTES> RECONVERTING AN ILLEGALLY ENCLOSED PATIO TO AN OPEN PATIO ' > COVER. Date: Applicant' ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMEN T SER VICES REQUIREMENTS 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 ZONING APPROVED H Y subject to the Workers'Compensation Laws of California. DATE: Date: Signature: BUILDING APPROVED BYpit/L e_, � DATE: NOTICE:II.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: -- Y: _ . DATE: 037, '3� which this permit is issued(Section 3097.Civ.C). ********************** ' 'a'rxx r,r."a.—.—._.-- .i: **************** **** LENDER: "LEGALIZATION" PERMIT ************************** - . . . . . ****aE****************************************** ADDRESS: * LEGALIZATION:Y 'F E E S U MA A R YSTRUCTURAL SEGMENT:Y .0'.4 OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC ''FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 252 . 00 —, 1 . 09 repair any structure,prior to its issuance.also requires the applicant for such permit to tile a signed statement that he/she is licensed SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN ' and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031.5 by ISSUE FEE '" any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). I, as owner of the property or my employees with wages as their sale compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS 253. 09 0 , 00 0 . 00 2 5 3 , 0 9 253. 09 0 0 does not apply to an owner of a property who builds or improves(hereon,and who does such work himself/herself or through - his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or REVENUE DIVISION TOTALS--> COLLECTED: 253 . 09 OVER/SHORT• 00 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT - GRAD ING PLAN—CHECK for the purpose of sale). 252 . 00 1 .09 I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business V. ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon ****************************************************************9F************** and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E B R E A K D 01 W N X I am exempt under Section:BP7044 B. 8 P.C . for this reason: ALL WORK BY OWNER TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: I Owner: �(!l/L/t SFR 252 RES PATIO COVER—ENCLOSED PATIO 36 . 40 . 9, 1'12 . 80 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFR 100 RES—GARAGES TYPE V 17. 30 1 , 730. 00 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a •. END OF FEES �, permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from ; ,,,• , these provisions. Date: Applicant: EXPIRED I hereby certify That I have read this application and state that the above information is correct.I agree to comply with all city and county Incomplete Inspections ordinances and slate laws relating to building construction and hereby authorize representatives of th city to enter upon the above-mentioned property for inspection purpoosssees. V ,_/j /J� - date: cr_ 3 ! I Signature' e Cly- V�/�� Date �.__ _ — —_. Sig 01 3C'C =a}l—'y08655S TL, . .. Driver's License or Social Security x: DATE: 05/03/91 TINE: i2'54 _ II i 1641-46 White—Building:Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor r* - CONSTRUCTION AND PLANNING POL _ & SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd,- 53. Steel Reinforcement - . 3:-Electncal Condiiii,liility-Undrgrnd. . 54. Forms '4.:Electrical Conduit-Undrgrnd. ' 55. Electrical Bonding . :5 'Steel Reinforcement:-. - 56. Rough Plumbing & Pressure Test ,67, Electrical UF ER Grnd. 6 57. APPROVAL TO COVER-GUNI.TE - /:'-Footings 5..' C 58. Electrical Conduit-Undrgrnd. -',1? _ , r8. Foundation 59. Gas Pipe, O Undrgrnd.,Test r - - '9. Water Pipe-Undrgrnd. '' 60. Backwash Lines, P-Trap, O 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 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 9 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT C', +•w: _ ^, 20:2nRoGgh Eactory Fireplace , tiro <4 - r".• -r ,,APPROVALS ==Permit # , r•O Tr --.1: .., r,t' S,`:,. . . n - . Z _ 7 r':. 21`:Ducts, is Str,uctufe . ;� r ; _ .- '':70. Underground Hydro "+ 22.-Ducts, Ventilating :c. . r ; d- ,' f71. Product:Piping 0Gas El Oil Y 23..Ga's Pipe=Rough 81.1-,est r,, .4 �-. -72. Underground Fl`usF _ , 24;cRo6& Framing r "s• '� - - .'- S732 Undergrnd.Stoiagg-Tank'O Gas 0 OP 25. Roof Sheathin ' °' 4' `ri h j, `-i.. 1 "4 - ' ' `" ' 9 ,y ,_ �,_ .01. ,, 747,-OverheadHydro: ,T-Bar Ceiling (Structural) &:Monocoato::;u .n l9 v Y- 75:;Dry Chemical = ' - - .r.•X 27`.' Frame and Flashing C);,,, m .. C . ,tr ,J 7. _ .. r, 76.'Dry StandP-pe ' s, ;.-28. Lathing•& Siding^:, -.y;c c;' :v X, •- •• 77' FIXED SYSTEM FINAL' 'r '; '29. Insulation L '- -• >''' ; '`' i _. _ ,- "' � ' ', 78,iFIREPREV. FINAL ,. 'x'30. DrywallNailing ��.T .� '• i- HEALTH;DEPT. REQUIREMENT L: L mn ;31. Plaster Brown Coat` i` .r ..79."FINA L INSPECTION : - - D r r .a: 1 - Fl i ��32-Electrical Power Meter:Final - p ,v , C x :-80.. FOOD CERTIFICATE ISSUED ,- l , 33'Final Electric '.; n+ � " y' `' 1 h. ° 'Notes: , - '1 - ' ,. 34, Final Heating&Air Conditioning, ;-1• I .. C' 2 . - 35.'"Final Gas Pie-Test - 1 71.2: " 'r 1". ' 136. Hood or--Canopy :;i r - -4 I - - :71 - - •37.-Final Factory Fireplace": , XV' °''` ''tp • - J-4, 1 I F: :1: 1 'r r: X38. Final Plumbing - gyp_ , ` -Cd I r•1 u 39. Water Service l' mo Firiai',!. i - n i - , ... z - M ., . .- ;,40. Gas Service-:Final yt. r S. `` ?.J '.41. Solar Domestic-Final; - ••" - Er 4 - ,-, -e ., :. , t , b .: . -42':-Backflow Preventers 1.1:4.1, ' I �; - ..- -. _. ` 43. Backflow Irrigation' :-:� _ XE X`PFR E D ' • • ,r„' .1; .. Incomplete Inspections ' '- , ,44. Landscape Irrigation Systema„ _;; ;• ::.•; . _ ---1,0' r•toL. ; ,: / ts1 45::.Sound Attenuation r `r. r� r e , x ;pate L°26 ,a; S �' ..."..i46:,'Handicap Regulations -- -Yc . •• x c..' 47.0:FINAL STRUCTURE & BUILDING c- I I r A ' 11:2:.• - 48: _FINALPLANNING • ' '` .n •L .._ - .- -:49.rElectric Release to'_Edison 1 T I i -- • 50.;Ga sRelease.to Southern California Gas Co x I E' - • �, ,- `51. CERTIFICATE OF,OCCUPANCY , .l , ,, ',-;, .-• , • ..-00.-_, No. - Date _ / H . V . LAWMASTER & CO. , INC . 71CM5-6280-003 7940 MAIN STREET — STANTON, CALIFORNIA • 829-8040 Report Lumber DAILY REICUT Of REGISTERED CEIUTY ILJIF.CTOR - LGNCRCIC Froiect Thomas Gee Pool _ Fermit F,c. 32757 Project Location 1713 Crease, Costa Mesa, Calif_ Contractor Anthony Poole Architect __— Sub __Sub Contractor Engineer SOURCE OF MATERIAL: 1L EL F.l: Cement (Brand) Tv;e. iestec Dy Sand Admixture Rock Loncrete Ilant Reinforcing Steel fee•tod By Concrete Proportions 8 Field Weights for Cubic Yards Cement _ lbs. Water in Aggregate Gals. Sand lbs. Water Added of Plant TGals. No. 4 Rock lbs. Water Added at Job^"lt D�p1/+ SAFETY DE ra1s, No. 3 Rock lbs. Total 'WAter Used (jjJ L rile Gels. No, 2 Rock lbs. Total Alloo-able b!oter MAY 12 19/1 Gals, Admixture lbs. Average Slump Inches No. of Test Specimens Made Gllons of Water Fer Sack Concrete Design Strength FSI Total Cubic Yards Placed Inspector L. E. Sprague Date of Inspection 5/7/71 Description of Work Inspected Pool installed sometime in the latter pert of Feb. 1971 . Gunite leaks in love seat and along south wall. Jack hammered concrete out 3 or 4 inches and found no soft or rebound in concrete. I advised Anthony to plaster pool • and see if that would not cure the problem. Anthony representative agreed end said that they fully guaranteed the pool for the present owner as long as they owned the pool. I believe this is the way to cure the problem. Registered Deputy Building Inspector's certificate signed by inspector has been filed and states that the above work was inpsec ted by him Ind complies with the provisions of the Building Code applicable there to. Respectfully Submitted, Phoned report to Mr. Hanhardt, Bldg. Director City of Costa Mesa - H. V. Li:•imaster r. Co. , Inc. FORM M - 013 RCE#6207 By 1 H. V. LA hW fAS'I R & U INC. . . LAWMASTER & CO. , . _4C. 7940 MAIN STREET — STANTON, CALIFORNIA 71 CMS-628Q-002 828-8040 XXX Field Data on Test Specimens Core Concrete Gunite Grout/Mortar Project J. baa Pool Permit No. 32757 Project Location 1713 Orcas Dr. Costa Mesa Contractor Anthony Pools Architect Location in Structure Engineer Date Moulded 3/17/71 No of Specimens 6 Slump Specimens Marked Specified Strength at 28 days 2000 P.S.I. Mix Designation Age to be tested 7 days 28 days days days READY MIX PLANT AGGREGATE SOURCE Weather Condition 1 Yd. _Yd. Batch Cement Type Cement, lbs. 160 sks Admix Sand 39 ton Specimens made by #4 Data by #3 Delivered by #2 Date Delivered �y # REMARKSCAWM5—f-"y'` // Water, Gals. FOR LABORATORY USE ONLY Lab. No. 71398 71399 713940 71401 71402 71403 7 Day Test 7 7 Day Test Day Test Day Test Date of Test 3/24 3/24 6.29X 6.17 X 5.73X Specimen Dimensions 12.25 12.125 12.5 Area 33.03 29.90 25.79 No further testa required Ultimate Load 117,000 101 ,500 90,000 BUILDING SAFETY DEPT. Lbs. per sq. in. 3,542 3,395 3,490 MAR 2 5 1971 1-1/0 Corrected FORM M - 015 Gi.`L{.'L-2.a/1,-, I i.17'�[.a,+..... • March 1, 1971 Mr. Thomas Gaa 4%4 1713 Orcas Drive Costa Mesa, California Dear Sir: A building permit has been issued to Anthony Pools to construct a private swimming pool your property. In order that your poo will be a safe one and for the purpose • of advising you of your respo sibility regarding the requirements of the -Costa Mesa Municipal Code, we refer you to Section 8107, a copy of which is ttached. This letter is irected to you in order that you will be aware of our ordinances an an make a complete safety check of your pool area. Sincerely yours, RICHARD HANHART Building Safety Diiector RH:dh OWNER GAA, Thomas DATE 2-25-71 JOB ADDRESS 1713 Orcas Drive BUILDING PERMIT NO. 32757 GENERAL CONTRACTOR Anthony Pools DESCRIPTION of WORK Pvt.Swim Pool AP No.139-152-17 LOT TRACT FIRE ZONE VALUE $ 21900.00 INSPECTIONS Signature Data GROUP J TYPE III ZONE R-1 SOIL pg-7,--inc..4-AW /l) c 3-/s^-7yPERMITS ISSUED IGAS SUBCONTRACTOR Date I Number I Signature WATER a,M,24 .� Aeis 3--.t/ -v/� / Plumbin•, ROUGH PLUMBING //...� /!a/ 1 .i _,. - 14 �fa PROP. SWR. LINE ❑ HOUSE CON. 0 A , in fi , //'- / . A� / SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING + TEMPORARY SERVICE OR POL iLj, (L( 3-d -77 UNDERGROUND A21 POWER 0 // /e e 3- 17. i/ ROUGH WIRING S-� // /f 3-17-Z( Heatin• and Vent. TRENCHES 0 FORMS Ei STEEL REINF. 0 FLOOR SYSTEM P---STEEL BOND BEAM ta.-�.STEEL REINFORCE Fr" /r`11�� C.-er-77 SHEATHING FRAME AND FLASHING LATHING - IN n OUT in PLASTER, BROWN COAT STRUCTURAL, FINAL /�� y "�}�}� HEATING, VENT., RERRIG. AND A.C. FINAL ///��/Z r alra2eVALV �� PLUMBING, FINAL AND?1y. I i(i. fu -'L7'7/ AIIIIIIIIIIIIIIIII ELECTRIC, FINAL �so -17 -•7/ BUILDING, FINAL "�linillt' OWNER ntarufr.L, dUll[t r. DATE e•-e)..0) JOB ADDRESS 1713 Orcas Drive BUILDING PERMIT NO. 23660 GENERAL CONTRACTOR, Owner-Bldr. DESCRIPTION OF WORK Add Pat.to res. AP No.139_152-17 LOT TRACT • FIRE ZONE VALUE $ 350.00 k INSPECTIONS Signature Date GROUP,? TYPE V ZONE p_i Soil PERMITS ISSUED Gas SUBCONTRACTOR Date Number Signature Water Plumbing Rough Plumbing Prop. Swr. Line O House Con. 0 Sprinkling System Miscellaneous _ Rough Heating and Air Conditioning Temporary Service or Pole Underground 0 Power 0 Rough Wiring Heating and Vent. Trenches 0 Forms 0 Steel Reinf. 0 Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing (f/%,() Lathing—In 0 Out 0 Plaster, Brown Coat Structural, Final Electric Heating, Vent., Refrig. and A.C., Final Plumbing, Final and Gas Test 0 Electric, Final Building, Final Y/it.6 4g6•cy- Snarial Ronuiromonts ` ' — 32757 FEB 25-71a-KSA00 858* ****34.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 For Applicant to Fill in Completely APPLICATION FOR BUILDING PERMIT RECEIy,EV DATE RECEIVE DATE ISSUED BUILDING 1713 ORCAS DR p - 2/ 7 ADDRESS -'Z / J THOMAS GAA /3 9- �3,2-/7 PET-S OWNER A.P. NO. ! •/ / MAIL ADDRESS SAME BUILDING 171 ORCAS DRIVE Z ADDRESS W W TEL. J 0 O 3 CITY NO. TRACT v'� LO-6 BLOCK HZ Z Q CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH — H LENDER Cash • o. m XX J D BRANCH JN OWNER THOMAS GAA Q W ADDRESS m J swim pool VALUE •CO ARCHITECT J Q OR ENGINEER C. Adams No` Sp-3221 s 2900. 00 Din Q FIRE W 2 ADDRESS ZONE TYPE GROUP ^ 111 a. W r•, ) CO APPROVED � ! —�V / CONTRALTO RArithony Pools BY ATE,2-.26---/- Zc. ZIco ADDRESS 5871 Firestone Blvd. 1 W W TEL. ZONE NO.OF USE OF N ZF CITY South Gate NO. Sp-3Z17D I / PLANS oR BUILDING • T`t'/ W 0 STATE CITY YARDS APPROVED YARDS APPROVED• 7 O LIC.NO. 190179 LIC.NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO.OF BLDGS. (FROM C/L STREET) OF LOT I NOW ON LOT FRONT / �J FT. /b T. ]' USE OF EXISTING BLDG. residence & garage B.SIDE FT. FT, 6, I— SIZE OF 67 NO.OFZZ NEW BLDG. i-7 ROOMS STORIES L.SIDE FT. ‘ FT. U EXTERIOR WALL ROOF A _ COVERING COVERING REAR FT. FT. —I USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 0- C- MAIN BLDGS. ACCESS. BLDGS. Q VAR.# DATE o Private swim pool in rear C.U.P.# APPROVED F APPROVED Z of side family dwelling —ay ^DATE - e].5-7/ 0 U I hereby acknowledge that I have read this application and state D that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ I— any person in violation of the workman's compensation laws of cj the State of California. to ? I hereby certify that I am properly licensed as a contractor under SO.FT. o the State of Cal . t usiness and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR b• Chapter 9, a . that suc licenses are In force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am ezemp rom the pr. Isions of the -tate .f Calif.'niaam properCC li-C) and Profe sions Code,Disision 3,Ch •ter 9. n PERMIT FEE S�c O Signator• of / — sl) m Permltte- a ��iea i art S 'Hu r PLAN CHECK $ // `� E Authorized Agent -� �� " / c( _/ TOTAL FEE $ �'� u. 23660 FEE RECEIVED FEB 25 1965 COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P.O.BOX 317 COSTA MESA.CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING For Office Use Only ADBUILDING 17/3 OBcAS DR DRESS RECEIPT NO. PERMIT NO. COSTA MESA. CALIFORNIA 73RRli l OWNER JORN F M IC N4�L RHC81yp7BY{ DOE 2R`JH�H.I/]H��,/T 23}H�UED f MAIL �J /� (' r�i ADD EEI//SSS/ / 713• Q/CCW/ ,t, S (Cr ADDRESS /7/3 Alr1�c/�`IJ 6/I\ FIRE�y� 1 , CITY COS A- AI Z s,t NO. J-rG-OJ45 ZONE ,y TYPE M , GROUP APPROVED [r /a v�!/� 4 ARCHITECT STEL. BY F" 6AYE OR ENGINEER NO. ZONING (O -, ADDRESS • c //�� I �� Tr- CONTRACTOR e[dfW4`.e4 AO,IDegabo.ZONE' `1 I PLANS eu�D NG V` ' LEGAL T I . /I U ADDRESS �_ - DESCRIPTIO CITY - A.P.NO. I3 / - Is i- 17 NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE TEL. 90'TO SIDE @ REAR P.L. LIC.NO. ,, AA ll�� NO. EAVES size 1/ OF LOTtY'(��" 1 I NO.OF NOW ON LOTS J ALLOWED (U.B.C.REQUIREMENT) USE OF // ,._�.r_ YARDS APPROVED YARDS APPROVED EXISTING BLDG. "�. it a-ti )4P--.1(--Y. MAIN BUILDING ACCESSORY BUILDING (FROM C/LSyT-R�E'ET) SETBACK LINE FROM FRONT a-Z.-T.. O pa. FT. CENTER OF STREET REAR YARD 1 SIDE YARD I LEFT I RIGHT R.SIDE 1 YFT. L-0-70 Ff. DESCRIPTION OF WORK L.SIDE/ �FT. - J/G FT. �--4? FT. NEW ALTERATION _ ADDITION 'C REAR /J -% FT• DISTANCE BET. BET.MAIN @ MAIN SLOGS. ACCESS.BLDGS. REPAIR _ MOVING DEMOLISH BUILDING NO.OF VAR.# DATE SIZE X ROOMS O STORIES C.U.P.# APPROVED EXTERIOR WAL ROOF '�j APP�Q,VED (.01 ^ �` COVERING 1<I COVERING JJ//1.�/\/\ BY /�// m�d]/yfE p-O�S`�-� USE OF BUILDING AND WORK TO BE PERFORMED nl/n`/A 0U1TIaN ato 1, o/PNc e z did SQ.FT. T J I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE F AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM• PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION CO ` ^q BUILDING CONST CTIQN, 3 SIGNATUREO� . D _coERMIT FEE $ m PERMITTED LLL/`_ ��TT $ PLAN CHECK 5 �II AUTHORIZED GENT .3 u TOTAL FEE $ OWNER MICHAEL, JOHN F. DATE 11-24-61 JOB ADDRESS 1713 Orcas Drive BUILDING PERMIT NO. 15888 GENERAL CONTRACTOR Owner–builder VALUE $ 693.00 COv.to res. AP No.113-382-26 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Add att.pat.& INSPECTIONS Signature DATE GROUP J TYPE Vi'ZONE R-1 Soil PERMITS ISSUED Gas -- SUBCONTRACTOR DATE NUMBER _ Water Rough Corn. Ref rig. 0 Air Cond. 0 Rough Heating Rough Plumbing Miscellaneous Prop.Swr.Line 0 House Con. 0 St.Swr. ❑ Sprinkling System Construction Pole Underground 0 Power ❑ Rough Wiring Trenches 0 Forms 0 Steel Reinf. 0 Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing Lathing — In 0 Out D Plaster, brown coat Ref rig. 0 Air Cond. 0 Final Heating, Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Finaliv,- _ _ Building, Final Y ` / �- 6 r • OCCUPANCY ////// FORM BU4 5M - 7.61 �CHAP • FEE RECEIVED NOV 24Ml COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P. O. BOX 517 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely CITY OF COSTA MESA PP P Y APPLICATIONNFOR PERMIT TYPE OR PRINT BUILDING BUILDING / 7i •' ^ �jlAS bR ' ADDRESS COSTA MESA. CALIFORNIA For Office Use Only �.j A fl/�. /I RECEIPT NO. RMITh N0 1 -1 OWNER y � ''ii�X^ ..�Ly� I I Vl_ AMAILDDRESS /� 3 DRGAS RECEIVE/OBY DATE ECEIVED DA ISSUED /- �/ 11 y-• (C- ^/I 2/1=�y-4 /j .z ti..-e/ TELCITY COS STA N1 ESA NOKL O IIO1 ADDRESS / ( ( 1 ) Q No:3_ —p r I ARCHITECT TEL. COSTA MESA. CALIFORNIA V OR ENGINEER NO. FIRE \\\///��I///��/ ADDRESS ZONE' TYPE �/ �/ /� r /.� {� GROUP !/(7J/ CONTRACTOR O�v�I�T{ BVI (/ �+ �• ZONEBY DATE/`��i/ ADDRESS ZONING a-JIF'3`T11-if ZONE -/I I NO.OF USE OP NEWT,c_t . "- ` CITY •�(+ I PLANS BUILDING/'� LIC.STATNO. i;_y. n 0 NO. LEGAL /I �- / 2,7 y\ 1 5//� AGR. DESCRIPTION �V'-f L� OF LOT .7n Id O - NOW ON LOTS P p ^J / USE OF7 ) YARDS I EVES EXISTING BLDG. 9" . - ark e/I/✓. APPROVED ALLOWED SETBACK LINE FROM (CENTER LINE ST.1 ( CENTER OF STREET REAR YARD FRONT (f .. . -ties 6'1 IN. SIDE YARD I LEFT I RIGHT R.SIDE ar,[ ( FA. -41, IN. DESCRIPTION OF WORK SOL.SIDE DEFT. N. NEW I ALTERATION • I II ADDITION I Y REAR �-V FT. -r IN./ REPAIR MOVING ' ' I DEMOLISH I APPROVED R,/ �I Or DATE /k-01/-1,1 BSIZIEL.DING/4 V )g O. OF NOOMS A /STORIES !'Ap s�"/ EXTERCOVERIOR ING WALL R I COVERINGVF A t.UM ea �'t-[(a USE OF @UILDING!(ATiOWORK TOOE PERFyRMEjJ' 0:0 �a+ 7.Al LDI G ILLS Q fl I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE 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 COMM' UCTION. VALUATION SIGNATURE Of' 0\..L �O PERMIT FEE $ y_____ N PERMITTEE /V/Jti/�/IW1 T S /J / PLAN CHECK S 4 Z AUTHORIZED AGENT E TOTAL FEE 0 OWNER MICHAEL, John F. DATE 5-18-62 JOB ADDRESS 1713 Orcas Dr. BUILDING PERMIT NO. 17137 GENERAL CONTRACTOR Owner-Bidr. VALUE $ 165.00 AP No. 113-382-26 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Attt.Pat.Rcv.to INSPECTIONS Signature DATE GROUP J TYPE V ZONE H-1 es. Soil PERMITS ISSUED Gas SUBCONTRACTOR DATE NUMBER Water Rough Com. Refrig. 0 Air Cond. 0 Rough Heating — Rough Plumbing — Miscellaneous Prop.Swr.Line ❑ House Con. 0 St.Swr. 0 Sprinkling System Construction 'ole Underground 0 Power ❑ — Ol Rough Wiring _ rent es ❑ orms ■ •e -•1n . ■ Floor System Bond Beam ❑ Steel Reinforce 0 Sheathing _ -Frame and Flashing Lathing — In ❑ Out ❑ Plaster, brown coat efrig. 0 Air Cond. 0 Final Heating, Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final Building, Final . P i. v , ri&r24a, OCCUPANCY FORM BU4•661 - 7-61 17137 RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT Akil ��AY 1 8 iggr P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE EEE DEPT CITY OF /�(� T For Applicant to Fill In Completely APPLICATION FOR PERF�F(A MESA TYPE DC.OR PRINT BUILDING BUILDING 7/jfl ADDRESS / OAS OR . COSTA MESA.. CALIFORNIA For Office Use Only OWNER ►o h ni- F. T /I l v'"A ti- RECEIPT NO. I PFr7fl7 MAIL A.,�ff np�+ t� RECEI ED BY OA EFAIY ... DA?EI5}I- ADDRESS / /,1 `1//1C/'T‹ on i Oy.Vvl S O(/'.,ED, CITY COSTA M 'E-eA NO. 0/HS X2.,,,4"ADDRESSILDING 7�3 �t�(,.(J,/ //"�,® (/� ORCHITENTTEL. COSTA MESA, CAI/;IFORNIA OR ENGINEER NO. ✓ CA ADDRESS FIRE ZONE TYPE GROUP 2 APPROVED ✓J / 7i CONTRACTOR BY ��7YATE ADDRESS �O NG �2w// ZONE NO.OF ^ USE OF NEW G`ITY PLANS //- BUILDING STATE TEL. I ------ LIC.NO. NO. LEGAL DESCRIPTION DESCRIPTION i-r `/f / /7�R I -yrs- SIZE 1 NO. OF BLOCS. •✓ OF LOT 7 �j(7 ‘4.-) C t.) ^ NOW ON LOT / A.P.NO. 1i 3 -3p --- t// USE OF / YARDS EVES EXISTING BLDG. \y .n APPROVED ALLOWED SETCENTER OFACK INE STREETM // REAR YARD `-�/k/ FRONT ,,S. LINE sT.> S.y4T. � 5 IN. SIDE YARD I LEFT A RIGHT /I R.SIDE 0--.--C.-*.- `5,, -_E-7,7 - IN. DESCRIPTION OF WORK L.SIDE ��FT. y 1 N. NEW I :VII ALTERATION l Il ADDITION I REAR d/( iST.( .�// .,--e-1.1, IN./ REPAIR I II MOVING l l DEMOLISH I BJj P,PROVE( 712 , yDAATE ( U D-b{� / SIZE BUILDING//\j)5/ RNO. OFOOMS �-STORIESS / (( �/ ' EXTERIOR WALL I COVERINGVF j�r!IC$/ COVERING USE OF BUILDIN AryryD WDRMTQ B -PE RM D i I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING PERMITTEE CON �tUOTION. ,_,,7/ e,Q VALUATIONUf PLAN CHECK S '�' SIGNATURE OR I ). ` /`l�i�i / / -7 PERMIT FEE $ N AUTHORIZED AGENT / !_- �• / !/`^-'�7 r �.- E TOTAL FEE $ y0, OWNER MESA VERDE ESTATES DATE 32-9-58 JOB ADDRESS 1713 .0a99-14. G I-d_S S Th t- I U C. BUILDING PERMIT NO. 8197- _ GENERAL CONTRACTOR L. G. Robinson VALUE $ 1)4,319.00 AP. No. LOT 62 TRACT 3115 FIRE ZONE DESCRIPTION OF WORK Res & Mt/gar GROUP I & J TYPE V ZONE Al PLAN NO. 8197 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches v Forms ` Steel MIS /y-2?tit, Floor System Steel Reinforce Chimney Re-Rod Bond Beam 4 4 6q -ln SI Frame and Flashing A.--g--- S Lathing, rn Out 4_' 4_0^f 7 Plaster, brown coat c.. l Underground soil W/G Pipe Test/HIS/2.-23-fl Top Out /2 i"ir �/ y Furnace L� �' - pp -� - � Gas Vents Rough Plumbing /y//5 2-SS �ti �/1/ -H �ir, C (�.-i0-s�°_ /67/ �7- / 1(1\ Cesspool Septic Tank Prop. Swr.tj ine- Hous._ St. Swr. -.4.4 '7 e fl-&K_11-1�,1[f�rsf 'y' /2-2/y f' Sprinkling System I 19 Heating Final /V}/-( 41-7-4---4-47 I ii Plumbing Fixtures, Final /WS "1-24-{Ti Final Gas Test /i- 41-17C ii-29-s-4 Construction Pole WnJ—tpvt, cf-e-c> (Loy / –S-o rj' _ '77 V T t Underground Power ,/ / t Rough Wiring ), t L_l Sl-)3 (1)//47t7 j a - fl • � - n1/7 , V 1� Fixtures, Final till?! 27_re? \l/ OCCUPANCY f1f./-r. [�i_ cy�fr Form 210-5M—t-57 ' 819'7 DEC 913 e :. ,-A' COSTA MESA BUILDING DEPARTMENT FINANCE DEPT. P.0.BOX 317 COSTA MESA. CALIFORNIA QITy QF COSTA PrhESA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT ABUILDING DDRESS 1713 Ortes Dr. BUILDING COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY OWNER Mesa Verde Estates RECEIPT NO. E.PERMIT7. RECEIVED BY DATE RECEIVED DATE ISSUED MAIL ADDRESS 1701 Gisler Ste yy) .77) n- -f—sT' /a-' f- S J? BUILDING CITY Costa Mesa Na Ki 5-1751 ADDRESS ARCHITECT LIC. J.R.SheI 1e OR ENGINEER Y NO. C-2170 COSTA MESA. CALIFORNIA LONG BEACH Ge 9-0908 FIRE ADDRESS ZONE CITY LIC. ZONE ii NO.OF PLANS TYPF GROUP / ^ CONTRACTOR L.G.Rob i nson NO. 1 123 7 ,�--tI � 4'3 _ADDRESS 1701 Gisler TEL. No. KI 5-1751 BPPROVED DATE `EGALL CORRECTIONS DESCRIPTION NOT' 62 BLOCK TRACT 3115 A.P. NO. SIZE NO.OF SLOGS. OF LOT 70 X !no NOW ON LOT r,pne USE OF EXISTING BLDG. SETBACK LINE FROM 500+ 2Dr+ CENTER OF STREET REAR YARD C - SIDE YARD RIGHT 51+ LEFT 5f-1- DESCRIPTION r+DESCRIPTION OF WORK NEW X ALTERATION ADDITION REPAIR MOVING DEMOLISH BUILDING 440 UT NO.OF SIZE 1433 Sa.Ft. ROOMS 6 STORIES I EXTERIOR WALL ROOF COVERING StUero COVERING AGphoI t & QCCk USE OF NEW BUILDING Residnece & Attached Garage I HEREBY ACKNOWLEDGE THAT I HAVE READ T;IS�A LICATION AND STATE THAT THE ABOVE IS CO�YAND AGREE TO C MPLY WITH ALL CITY ORDINANCES AND TATE 5 REGULATING OW INC CONST RV C- norv. / 7/ /' VALUATION PERMIT FEE ei 0 PERMAITTEE OF .. �N�f41 -A: 1 �4LN�`J"`-`/� J ..-0 S it) J/9 (L.--(L.-- / PLAN CHECK S / . .....,../� I AUTHORIZED AGENT TOTAL FEE S Si ./ vse