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Home My WebLink About3252 IDAHO LN - Building PermitsCITY OF COSTA MESA oT""'F BIIILDING DIVISION i , � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • vnvw.ci.costa-mesa.ca.us : � ` FOR INSPECTIONS CALL: (714) 754-5626 •�`"*�une �'• PERMIT NUMBER: E10-00161 PERMIT TYPE ELEC STATUS: ISSUED APN: 13906604 DATE ISSUED: 06I30I2010 ISSUED BY: CAC JOB ADDRESS: 3252 IDAHO LN CM Vicinity: Suite/Unit: SCOPE OF WORK: NEW CONDENSING UNIT 80K BTU. AND REPLACE FAU IN THE CLOSET. 1 OUTLET AND 1 SWITCH OWNER: OSBORN, NAN D TR Address: 3252 IDAHO LN Unit: PHONE: City/State/Zip: COSTA MESA, CA APPLICANT: ROBERT PALACIOS PHONE: 714-901-0500 CONTRACTOR: A PLUS HEATING AND AIR CONDITION Address: 7600 GARDEN GROVE BLUnit �City/State: WESTMINSTER, CA ZipCode: 92863 ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $25.70 Reinspection Fee $0.00 TOTAL FEES $25.70 a Address: 7600 GARDEN GROVE BL Unit: City/State/zZip: WESTMINSTER, CA .'� fi ��i;? a� License No. 763154 PHONE: 714•901-0500 CELL: �-'„!If'�'1 ..1r NOTICE: The work authorized by this permit shall comply vrith all applicable handicap access requirements under Califomia 5tatutes and related regulations. (Ord. No. 92-28, § 1, 72-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. iINSPECTIONS: In order for the work authorized untler this permit to be considered legal, such work must comply with all applicable codes, and all �required inspections and final approval must be obtained. Failure lo obtain inspections and final approval will result in the expiration of this permit. � OE� INSPELiIONflPE OqTE INTITIALS fi��EN INSPEC➢ONTVPE ORTE IN➢nus 1616 Fixed System Final Pire Prevention 206 Final Mechanical 7266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electnwl ��/�'�l7 r 201 Final BIwWRetaining Wall 212 Final Fire Prevention 202 Final Factory Pire Ptace 220 Final Planning Approval 203 Final Sign 222 FinalSite 204 Final Demolition 250 Final Building�Occupancy •.I i .c WORKERS' COMPENSATION DECLARATION: I hereby afTirm unaer penalty of perjury one of the tollowing tleclarations: ❑ 1 have and vrill maintain a certificate of wnseN to sel4lnsure for workers' compensation, as provided for by seclion 3700 of the Labor CoOe. for the pertormance of the work for which this pertnit is issued. � have and will maiNain workers' cwnpensation insurance. as required by sectbn 3700 of the Labor Cotle, for the perfortnance of the work for which this pertnit is issued. My vrorkers' wmpensation Insurance carner and policy n e: �.�. //� Carrier J V �� ^� V/ I �l /ed /��e pe.m4 is vaAreO a� are nuM�'eE aWars (S 1001 a leu ) POIi Nu r: i 5 D3 ❑ I certify that in the peAormance of the work !or which this permit is issuetl, I shall not employ any person in any manner so as to hecome subject b the vrorkers' compensation laws of Calilomia, and agree thal il I should become su�ject to the workers' compensation provisions of Section 3700 of the Labor Cotle, tha�l vrit w ese provisions ��( { Appli i re e WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirtn that I am licensed untler provisions of Chapter 9(commencing with Section 7000) ol Division 3 of the Business and Prolessions Code, and m�se is in full force an effect. C ss ana' � naWre CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrtn that there is a constructbn lending agency for the peAortnance of the work for which this permit is issued. (Sec. 3097, Civil Code�. Lender's Name: Lender's Address: SigwWre OWNER-BUILDER DECIARATIONS: I hereby affrm that under penalty of perjury that I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for Ihe (ollowing fea5on (Se[. 7031.5, Business and Prolessions Code: Any ciry or counry which requires a permit to conswct, alter, improve, demolish, or repair any strucWre. pnor to its issuance, also requires the applicant for such pe�mit to file a 5ignetl 5laiemenl that he or she is licensetl pursuant to the provisions ol the COMractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Cotle) or that he or she is exemp� lherefrom and the Dasis lor the allegeC ezemption. My violation ot Section 7031.5 by any applicanl tor a permit subjecls the applicaM to a civil penalty ol not more than (ve huntlred dollars ($500�.�: ❑ I, as owner of Ihe propeny, or my employees with wages as Iheir sole compensation, WILL DO THE WORK, and the structure is nol intended or oRered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply lo an ovmer of property who builds or improves lhereon, and who does such vrork himsell or herself or through his or her own employees, provided that such impmvements are not intentletl or offered for sale. I(, however, the building or improvement is sold within one year ol complelion, the ovmer-builder will have Ihe burden ot proving Ihat he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044. Business and Pro(essbns Cotle: The contractors License Law dces not appy lo an owner of property who builds or improves thereon, and wtw cont2cts fw such pmject vrith a cmtracta(s) Gcense pursuant to the Comractors License Laws.). ❑ I am exempt under sec. Business antl Professions Cotle for this reason: Signalure Daie 905]�a6 (10l � Owner ID verifietl by driver s license. ❑ Ves ❑ No Oriver's License No. Expires: Veri(cation of Ownership by (type oi document, i.e. - property lax bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify mat no excavation frve (5) or more leet in depth into which a person is required to descend, will 6e made in connectbn with nvrk authorized by Ihis pertnit, and that no building strucWre, scaffdding, false�wrk, or tlemolition or dismantling thereof, will De more than thirty-siz (36) feet high. (Chap. 32, Grp 2, M 2, Sec. 341, Title 8, Califomia AdministraWe Code). � As owner-buileer, I will not employ anyone to do work vfiich v.oultl require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to tlo such work from the division. AppliwnCs Signalure Division of Intlustrial Salery Permit Number. _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant neetl to file and certify a Business Plan for emergency response to release or threatened release o( a hazardous material? ❑ Yes ❑ No (Section 25505 0( the California Heal�h and Safely Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantily of hazardous matenals equal to or greater than a weight of 500 pounds, or a volume o! 55 gallons, or 200 cubic feet of compressetl gas at standard temperature antl pressure). 2. Does or will the applicant or present or future building occupant need to file a registration (ortn for acutely hazartlous materialsT ❑ Yes ❑ No (Section 25533 of the Califomia Health and Sa(ety Code, with some ezceptions, requires re9istralion with the Costa Mesa Fire Department by each business vfiich at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight o( 500 pountls, or a volume of 55 gallons, or 200 cubic teet of wmpressetl gas at standard temperaWre and pressure). 3. Does or will Ihe applicant or presem or /uWre building occupant neetl to prepare an RMPP (Risk Management and Prevention Program for awtely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Health ana Safery Code pmvides lhat Ne Costa Mesa Fire Department may require the preparatioq certifcation antl fling with Ihe Fire Department of an RMPP by businesses which are required to register acutely hazardous matenals with Ihe Fire Department. 4. If an RMPP is pre5ently required, ha5 Section 25534 of lhe California Health antl Safely Code been lully complied with? ❑ Yes ❑ No 5. Does or will Ihe applicant or present or fulure building Octupant require lor lhe work which is the subjec� ol this application a permit for such construclion or modi�wtion !rom the South Coast Air Qualily Management DisMct or from any other air pollution control district or agencyT ❑ Yes ❑ No (Section 658502 of the Califomia Govemmem Cotle requires that the requested, informatbn be fumished on applications (or ran-residential buildirg pertnits�. 6. Will any part of the facility to ba constructed under Ihis pertnit be wilhin t0001ee1 from the outer boundaries ol a school? ❑ Yes ❑ No (It'yes", the facility must meet the requirement of Sections 25534 and 42303 o( lhe California Health antl Saleiy Cotle). 7. I! a pertnit from the Soulh Coast Air Quality Management District or other air polWtion conlrol disirict or agency is required for the work which is the subject of this application, have all of the tlisclosures prescribed by Califomia Health and Salery Code Section 42303 been made? ❑ Ves ❑ No 8. (If'yes". atlach certificate of compliance from the appropriate air pollution coMrol oKcer). CERTIFICATE OF COMPLIANCE: I certify that under penalty o( perjury the information given above is correcl. I agree to comply with all state laws and city ordinances regarding HazaMous Materials and Emissions. Signalure Da:e CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the intortnation given is correcL I aqree to comply wiN all state laws and city ordinances relating to builtling conslniction, and authorize representatives of the City of Costa Mesa ro enter upon the above-descnbed properry for inspection purposes. I agree nol to occupy or allow occupancy ot any buil0ing authorizetl by this permit until final inspection. 1�� ,.. .T.}i{T+.. ,t. a MFS a Q n. Y., e , r J u B ,�`�+�mm `�,' CITY OF COSTA MESA � BUILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • �wvw.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT TYPE APN: 13906604 JOB ADDRESS: vicinity: SQ. FT: 0 MECH 3252 IDAHO LN CM PERMIT NUMBER: M10-00060 STATUS: ISSUED DATE ISSUED: 0 613 012 0 1 0 ISSUED BY: CAC Suite/Unit: SCOPE OF WORK: NEW CONDENSING UNIT 80K BTU. AND REPLACE FAU IN THE CLOSET. 1 OUTLETAND 1 SWITCH OWNER: OSBORN, NAN D TR Address: 3252 IDAHO LN Unit: PHONE: City/State/Zip: COSTA MESA, CA APPLICANT: ROBERT PALACIOS Address: 7600 GARDEN GROVE BL Unit: PHONE: 714-901-0500 City/State/zZip: WESTMINSTER, CA CONTRACTOR: A PLUS HEATING AND AIR CONDITION Address: 7600 GARDEN GROVE BLUnit: Ciry/State: WESTMINSTER, CA ZipCode: 92863 MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $53.10 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: $0.00 REINSPECTION FEE: $0.00 1.` TOTAL FEES: $53.10 License No. 763754 PHONE: 7'14-901-0500 CELL: "'i t�'��il�� ..� .��V� NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California slatutes and related �regulations. (Ord. No. 92-28. § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 9NSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply vnth all applicable codes, and all ; required inspections and final approval musl be obtained. Failure to obtain inspeclions and final approval will result in the expiration of this pertnit. 'COOEO. INSPEG710NTYPE � INTITIRLS COOEi INSPECTIONME DATE pINPTIRLS i616 Fixed System Final Fire Prevention 206 Final Mechanical �— �—�fl �/�yp (�,� 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electriwl 20t Final Block/Retaining Wall �202 Final Factory Fire Place 203 Final Sign 204 Final Demolition 272 220 Final Fire Prevention Final Planning Approval 222 Final Site 250 FinalBuilding/Occupancy ` ' ro.' WORKERS' COMPENSA710N DECLARATIO� I hereby aKrm under penalry of perjury one o( Ihe following declarations: ❑ I have and will maintain a certifcate of consent to sel4lnsure for vrorkers' compensation, as providetl (or by section 3700 of lhe Labor Code, for �he �perf rmance of ihe vrork for which ihis permit is issued. I have and will maiNain vmrkers' compensation insurence, as requiretl by sectbn 3700 0( the Labor Code, (or the peAortnance of the v.ork for which this permit„is-issued. My workers' compensalion Insurance carrier and policy number !'_; 1/� Ca � . 'Ut't� (Thusetlai notoem�ni(d�efereame1p�e1rma'avaruedatmenuiMietlddlars(E�oo)wless) P Ifc N er: Q�SC), )�/.J ❑ I certify that in the pertormance of the work !or which this permii is issuetl, I shall not employ any person in any manner so as to become subject to the vrorkers' compensation laws of Calilornia, and agree that il I shoultl become subjecl ro U vrorkers' compensation provisions o( Seclion 3700 of Ihe Labo all rthw' mply with these provisio s. •. ol's at Dat WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed untler provisions of Chapter 9(commencing with Seclion 7000) of Division 3 of the Business and Pm(essions Code, and my license is in full (orce a effect. ic'#`�� Qas # � _ ractors i wre �e CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrm that there is a construction lending agency for the peRormance of the vmrk f« which this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lentler's Address: SignaWre Date OWNER-BUILDER DECLARATIONS: I hereby affifm lhat Under penalty of perjury (hat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW lor lhe follOwing feasOn (SBC. 7031.5. Business and Professions Code: Any city or counry which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance, also requires the applicant for such pertnil to (le a 5ignetl slatement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom antl the basis for the alleged exemption. Any violation o! Section 7037.5 by any applicant for a permit subjects the apDliwnt to a civil penalry of not more than five huntlred dollars ($500).): ❑ I, as ovmer of the property, or my employees with wages as their sole compensation, WILL DO 7HE WORK, and the slructure is nol intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors license Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or throug� his or her ovm employees, provitled thal such improvements are not imended or oReretl lor sale. If, however, the building or improvement is so10 wilhin one year o! completion, the owner-builder vnil have the burden of proving that he or she did not build or improve for purpose of sale.). � I, as owner of the pmperty, am EXCLUSIVELY CONTRACTING WITH UCENSED CONTRACTORS to consimct the prqect (Sec. 7044. Business antl Professbns Code: The contractors License Law dces not apply to an ovmer of propeny who builds or improves thereon, antl who cont2cts for such prqect wilh a contraclor(s) license pursuant to ihe Cont2ctors License Lavrs.). ❑ I am exempt under sec. Business and Pro(essions Cotle for lhis reason: 3�5Aa6 (3/0]� Owner ID veri(ied by drive•ense. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (rype of documenC i.e. - propeny [ax Dill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation frve (5) or more ieet in tlepth into wfiich a person is required to descend, vrill be made in connectbn with wvrk authorizetl by this permit, and that no 6uilding sWcture, scaKdtling, falsework, a demolition or dismantling ihereof, will be more than Ihiny-six (36) feet high. (Chap. 3.2, Gry 2, Ari 2, Sec. 341, TM1Ie 8, Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would requi�e a permit (mm the Division of Industrial Satety, as noted above, unless such person has a permit to do such work (rom the division. Applicanfs SB^aWre Dale Division of Industrial Salety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building ocwpanl neetl to file and certify a Business Plan (or emergency response lo release or threatened release of a hazartlous material? ❑ Yes ❑ No (Section 25505 of the Califomia Health antl Safery Code requires, with some exceptions, that a Business Plan be (led wilh [he Costa Mesa Fire Department Dy every business which has at any one time dunng a reportetl year a quantity of hazardous materials equal lo or greater than a weight of 500 pounds, or a volume o( 55 gallons, or 200 cubic feet ol compressed gas at standard temperature antl pressure). 2. Does or vnll the applicant or present or future building occupant need to (le a registration form (or acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of �he Califomia Health and Sate[y Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hantl a quantity of acutely hazardous materials equal to or greater than a weigM of 500 pounds, or a volume o! 55 gallons, or 200 cubic feet of compressed gas at standard temperature antl pressure). 3. Does or will the applicant or present or fu[ure building occupant need to prepare an RMPP (Risk Managemen[ and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Health antl Safety Code provides that the Costa Mesa Fire Departmenl may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required ro regis[er acutely hazartlous materials with lhe Fire Department. 4. If an RMPP is presently required, has Section 25534 of the Califomia Health and Safety Code been fulry complied vnth? ❑ Yes ❑ No 5. Does or will ihe applicant or present or fuNre builtling oCcupant requife (Of �h2 wOrk whith is the subjecl o( lhis application a permit for such construction or motlifcation from the Swth Coast Air Quality PAanagement District or from any other air polNtion control district or agency? ❑ Yes ❑ No (Section 658502 0! Ihe Califomia Govemment Cotle requires that the requested infortnalion be fumished on applications for non-residential building pertnits). 6. Will any part o( the laciliry to be conslructetl untler this permit be vrithin 1000 feet from the outer boundanes of a school? ❑ Yes ❑ No (If'yes", the (acility must meet the requirement of Sections 25534 antl 42303 of tha Calitornia Health and Sa(ery Cotle). 7. If a permit from the South Coast Air Quality Management District or other air polWtion control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been matle? ❑ Yes ❑ No 8. Qf yes", attach certificate of compliance from the appmpriate air pollution control oKceQ. CERTIFICATE OF COMPLIANCE: I certify that untler penalty of perjury the information given above is conecL I agree to comply with all state laws antl city ortlinances regarding Hazardous Matenals and Emissions. Dace CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify untler penalty of perjury that I have read this application and state that the informalion given is correct I agree to comply with all state lavrs and ciry ordinances relating to building constmction, and authorize representatives ot the Ciry of Costa Mesa to enter upon the above-descnbed property for inspection purposes. I agree nol to occupy or allow occupancy of any building authorizetl by this permii until fnal inspection. na ! Legal Own Dai An Wlll�r e0 Ap I[a� \- le 1 , �tlh� S � �;'U'�4 -Y� 5 ��1 t�q'� j� l� �� Y � � i t. '.r +.� � �� . '' � = � .,� ,• � ::: ! „ .7�. � J��!.` ��. �. �'et�)-- �' �\�J + �� .' � = �.''k�a j , v�- . ., . . . . . < . .� � < �.: . : � -� , . . . _. .__ , , : w : —� .S � �..a -� � r_ ti � r �a� . * - � If '� L: � � �� rY' �� •' ~ " Y �7 i� �� \ � -c�.__.�J � �. I ',.' h�� yY:-.. r� '�' � �r.`" j .''.."� -� A _.�� ' � � '�-- -' ' • _ --�—�..� .L '`' - _� �r�' -y- ,�_ � � >ri� ��, � �.- _ . �=�� s�� - f�� ' � ,;I. � . J ��f y �__3-�,��.,ti. i' S: _' � �� Q — '` � .�'iA� ��Ir�7 _ :.�' � � ._. '. . . : '"i '�j `'... � , � � f'- Pj!I, t"hi�.. 'J Uti=' ' t'sT� � -� ' ��Q�' �� 'jj� t� � ' � . . O . - .� `�•�J .� _ � � � ` � J-1 r.� �• G.. �_ . � s > , � ,'_F'�' � =� -��..: ' " `� ;; � � �� c��b j-' � �n. � . -�''�..,�' ""�}ti�.�J` � ti,�. ,.,�, . . 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GLIFORNIA For Applieanf io Fill In Complefely . TYPE OR PRINT � MAIL COSTA MESA. CALIFORNIA TEL. 612E NO. OP eLDoB. __ __ fillvl AA .._... _.. . __ � 88TB/1CK LINB PAOM CeNT6R OP BTfie� SO i REAR YARI 8IDE YARD I LEFT S T I RIGHT DESCRIPTION OF WORK APPROVED ZONE R• LBGAL FEE RECEIVED �� -�-bQ-g�. fINANCE 6EPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Office Use Only nECE1PT NO. � }Gjtpf OY � pAT$_FECi1VQD � � DATE COSTA MESA. CALIFORNIA ZONING Ho. or I use ov n PL./�N8 �J BUILDINO YARDS APPROVED (CENTfiR LINB BT.) � FRONT � R. SIDE S ZE DING 15(�7 � J ROOM6 6 STORIES FXTBRIOR W�� IROOP WOOd Shingl2 COVERING COVERING USE OF BUILP�NG AND WORK TO BE PERFORMED and Atitached Garage Plan 2-A � 1 HHRBBY ACl�MOWL8D6B TXAT 1 HAVB ReAD THIB MPLIGTION �ND BTATe THAT THe A60V8 IB COf1AlGT AND AGH88 TO WN- PLY WITH AL4 WT' GIi��N�NCHB ANp HTATH UWB PEOUTATINO BUILDINO CONBT/MU�CTION. � H 81GNATURE Ol / 0` ` p �� PERMITTB� � 6 AUTHORIZED AGENT EVES iH! AMDUHT BXOWN UNOlN VAI.UATION IB IOP THE PUIVOB6 OP EBTABLIBHINO A PHRMIT IEE ONLY. VALUATION /� �j/ � PERMIT FEE $ � ��J� S � PLAN CHECK $ �^V /� TOTAL PHB �/ / �