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Home My WebLink About3237 IDAHO PL - Building Permits� �',� , PHOIECT RODflE55: � Z�% IDAHO PL OWNEP'SNPME: ANAST, GEOAGE F aooxess: AT]AST ATHETIA 3237 iDAHO PL COSTA MESA,CA 92626 APCN/FNGINEEB: � 7 1 4� 4 3 4— 8 � 1 1 - REG.NO.: ROOPF55: uxiT: UNIT: PEpmiTTEE: pERFORMANCE ROOFIP7G CO. ( 714 ) 645-2382 1 aooRcss: zq�6 NEWPORT HL 1/2 COSTA MESA CA 92627 LICENSED LONTBRCTOP OECIANATION: I nereDy a��irm IAaI I am licensed unaer provisians o� ChaO�er 9(commencing wi�h Seciion 7000) ol Urvision 3 al �he Business and Pmlessions Cotle. antl my license is in �ull force an0 eftect. CITV UC.: STRTE UC.: (j 61 2(j'� cuYss/ C-' � EXP : �a�e _1.7-_� 6 9 y SignaWre: �.(/"' EBS' COMPENSRTION OEClANl1TI0N: I �ereby aifirm t�at I �ave a certilicaie of consent t msure or a rtificate ai Workers' Comoensdtion Insurance. or a cendieU copy tnereaf (Section 3800. LaU. CI. eoucrNo.: 1332836-94 E%P.ORTE: OL/OS/9S cornvnxr: STATE FUND ❑ Cenifietl cooY is �ere�y lumis�etl. Q Certilied copY is vii� I�e ciry BuilOing �ivis' �n. Da/t2e �a-l_iV l 4� Applicant: �� FdEMPT10N FROM WOfl8EP5' COMPENSNTION OECIABATION: Q�is section nee0 no� be completed if �he perm is forone hunGreA ($11q) ar less). I ceriily �hat in the pedormance ol Ihe work lor which Ihis permit is issuetl, I shall noi emD�oy any perso come suble« �o Ihe Workers' Compensation law5 ol Califomia. Date: Signature: NO710E: II, aller making IAis Ueclara�ion, you snoultl �ecome suDiect lo the Workers' ComDensation provisions ot tAe La6or Cotle. you musl fonhwitn comD�Y witn sucn D�ovisions or inis permit snall be aeemeJ revoketl. CONSTflULTION LENUING AGENLY: I hereAy allirm Ihai l�ere is a con5imction lentling agency �or �he pertormance ot �he work �or which Ihis permit is i=suetl (Sec�ion 3097, Civ. C�. LENDEfl: nooeess: OWNEP BUIL�EN DECIAHRTION: I hereby allirm ihat I am exempt Imm ihe Contractors' State License Law for tAe following reason �Seclion 70JL5 Business and Pmlessional Code: Any city of counry wAich repuires a permi� io cons�mct, alter, impmve, Aemoiish, or repair any simcture. o�ior to its issuance. also repuires the apDlicant lor sucA Dermit to file a signetl statement ihat ne/she is licensed Dursuam to ine pmvisions ol the Contractars' Slale Licens¢ Law (C�apter 91�ommenting with Seclion 7000) ot �ivision 3 ol ��e Business an0 Pmlessions CoCe� or t�ai he/s�e is exempt �nerelmm antl t�e Gasis for the allegetl e�emOtion Any Wolatbn o� Seciion 703L5 �y any a071ican� far a permii SUDIe��s l�e a001icant lo a civil penalry of no� more t�an Irve hunOretl tlallars (5500). i, as ovmer of tne o�operty or my employees witA wa0es as tneir mle campeirsation, vrill Co tAe wark, ana tne ❑ stmclure is nol imenOeC or ollere0lar sale (Secuon 70aa, Busineu an0 Pmfessional Cotle: T�e Contractors' State Licenu Law aoes nol aDDly to an owner oi a pmpeny who builEs or impmves t�ereon, and who Aoes such work �imseltlherseli or lhrouAh his or �er own employees. proviCed t�at such impmvements are not mtentletl ar oflered lor sale. Ii, however the builAing or impmvemeni is soltl wil�in one year ol complelion, �he owner will �ave Ihe burtlen a� pmvinA he/she di0 not Euiltl or impmve for ine purpose ol sale�. I, as owner ol Ihe pmDeny. am e.clusively coniracting wi�h Iicense0 coniracmrs to constmct ihe pwject (Section 7064, Business ❑ ana Pmfessions CoOe: T�e Comracmrs' Slale License Law Uoes not aDON �o an ovmer oi proDertY who buAEs or impmves ihereon anE w�a [on�mcls lor such pmjetls vnl� a contraclor�s) licen5e Dursuan� to ��e Contraciors' S�a�e Lic¢nse Law). I am awafe Iha� pwof ol �Aeir Worker's Compen5diion insurance s�oWd De O�ovitleG to me. � I am exempt unGer Seciion: B. d P. C. for I�is reason: Oaie: Owner. I Qo �ere0y ceriify Ihat I am aware ol an0 unCerStanG Ne repuiremenis ol Califomia Heal�h and Sate�y Cotle S¢c�ions 25505, 25533, anA 2553d ana Iha� I or any fuiure Duilaing occupant wilVwill nol �circle one) neeG to [omply wiU said sta�e coaes anA IM1e reQuiremen�s br a permil for consimction or modilicalion Imm I�e Air Ouality Managemenl �islrict. FesiAentiai consimtlian applications are exempt irom Inese provisions. �ate: ADDlicanl: I hereGy certitytnatl have reatl I�is aOVlication and statet�att�e abaveinlormation is mrrecL I agreeto campty witllall city antl caunty orainancesanOs�alelawsrelalingtoGuildinpconsimtlionantlhere authonierepre5entaiive�ciryloenterupaniheabove�mentionea prOp¢f�y IOf insDP'Ilon p fp05¢5. pa pj ; Q'� Signamre: • e Driver'S License or Social Securily M: I6aLa6 Whiie—tlw�Qing: Greon—G000 [nmsement; canary—MppncunC rinx—nevenue; aoioenreo—nssnssu� CITY OF COSTA A1ESA - BUILDING PERMIT PEP.MIT NO: B 070232 PLAN CHECY. NO: N CONSTRUCTION TYPE: V-N PERMIT TYPE; STR PEP.M NO; B Q7023: GOVT: N SUFP: N PURPOSE: REP JOb DESCRIPTIOPJ , REROOF / NEid ?CYR COMPO OVER COMPO SQ FT: 4,100 CLAIM VALUE: 4,100.00 CALC-C'ALUE; 4,100,OQ GROUP OCC: R-3 /M-1 COMMENTS: NEW COMPO ROOF O��ER OA]E EXISTING COMPO ROOF / SMOKE DETECTORS P.EQ if jF iFic if If if iE if if if i! iFifiF iiiF fF ifif if iF # tF if if #�f lE if iF iE iE 1f�tE 1E jE i�-*iEiF K+t iF ac �c +f jf i(�iFif M�c # iF if af aE N�1f +E # i/�if if it af if af ifif�Y jE�lf af if af if aR Z O N Z N GS EPTEB�AUCIKRSE M E N T S SMOKE DETECTOR FRNT; FT MAIINHREARir�G FT IN FRNT; FTCESSOAYPbARREQ��II��N- LEFT; FT ZN RGHT; FT IN LEFT: FT IN P.GHT: FT IN PARKING REQ: PROC'; PARCEL: 13°Q8311 ZNE: REF A70: FLA!]NING NOTES> i il-1Eif %'If'If 7E'lf i(��)f if iR 1fiF')f M il�if�iE if iE Y 1! iF if if'1Fif if if if if iE'N-�)f #if if iI-lfihiF iFiFil�'lf iE if 1M1 if K 1%-If')fifY if 4 iFiE��IFY iF iE M it Y ak ?E�14ii if�i4 iE�M JF Y-'V iL 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 20NING APPROC�ED BY DATE; BUILDING APPROC�ED BY : DATE; APPLICATION ISSUED BY: -� DATE: (2.�C7��JGL ifMltit+tV�Fiffti�-#iflfififltlEifif#`ifif3tf'Fir w +tf .�-+!x +fififN�i:itif�)t�faM1iF+-F'$F'�£ iFif�ac��. k if 4 ifiE V if ff 1E if if if if if if iF it if i(�iF if if�iF�)cif�lf IFif�F �F if aF iFafif�lf 1c if if1fK �.. . if iF if �f ac+f M if�h if if r!! # i� if 3f if it # kM if# if if �E +P if fE if iF # i( ir� LEGALIZATION;D7 F E E S U M A1 P. P. Y STAUCTOAP.L SEGMENT:Y BLDG PMT PLUMBING ELECTP,IC MECHANIC FIRE SMIP/RES GRADING PEP.MIT 72.00 . ,50 SMIP/NON-RES PLAN ISSOE FEE - PUILPIr1C-PIV-:•• P�'�,+�MIT ZSSUE PLAN-CHECH TOTAL _ PAID DUE T�a'�r?L6----:� 7_.`_�U O�CtO �:pt1 7`�.5t1 72.50 .00 REVENUE DIC'ISION TOTALS--> COLLECTED; 72,50 OVEP./SHORT; ,00 HLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK 72,00 ,50 �IE 4iR �t iF M if if iE if if�lf afif 1F lkif if if if ifV i! sl�* if if �Fif 1f if iR�1f iE if�Y�)f M 1f1t�F�1F iF iF iR i/�iF iF iE fi# 4if iF 1f�if iE ifif iFiR i' if Y��IE i if iF iti�-i4iR�IR-1Fif Y-if if iF I N D I C' I D U A L F E E 5 P. E A K L O N N TYPE QTY D E S C R I P T I c� N UNI�' COST TUTAL COST SFR 9100 AEROOF BY C'ALQE RESIDENTIAL NOZONE 1.00 9,1OQ,00 END OF FEES � >� 01 OD172903-00172?04 T�� T DATE: 12/Ct6/^4 TIt1E: ]2:27 I 7?.SQ � w - _ CONSTRUCTION AND PLANNING POOI & SPA APPROVAIS Permit # Date Inspector AppROVALS Permit # Date Inspector 1. TemPorary Electrical Service or.Pole '. 52. Pool & Equipment Locacion - 2, Soil Pipe�Undrgmd. . . -�- 53. Steel Reinforcement � 3. Electrical Conduit Utility�Uridrgrnd. � 54. Forms 4. E4ect<ical Cortduit�U�drgrnd. 55. Electricat 8onding '� 5. Sreel Reinforcemenc 56. Rough Plumbing & Pressure Tesi 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE �. Footings 58. Etectricai Conduit�Unclrgrnd. 8. Foundation � 59. Gas Pipe, O Undrgrnd., Tesc _ 9. Water Pipe-Und�grnd. ' ' 60. Backwash Linet, P�Trap, O Undrqrnd. ' 10. Str�Gtural Floor System 67. APPROVAL TO DECK � i t. Properzy Sewer l,ine & House Connection -, 62. Backwash & ReceptorFinal 12. Sewer Cap �' 63. Heater & Vent�Final % - 13. Foof Drains - 64. Plumbing System - Final " 14. Rough Plumbing � - �" 65. Electrical-Final 15. flough Etecc{ical-Condult � i 66. Sofar SYstem-Final � i 16. Rough Electric Wiring 67. Fencing & Access Approval 77. Rough Wiring Sign 68. APPROVED FOR PL.ASTERING 19. Hou�h Electrical�T Bar Ceiling 69. POOLISPA SYSTEMS FINAL 19. fiough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 27. qucts, in Structure 70. Underground Hydro 22. puctz, Ventilating 71. Product Piping f-.lGas �Oil 23. Gas Pipe�Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T�Bat Ceiling �Structurol) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. �aih�ng & Siding 77. FIXEO SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Dryevall Nailing HEALTH DEPT. REQUIREMENT 37. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Po�ver Meter�Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Finai Heating & Air Conditioning 35. Final Gas Pipe-Test � 36. Hood or Canopy " 37. Final Factory Fireplace `'- 38. Final P�umbing � 39. Water Service-Final 40. Gas 5ervice-Final 41. Solar pomesticFinal 42, Backflow Preventer I�,..�_ AL�� `.��,/1 �� < <- � 43. Backflow Irrigation 44. Landscape Irri4ation System 45. Sound Aitenuation 46. Hand�caD Regulations 47. FINAL STRUCTURE & BUILDING /Z�/u_Qu �,✓�,[�. ( � (_�r3 -r 46. PINAL PLANNING � � 49. Electric Release to Edison � 50, Gas Feiease to Southern California Gas Co , 5L CERTIFICATE OF OCCUPANCY No, Date Appllcant t0 �ill in all spaces axcept those wit�In heavy Eortler Iines an0 sign all apO�oP/�ale Geclarations. �E�Q! r. ION P�RMIT� I ApplicanYSMailin,yB/A�ddress. �»i0 v�i ivvi.v��i.J i�.�.�rv Owner'sName -ILL— �%3�%�C�Z(—f��V Phone �!�--��z Addreu �� % "1 /)f�I'l0 I��ALE (',U�NA //%b'�+�' Arch/Eng. License No. Address � Contractor's Nem A �*� — hone y s �t' \Addresslmailing) ��R w �V�WOc9D �L.� /li✓/`ifir�/i'J � City Licanse No, � ' LICENSED CONTRACTOR DECLARATION M I hereby affirm that I am Iicansetl untler provislons of Charter 9(tommencing with sectlon 7000) of Divislon 3 oi the Buslnass antl Protesslons Cotle, antl � my licensa is In full t antl eflect. � �� Llcensa I s se o. � Date Si9nature WORKERS'COMPENSATION DE LARATION I hereby alflrm that I have a cartlflcate of consant to self-Insure or a certlflfate of Workers' Cor�Pensatlon Insurance, or a certitietl copy thereof (Sectlon 3800, Lab. C.I.D��i/// � CortlPanY �A/�� PoIItY NO. /� ry Certifletl copy is hereby furnlshetl. /J'w Certl}Idtl c i fileU wIM the d[y B Iny Dt145yqn // , Date 7� APGlicant��+�/ LI�1� . EXEMP ION FqOM WORKERS' COn5PEN5ATION DECLARATION (This section naed not be completetl if tha Parmit Is for, one huntlretl (5100) or less). � " I cerilfy that in the per�ormance of the work for which tnls perm�i is issuetl I ihall not employ any per5on In any manner so as to become subject to t�le Workers' CompaPsatlon Laws of Californla�, Date •� 519nature NOTICE:'if,iaftef makinq this tleclaration, you shoultl become subject to tha Workers' Compe�sation provlilons of the Labor Cotle, you must fortnwith comply wlth sUcn provlsions or this Oermit � shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV I hareby afflrm tpat thare I5 a construcNon lentling agency for Ihe performance of tne �work for whlc� sptc- permi[ is Issuetl (Sactlon 3097 Clv. C:) tantler'S Nama � Lentler's Aaaress OWNER BUILDER DECLARATION I herebv afflrm Chat I am exemOt trOm the Cont�ac[o�'S LICanSa Law fOr th0 a oermit to construc[. a �eirom antl Ne Dd5i5 to� t�e allege0 exeTpUOn. Any vlolaLoO o� SeGUOn I3.5 by any applicant for a permit subjects tna applicant to a civil alty of not more than five �untlred tlallars (5500). I, as owner ot Ihe Droperty or my amployees with wages as thelr sole lpensatlon w�� tlo thB wOrk, antl the struClu�e I5 not Intentletl or offeratl sale �sec4ion 7044, Buslness antl Professlonal Cotle: The Gontractor's :nse Law Coes not apply to an owner o! a property who bulltls or Improves reon, antl who tloes such work nlmsolf/herself or through hls or her own �loyaea, p�ovitletl that SucM1�improvements ara not intentlatl o� offe�etl fOr If, howavarr tha bulltling or improvemen[ is soltl within one year o( com- '.ion, lhe OwnGr will hdve tne burtlen Of prOving ha/she dIE nOt buiitl Or IT- vl,fOt tlte pu�Pose of Sale). 1, as ownar o� Iha proDerty, am excluslvely contracting with Iicensetl con- 3orsic <onstruct tne pro�att (Sectlon 7044, Bu5ine55 antl Professions Cotle: i Contractor'f License Law does not apply. to an owner of p�operty who Itls or ImproJes theraon, antl who contrac[s for such pro�ect5 with a con- :tor(s) Ilcense Pursuant to the Cqbtractor's License Law1. 1 am exampt�er Sectlon� �— 8. L P. C. tor thls reason Data _�— ��+ner _ I harebvi certilv that I hava reatl this cou OF CONSTRUCTION LJ CONV,ERSION ❑ DEMOLI SCRIQTION OF WORK �( TVPE OF PERMIT U GRADIf3 ❑ TENANT � ELECTRICAL ❑ OTHER PROJECT DESCRIPTION Scl. FT._ CON STftUCT�ON TVPE� 20NE _ GR Rema�ks: Sink L�CADD I_I ALTERATION LJ REPAIR �— � OTHER A p # 1 — � o� S MainBui FOVNDATION STRUCTURAL T Front PLUMBING ❑ MECHANICAL B Rear A C Aight ' OCCUPANCV � VALUATION $ �� $ Left IG CV. VDS. ACRES ' � pjng. Ref, dh � . n.c - a -�,- s ' ' �-� -- �-- PLUMBING FEES Showers Preventer ' Service Sink � Irrigation Sewer Cap - Sewer Connection � $018!'COIICC[Of5 Dishwasher Drinking Fountains Floor Drains � Floor Sinks � Gas Service � Interceptors • Kitchen Slnk Levatories P—Trap Roof Drains Reinspection Fea Swimming Pool w/Spa Urinal Outlets Water Closet Water.Heater Water Service Boiler Duct - Under Ground $25 Duct - Ventilating Ezheust System ❑ Multiple FirepUFact. Blt. ICBO # Heating System & Ducting ❑6700,000 BTU 0100,000 Signature � ua[a Drivars' License r 5� Reinspec[ion Fae CMF 0865-46 rev. 12/83 White - Builtling: Canary - Ap�lifant; Pink - Actounting; Goltlenrotl - A55essor S25 Isue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System 04100,OOOBTU ❑100,000 System RepaidAlteration Iswe Fee Use of Building: Planning Notes: 3784 2/06/84 , 126.72 —� Zone'� _� . Accessory Building: 2 L� , O 7 N � N G R E Park.Fees $ , � U I � l h %L'�N`S2.'t CC E / ^OZ .S M E _ / . S T ELECTRICAL ' Automatic Washer Transformer � 15-50`KW Consttuction Pole Sub. � 50+ KW Cooking Unit Meter �up to 100amps ` Dishwasher Meter pover100amps Dryers ❑Gas ❑Electric Sub Panel '� Ayy Fan Momrs�PiHP�iX-8 - .F.A.U. � Inc.Solar �9-15 HP �16-15+ ,Fixtures � Microwave �Device Boxes Pole Light Outlets Range Switches �Sign Garbage Disposal Standing Sections � Generator 065 KW �5.15 KW Trash Compactor 5 3 �.� Reinspection Fee FEES f- ' PUeLIC SERVICES R 2oning Approved By _ % Building APProved By APPlintion laued Bv_ $ 3 Issue Fee SU M R 95,FEES BUILDING PERMIT $ � �J SMIP ' PLAN CHECK $ ' � PERMIT PLUMBING 5 �S, D ISSUANCE PIAN CHECK 25% S SD ENERGY P.C. ELECTRICAL § � GRADING PLANCHECK 50% $ %�� MICROFILM MECHANICAL $ TOTAL FEE PIAN CHECK 25% $ , .� , FEES S 3• ta z— �e —A4 t � � � g , S!) $ $ $ $ � y� '� � $ L�L� TRUCTION.AND PLANNING . POOL & SPA � - riOVALS - Permit# Date Inspector qppROVALS� Permit# Date Inspector emporary Electrical Service or Pole• i , 52. Pool & Equipment Location � � , . Soil Pipe-Undrgmd. � � . . 53: Stezl Reinforcement" r 3. Electrical Conduit Utili4y-Undrgmd. � 54. Forms . - - � - ' .' �' ,4�. Electrical Conduit-Undrgrnd; ' 55.` Electrical Bonding ' � � 5. Steel Reinforcement � � . 56. Rough Plumbing'& Pressure Test , . ,: �6. Electrical UFER Grnd. _� � 57. APPROVAL TO COVER-GUNITE_ � 7. Footings , � � 58. Electrical Conduit-Undrgrnd. � 8. Foundation , • 59. Gas Pipe, Undrgrnd., Test . a�/�//d'K � �' 9. Water Pipe-Undrgrnd. . ' � '60. Backwash Lines, P-TreP, � Undrgrnd. , .' � . 10. $tructural Floor System � -. 61. APPROVAL TO DECK '� _ 11. Property Sewer Line & House Connection - , 62. Backwash & Receptor-Final ' ' 12. Sewer Cap � 63. Heater & Vent-Final � - � 13. Roof Dreins -. � 64. Plumbing System - Final � y�y�� (�p , 14. Rou9h Plumbing � . ` 65. Electrical-Final - - - ' I , � 15.'Rough Electrical-Conduit � - • ' 66. Solar System-Final � - . - � 16. Rou�h Electric Wiring ,- � 67. Fencing & Access Approval 17. Rough Wiring Sign �' ' 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL . 19. Rough Heating & Air Conclitioning FIRE DEPT. REQUIREMENT� ' � 20. Rouqh Factory Fireplace APPROVALS ' Permit # � � 21. Ducts, in Stcucture ' ' 70. Underground Hydro � � 22. Ducts, Ventilating .. � � 71. Product Piping OGas� OOiI � 23. Gas Pipe-Rough & Test , ,.. 72. Underground Flush 24. Roof Framing � � • 73. Undergrnd. Storage Tank' � Gas ❑ Oil' ' 25. Roof Sheathing : : , 2 ZZ-�y � 74. Overhead Hydro ,� � � 26. T-Bar Ceiling (Structural) & Monocoat � . . � 75. Dry Chemical ; ' ' - 27. Frame and Flashing � , la� f �' � 76., Dry Standpipe . � � � - , � 28� Lathing & Siding . . . 5 j� f 77. FIXED SYSTEM FINAL � ' 29. Insulation - ' ' • ' 78. FIRE PREV. FINAL 30. Drywall Nailing � . 313-� � !%S �HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat � . 3/!/-$� ,� , 79. FINAL INSPECTION 32. Electrical Power Meter-Final � 80. FOOD CERTIfICATE ISSUED 33. Final Electric G' � Notes: 2��-Z _ y Q 0 L� 34. Final Heating &'Air-Conditioning � Q i ' � .. 35. Final Gas Pipe-Test . � y/2Y1�'y Lfio � . 36. Hood or Canopy � ' - � - 37. Final'Factory�Fireplace ' . 38. Final Plumbing '' y� g4 �o .' � 39. Water $ervice-Final � � � ' � , , 40. Gas Service-Final � . ' '. , . 41. Solarpomestio-Final , , � �� ;' - , 42. Backflow Preventer � _ . _ _ . � � , � � 43. Backflow Irrigation � � � � � � � ' � ' � ' 44. Landscape Irrigation Systein . � � � , � 45. Sound'Attenuation � '1 � � � , ' . , 46. Handicap Regulations ' ' t _ , � _ 47. FIN9LSTRUCTURE&BUILDING� y �4/a '�5 � 48. Special Requirements Completed � � r � . � � �, " ' � � 49. Electric Release to Edison � ' � � � � � . ' 50. Gas Release to Southern C. liform`a Gas Co � � � � � � 57. CERTIFICATEOF=OCCUPANCY � - , - - ' ' � � ' .� ' No. ' Date . - . _ _ - _ '-- H. V. tAWMASTER 8 CO., INC. 7940 MAIN STREET — STANTON, CALIFORNIA 66�M5_zpgH_p02 � 828-8040 XXX Field Data on Test Specimens Core Concrete Gunite Gro�t/Moriar— Pro'ect Permit No. Z�� 9a � Melvin Chamberlain Saimpool Projeci Location 3237 Zdaho Place, Cpsta Mesa, Celif. Contractor California �'nols Architect 2_ floor - 2- walls Location in Siructure 2_ bond beam Engineer Date Moulded 7/�/67 No of Specimens Slump Specimens Marked Specified Strength at 28 deys 2000 p.S.l. Mix Designation Age to be tested 3-� days 3'Z8 days day's days READY MIX PLANT Job �'�ix AGGREGATE SOURCE Pherris Weather Condition Sunny warm 1 Yd. ��-Yd. Batch Cemenr Riverside Type I Cement, Ibs. 17A bags Admix Sand dt tons Specimens made by California Pools TM4 Data by J f4 Nalters =3 Delivered by #2 Date Delivered #,` �i � � ry L� — REMARKS: Water, Gals. $UILDIM SAfiTY DEPP� Lab. No. Date of Test Specimen Dimensions Area Ultimate Load Lbs. per sq. in, H/D Corrected 2906 7 Day Test 7/14 5,�1 X �z,75 26.52 63,000 2,376 floor Rh1 7��T �,� USE ONLY 2007 2800 7 Day Test T Day Test 7/14 7/74 5.77 X 11,9 5.89 X ��,5 26.15 27.25 68,Oa0 65,000 2,6D0 2,3�8 �dall Beam uhoQ, Q..� ( C'�>>,� JUL 1 ti 1967 r�n ,ID,11,1�,1,�,3,�i,5�6 . 2�09 — 2810 — 2811 Dav Test �da further tests required CITY OF COSTA MESA CALIFORNIA P. O. BOX��2o0 FROM THE OFFICE OF THE PLANNING DEPARTMENT August 8, 1967 Melvin Chambe'tlain 3227 Idaho Place Costa Mesa, California Dear Pool Owner: The Costa Mesa Planning Department has been notified of the completion of your swimming pool, So that your pool will be a safe one and for the purpose of advising you of your responsibilfty regarding the requirements of the Costa Mesa Municipal Code� we quote Section 9298,9: lo No swimming pool shall be comtructed closer than five i5) feet to any property lines, measured from water line of pool, 2> No swimming pool shall be constructed under any electric power lines or on any electric power easement, 3, No swimming pool shall be constructed unless the yard surrounding such pool is completely enclosed by a fence six (6) feet in height and has a self-closing and locking type gate or gates, This courtesy letter is directed to you so that you will be aware of our ordinances and can make a complete safety check of your pool area, Sincerely yoursp William L, Dunn Director of Planning � AVPlicant to fill in all sVaces exce0t those within heavY Eortler Iines antl si9n all aVGroVNate tleclaralions. ; CITV OF COSTA' MESA � ' ''� PEFMIT NO. - TRACT NO. LOT NO. BLD . . . - . � � � � CONSTRUCTION PERMIT � ' c�z�z� - /D$'O �� • ' ' 2176 ' I/10/B4 5.0� ' �� PrOject Addres5 D� 6 G��'Ji ME /� � TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ' ' Applicant'sMailin9Address � sq�MC �❑ CONVERSION ❑ DEMOLISH �� OTHER q,p,# � � Zone ' . owner's rvameM�`� �/�C L�/�%3r-•?G4/�hone� s%�� DESCRIPTION OF WORK � 5 Main Building: Accessory Building: � Z Addies ��% /1%/¢i�0 %�/4CC COJ il /`�'i�/� �� . . ., . " . O �,� o TV,PEOFPERMIT GRADING�J❑'��FOVNDATION STRUCTURAL � T Frant- � � _ N Arch/Eng. LiCens¢ No. ❑ TENANT ❑ EIECTRICAL � ✓LUMBING ❑ MECHANICAL ' B Reaf ' � � - ' � � � " � " ❑ �OTHER ' ' A + ' �� N • Address� � — . . ' �� ' , PROJECT DESCRIPTION 5�. FT. ' oCCUaANC C Right - G Contractor's Nam � Phone . K . , � ,. — R Addrew�mailing) � CONSTRUCTIONTVPE :� VALUATIONS� 'S Left ' -. � � E ' , . � . . ZorvE • cRADING GU. VDS. ACREs Ping. Ref. # � ' � Park.Fees $ ' ' n ' City License No. U LICENSED CONTRACTOR DECLARATION '. ' Remarkz: / / Parking R¢q./PrOvid¢d . . . �, � � 1 hereby. affirm that I am licensetl untler provisions of Charter 9��commencing � `-' L� � � DU %�I� � ��O N1Q[�l'� %L` R with section ]000) of Division 3 of the Business antl Professions Cotle, antl G� D G G 6' Fa v%� r �f !/C%/C Use of Building: - , � E my Iicense is in full fOrce antl etfect. , -- � License Class License No. , PLUMBING � . - FEES Planning Notes: . M E. Date Si9nature � - . � . - � BarSink Showers � � N WORKERS' COMPENSATION DECLARATION' � - T, � I hereby�atfirm that I have a certificate of consent to self-insure or a cerUflcate . gackflow Pteventer .. _ __ Service Sink -- . �- � . S of Workers' Compensation Insurance, or a certifietl copy thereof (Se<tion 3Boo, Lab. CJ • ' � � � � Backflow Irr�gation Sewer Cap � " � ELECTRICAL . - . FEES Policy No, � Company - � ' � � eCertifietl copy is hereby fumishetl. � ' ' Bathtubs Sewer Connection ' Automatic Washer . Trensformer ❑ 15-50 KW . i Certlfietl capy is filetl with the city Builtlinq DiviSion. � Date Applicxnt � Clarifiers � SolarCollectors � ConstructionPoleSub. � � �50+KW EXEMPTION FROM-WORKERS'�COMPENSATION DECLARATION � DiShwasher ' Solaf Piping ' ' CoOking Unit � ' �' MCtEr ❑up to 100 amps (This section ne¢tl not be com0letetl i( the permit i5 tor one huntlretl (5300) or less) � � Drinkin Fountains • � - ' ' I certlfy thaLin the performance of the work tor which this permH iz issued, 1 9 Solar Tank Dishwashef . Metef �over 100 amps i shall not ¢mploy any pe�son in any manne� so as to bemme su�ject to the - . � ' , workers' Compensation Laws of Calitornia. � Floor Drains � Swimming Pool w/Spa � Dryers �Gas ❑Electric� , Sub Panel Date ' ' Si9nature ' � � � , . � NOTICE: If, after.making3his tleclaration, you snoultl become subject to,the.- _ Floor Sinks _ . Urinal . Fan . . Motors �0-1-HP O1.'/z- 8. . -_ Workers' Compensation provitions of the Labor Cotle, you must torthwith ' . . ' ' - comply .wlth. such �;provisions or •this permit stiall be � tleemetl ievoketl: ,;/ Gas Service � Outlets: ; Water Closet ' FA�U. ' ' ' Inc. Solar 09-15 HP �16-15+ � CONSTRUCTION LENDING'AGENCY ' ' " "� ' � - � ' ' 1 hereby zfflrm that there is a mnstruction lentlinq agency for.tM1e performance , Interceptors � - W2ter He3t2� .�'� Fixtures � , � � � Microwave ' � � of the work tor which this permit:ls issuetl.'.(Section 309� Civ. C.) ' ' Lentler's Name,' � - - � � , , Kitchen Sink �� ' � Water Service � - Device Boxes � . � � Pole Light ' ' � LenOer's Atltlress � � Lavatofies' � ' OWNER BUILDER �ECLARATION � " ' ' � � � '� � Outl¢t5 . . R2nge ' I hereby afTirm that I am exempt fiom the Contractor'S' License Law for the p_Tra � � � � tollowing reason (Section 7031.5 Business antl Professional Cotle: Any city or � P. � _ -- - Switches . �$�y� � . � . � , courity wfiich requires a permiCto constiuct, alter, improve, tlemoli5h orrepair � �, � - . . ' •any structure, pdor to its'issuance, also requires the applicant tor sucn permit � 'Roof Drainst � � � � ' ' Garbage Disposal ' � S[ariding Sections . •to file a siqnetl statement�tnat ne/spe is licensetl'pursuant to the provisions ot , ' ' the Contractor'S-License Law (Chapter 9 (commencing with Section ]000) of `i � � . ' ' . - ' - ' �ivision 3 ot the.eusiness antl Professions Cotle) or that he/she.is ezempt � . -. , Generemr �0.5 KW �5-15 KW Trash Compactor : "theretrom antl Ihe basis for the alleqetl examptibn..Any violation:�ot Section . � �� . . . - 7031:5 by dny -applicant tor�a permit subjects� the`applicant to a Civil ' ' " ' .' • � - ' � � '3 • " ' � ' , ' i ! �-pg�y of�not more than five huntlretl tlollars (g500). � ,� ; ,-,� � _ Reinspection Fea �� • $25, -. � Issue Pee � $ , , ,e71, "d5 owner of the propecty o� my emplpyee5 with waqes as thei� sole Reinspection Fee � $25 ISSuO FBB� �$ 3 compeniation, will tlo the work, antl the structure is hot intentled oi offeretl � � � �� .MECHANICAL �' ' FEES tor sale' (Section .7044, Business antl Pro(essional Code: The'.Contractor's , , , , � - � . PUBIIC SERVICES REQUIREMENTS: � � • ' � LlcenSe I.aw tloez not apply to an owner ot a property, who�builtls or improves I 8oile� �� - HOod o� Type I ❑ '— . � ' thereon, antl who�tloes such work'himself/herself or tM1roOgh hi5 or.her own � '-� ' Zooing ApproVed By DetB ' • amplo ees, provitletl thet 5uch.improvement5 are not;intentletl or otferetl'tor "- ` i CanOpy Type II ❑ - � , Y Duct - Under Ground ' - ' ' � sale. It, hOwever, the builtling or improvament Is soltl within one year ot COm- , . Application ApprOved By � Ddte pletion, tM1e owner wIII.M1ave the bu�tlen o( proving h¢/she tlltl not builtl o� Im- . � � rove'for the purpose ot sale). I � . Duct - Structurel Refrigeration Sys[em `, . Appliwtion laued By ' ' i�� / � Dat � � I, as owner oi the property, am excluslJely mntracting with licensea con- ❑p-700,000 BTU ❑100,000 BTU � ' � � tractors to construct the oroject (Secbon �044, eusiness antl Protessions Cotle: Duct - Ventilating ' ' , . , 'SUMMARY OF FEES 1 , The Contractor's Cicense' Law "tloes not aoP�Y to'an owner at properry who . � -' BUILDING PEFiM1T $ SMIP $' � builtls o� Imp�oves thereon,iantl who contracl5 fo� Such p�ojects witn a con- • E%hdUSt Sy5t2fn ❑ Multiple ❑ System Repair/Alteration . • . tractor(s) license purs'uant to'ehe Contractor's License Law). . PLAN CHECK $ ,� , PERMIT ' ' ❑ I.am exempt untler Section B. , for this reason Firepl/Fact.'Blt. ICBO �k ' ' ' PLUMBING '$ ISSUANCE '$� Heatin S st g PLAN CHECK $ ENERGV�P.C. $ Date owner 9 y em & Ductin r ' ' - .i her certity at_i nave reaa this application antl state mat the above ❑0.100,OOOBTU 0100,0008T . - - ELECTRICA� $' GRADING $ infor tlon Is correct. ba9ree to comply with all tlty antl munty ortlinances � . i antl state laws relating to builtling constructlon, antl hereby authorize reore- , � ' PLAN CHECK � �$� ' ' MICROFI LM $' � sentatives Of' this, city to e q upon the above-mentiOnetl �p� ¢rty for � � � � � . TOTALFEE $ �S IJ inspettion p oses. l /O B � � � - MECHANICAL � $ iD 5ignatur *Y — ' peinspec[ion fea $25 i Issue Fee i ' $ 3 ' PLAN CHECK .$ � Drivers'.Li ense ar 55 � CMF OB65-4fi reJ. 7/83 White- Builtling; Canary -Applicant: Pink -Accountin9: Goltlenrotl -Assessor " ' � ' � -- . . � - "- ' � , ' ' ^ ' � ' ' - '`CONSTRUCTION AND PLANNING � � POOL & SPA APPROVALS Permit# Date Inspector p�ppROVALS Permit,# Date Inspector 1.'Tempora�y!Electrical Service or 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 UFER'Gmd. - 57. APPROVAL TO COVER-GUNITE � 7. �Footings , ' 58. Electrical Conduit-Undrgrnd. 8. Found'ation � 59. Gas Pipe, O Undrgrnd., Test ' 9. ,Water Pipe�Undrgrnd. ' 60. Backwash Lines, P-Trap, � 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 � Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing � �73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing � ' 74. Overhead Hydro 26. T-Bar Ceiling (5tructurall & Monocoat 75. Dry Chemical 27. Frame and Flashing - ' 76. Dry Standpipe 28.� Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing -' HEALTH DEPT. REQUIREMENT 37. Plaster Brown 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 ' 36. Hood or Canopy 37. Final Factory Fireplace � 3S. Final Plumbing 39. Water Service-Final . 40. Gas Service�Final . ��y[�/ , � 41. Solar pomesticFinal � � 42. Backflow Preventer 43: Backflow Irrigation � 44. ,landscape Irrigation System - � 45. Sound Attenuation , � � 46. fiandicap Regulations ; ' 47. FINAL STRUCTURE & BUILDING � ' 48. Special Requirements Completed 49. [lectrie Release to�Edison . • - � � 50. Gas Release�to Southern California Gas Co ' 51. CERTIFICATEOFOCCUPANCY . No. � � Date � . OWNER CHAMBERLAIN, MELVIN E. DATE 8-31-61 JOB ADDR�SS 323% Id2h0 Place BUILDING PliRMIT NO. � 5 '] GENERAL CONTRACTOR Owner VALUE $ 101.00 ro�e AP No. LOT C�p TRACP �(��K FIRE ZONE DFSCRIPTION OP WORKR..;..v ,.,...+.. r.._ INSPECTIONS �Signature� DATE � GROUP TYPE ZONE SU6CON'PRACCOR OCCUPANCY _ " 1:��`� : COSTA MESA BUILDING•SAFETY DEPARTMENT P. O. BOX 917 COBTA MHBA. GLIRORNIA For Applicanf fo Fill In Completely TYPE OR PRINT COSTA MESA. CALIFORNIA 'SIZE �OO X OF LOT � 86IHACK LINe FNOM TEL. NO. OP BlDGB. NOW ON LOT DESCRIPTION OF WORK r.r•ar•r EXTERIOR WALL GOVERING U$E OF BUILDING BUILDING FEE RECEIVED \�f AUG 311969� ��FINANCE OEPt. CItY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Office Use Only NECEIPT NO. PEHMI BY COSTA MESA. CALIFORNIA ZONING � 20NH I NO. OP I U8E OP NEW ��I PLANB Z �UILDINO �nCG� �o��.�...... TR 36 z s s'd YARDS APPROVED (CBNTHR LIN! OTJ �O FRONT .. ....... �� _ � / EVES � � � �/� P>s �o' A rra o C - 1 HEREBV ACKNOWLEDOE THAT 1 HAVE RGD THIB APPLICATION }H¢ �MOUNT BXOWN UNO¢p VpIUATION IB POR TH! ANO BTATE THAT TNE ABOVE IB COflRELT AND AGP88 TO COM• pUpp098 OR E9TABLISHING ♦ pHqMIT FEH ONLY. PLv WITX wLL GTY OROINGNGEB ANO BTAtC l.AWB RE6ULAT{NO Buaowa CONernuLnoN. VALUATION �] � SIGNATURE OF PERMIT FEE $ /l'S PERMITTE � �.(� $/0/ % PLAN CHECK $ AUTHORIZED AGENT �Jy�A,f� _ � � V WNF:It l:t1NMtlGtWti11Y� MB1Y1Sl LATl: O-G1 0( dOB ADDRESS 3237 Idaho P1aCe BUILDING PERMIT NO. 2719$ .GENLRAL CONTRACTOR Cal ifnrnia Pnnl c. Tnr _ DESCRIPTION OF WORK ArF _ Ctrim Pnnl AP No. 149-( INSPECTIONS SUBCONTRACTOR � ,-• 2�. �3g COSTA MESA BUILDINCrSAFETY DEPARTMENT P.O. BO% 7200 COSTA MEBA, GALIFORNIA YMtO For ApplJcant to Flll In Completoly TYPE OR PRINT ADORE'HII �Z�� `�' �A��! l� COSTA MESA, CALIFORNIA nwuwa NI E L V/N ClJ,4N1�3EIQ,I.A.,I � �C.TNO.�i�% T/% NO.�T�``Y�2 Blze r,�. .. ._ . I wo.or.LDoa. e i6TpACK LIMi 1110M DESCRIPTION OF WORK 0 EXTERIOR WALL I I COVERINO UYQ OF �UILDING AND WORK i � r, 1 X[P6BY ACKNOWL6�06 TXAT 1 AND BTATH THAT TN6 ASOV[ 1� PLY WITM �LL CITY ORDIINNCO oUILO1N0 CONBTRYRION. � AUTM01112iDA0[NT � 1U;� 21-67�ASF001836� t��**13.CC APPLICATION FOR PERMR BUILDINti fa. offr� u� o�►y RtC[IITNO. ��i�� 0 ZONINfi � IO MO.O/ UY[OIM[W ' ,�/ 1lAN� a lUILDINO o- //� �e DUC111RW1� �CAR� JQ'- //l. ��p 'c� A.P.NO. /�I�O(�-7�� N0T6: NOt/1V[OV[RNANOSlfALL�lLC88TMAN JO' TO 81D6 a RiAR P. L e�vea ALLOW[D (U.B.C.RlCOIRHMENTI VARDDMPROVHG YARDSMPNOVHD MAIN BUILDINO ACCEC80RY BUILDINO �fPROM C/'L/��yp� [T7 FRONT T F7. PT. / 1 , �r VAR.}i I DATH e PRO [� •/�.�M' OATC ci G% a 10LD FOR SPECIAL REQUJREM NT� � �i� .c.<..e. - G�s � � � �. �. � TN6 AMOUNT BMOWM YNDHp VALUATOH IB ROR TX6 j •URPOB[ OP iHTA�IIBN�NO A PEPMIT F8H ONLY. ib VALUATION � PERMIT FEE p =a�o� °� o w �VW1VM:tt I;tWP'1tlCiIV�f�11Y� ME1V1IIri. llATY: �-1V V� �JOE ADDRESS �37 Id8h0 P18Ce BUILDING PERhIIT N( � GENERAL CONTRACTOR Owner-Bldr. nESCitipt•iON OF WORK Add Patio Co� J AP No.139-0 3^].1 LOT Z'xACT FIRE ZONE VALUE g 150.00 � INSPECTIONS � Signature � Date GROUP J TYPE N& V ZON � Soil I PERhil'. � Gas SUBCONTRACTOR Date � Ni �� .� . ' 'G>�9 /-�. T� � COSTA MESA BUILDING-SAFETY DEPARTMEM P.O. BOX 1200 GOSTA MESA, CALIFORNIA 9262E For AppIIMM fo Flll In ComplNdy TYPE OR PRINT COSTA MESA. CALIFORNIA TEL uHa rnor DESCWPTION OF WORK WALL I1 NeRleY �CKNOWLiDO[ TIAT.1 NAV6 R�AD 1'HI� �I�LIGTON AND 9TAT6 TNAT TNi AOOV[ IG COM6R AND A011[i M COY• PLY WITH ALL CITY ORtl�W�NCi! AMO RAT{ IAMI/ 11LOYLATNO nui�oino coxmqurnoH. /y/ ,/ 816NATURl��- i�'�f/ /i/w. � AUTMORI2[D AO[NL � JUL 10-61r is��0 G07 �:::i:4i:�•Z.f C ArPLICATION FOR PERMIi BUILDINO ro► oarn u.. o�y �r m■ I wo. or I u�a or n�v+ �*�d Ko.{ � � � ►LANt z �UILDINO �� L,a f' So TiP 36 Z.� uace�mon w.r.no. l3Gi— �83— /l NOTH: NO eAVB OVHPHANO GlIALI EH LH88 TXAN YARD! MPROVlD MAIN BUILDINO i Flt NT C��RH[T� R. �o AH % �. aio � rr. — Reue Z�r� - oierwNee ear. MwiN ei.naa. VAR. Ji YARDB MPROVBD ACCHSSORY BUILDINO t e owrs APPROVHD ..._e 7 —/a ' a w � sa. rr. � n�a �rourrt �Mown uHnen vw�u�noH ie ron n�a = ►URP06[ O! YlAGYeNINO A P[PYIT I[l ONLY. � VAWATION ,7 PeqM1T FBe � •�� w �or 5O - TRACT 36z5 ' --' ' 1��4s COSTA MESA 6UILDING-SAFETY DEPARTMENT P. O. BOX 3f7 COBTA MEBA. CALIFORNIA For Applieonf fo Fill In Complefely TYPE OR PRINT ADD E'S3 3237 IDAHO PLACE COSTA MESA CALIFORNIA owNER KENKOL CONSTRUCTION C0. MA{L �555 PLACENTfA AVENUE ADORES6 TE .Z.L GIiY NEWPORT BEACH No. AfiCHiTECT TEL. CONTRACTOR K.W. Ko�� 555 PLACENTIA VENUE ADDRESS C�n, NEWPORT BEACH STATE 6i�95 TEI.�I 6-32z7 LIC. NO. NO. ow�or 5�.08 X lOO IRREG Inow'ona�o�'r'� � vnoM �n t � I LEFT � O� • I RIGHT 5� DESCRIPTION OF WORK I x I.._��._._..I II.��._._ BUILDING �6z� SF NO. OF SIZE ROOMS EXTERIOR WALL TUCCO IROOF COVERING COVER U@E OF BUI ING AND ORK TO B SINGLE �AMILY ESIDENi GARAGE LAN c-.�.� �:,��_ �_, �X�-� `i -13-kc ' ,n. � : ��iii� Vl_. Ij � : :;1�Y' �: 'CS?.'..:i�:' �. APPLICATION FOR PERMIT BUILDING For Offiee Use Only NECEIPT NO. . P[RMIT NO. O�TE IBBUED COSTA MESA. CALIFORNIA FIRE ZONE APPROVE� ZONING ZON� � I puN9 �I BUILDINfiJJ� !,_r , L80AL r�/�% / ,�.—i� Y_ �. YARDS APPROVED ZO� ICeNTBP LIN6 8T.) IE6 � ES / ! ACHED Y� / ^ EVES D Fr P�� i • /A � 1 HEREBY ACKNOWIlPOB TXAT 1 MAVE READ THIB APPLIGTION THE AMOUNT BHOWN UN�ER VALIIATION IB POR TX¢ AND BTAT¢ THAT TH8 I�BOVE I6 GORRHCT AND �GP6E TO GOM- PURPO6E OF EST�BLIBHING /. vERMIT P¢E ONLY. PLY WITH wu c�x owv�nu+ces AND BTATE LAWB RH6ULATINO BUuole+o CONBrnucTo� VALUATION �� ^ BIGNATURE OF PERMIT FEE $ PERMITTE / 3 p ^ $ Ifp� � �" � PLAN CHECK $ �P �J AUTHORI2ED AG Y �'L^" �t '1'l-M1�1. �/ TOTAL FEE S 7'�