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Home My WebLink About3237 INDIANA AVE - Building PermitsCITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT PERMIT NUMBER " M99-00045 (774) 754•5273 • Faz (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 3237 INDIANA AV Suite No Vicinity: ParcelNunmber: �3904250 Applicant: MC KENNA, VANESSA Address: 761 n richman fullerton, ca. Owner: SIEBELS, MELVIN J TR Address: 3237 INDIANA AVE COSTA MESA,CA � Contractor. MC KENNA'S AIR SUPPLY Address: � 761 n richman MECHANICAL PERMIT Phone: 714-879-4444 Zip: 92832 Phone: Zip: 92626 . Phone: 774-879-0444 fullerton, ca. Zip: 92832 . . . License: 626029 ArchlEng: - � Address: Phone: Zip: License: SCOPE OF PERMIT CHANGE-OUT EXISTING FURNACE(ONLI�. ISSUE FEE Inst FAU <100 k BTU Inst FAU >700 k BTU Repair / Alt Cooling/Heat Inst I Rep. Recess Wall Htr Refrig Sys <700 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood wlMech Exhaust VAV Box Vent Fan I Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < t0000cfm AirHandlers> t0000cfm Floor Fumace Floor or Suspend Heater $22.00 $13.25 $0.00 so.00 $0.00 $0.00 so.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Repair I Alt Absorbtion Unit Repair I.AIt Refrigeretion Unit Ventillation System Evaporative Cooler Commercial I nci nerator Domestic Incineretor Compressors I Absorption Svstems Uplo3hp/100kBTU 3 To 15 hp I 500 k BTU 15To30hp/1,OOOkBTU 30 To 50 hp I 1,750 k BTU Over 50 hp! Over 1,750 BTU Boilers Up to 3 hp 37o15hp 15to30hp 30to50hp Ove� 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspedion Fea TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Status: ISSUED Applied: 02/12/1999 Issued: 0?J12/1999 quantlty 50.00 0 $0.00 0 50.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 80.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 535.25 EXPIRATION: This permit shall automatically expire and become void ii work Is not commenced wlthin 180 days, or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, end all requlred Inapeetiona and (Inal epproval must be obtained. Failura to obtain inspaelions end final epproval will result in �he expiration of this permit. FOR INSPECTIONS CALL: (714) 7545628 WORKERS'COMPENSATON DECLARATON: I hereDy effirtn untler penalry o� perjury one ol the following declarations: ❑ I heve end will meintain e certlflcate oi cronsent to selFlnsure lar workers' compensetion, es provitled lor by aectlon 3700 of the Lebor Cotle, for Ihe pertormence ot t�e work for which IhiS permi� is issued. ❑ 1 have entl will maimain workers' compensetion insurence, as redulretl �y section 3700 W Uie Lebor Cotle, fOr the peMortnance af Ne work far w�ich Nis pertnit Is luued. My workers' compensation Insurance carrlar end pollcy number ere: Cerrier: pollcy Numbec (7hls sec(far need not be camP�efed ll the perm/f /s velued et one hundred dollers (5100) or /ess.) ❑ I cartity that In Ne perto�ance ol �he work for which this pormil Is issueq I shflll not employ eny person In flny manner so es to become subject to the workere' compensetlon lews ol Callfomia, end egree thet tl I should became eub�ect to the warkers' compensetlon proNsions at Seqlon 3700 oi Ihe Labor Catle, I shell farthwith Comph/ wii� lhe5e provis�o�s. Applicem Signeture: �/� �%7 � r Dete: �- � Z. �9 /C WARNING: FNLURE TO SECURE W�ER$' WfdPENSATION COVERAOE IS UMAW R1L AND SHALL SUBJECf AN EMPLOVER TO CRIMINAL PENA�TIES rW D CML FlNES UP TO dJE HUNDRED THOUSAND OOLLARE (5100,000), IN PDDIiION TO THE COST OF COMPENSATION, OFMAGES AS PROVIDE� FOR IN SECfION 3'l080F THE LABbP CODE, IMEREST, AND ATfORNE`fS FEES. LICENSED CONTRACTORS OECLARATION: I hereby ettirm Ihat I am licensetl under provisions of Chapter 9(commencing with Section 7000) of Division 3 of lhe Business and Pmfessions Code, and my license Is in lull force end etted. Lia k Class x Comrectots Signawre: �-!/ '7� � / � Date: 2 • �1 9 `� CONSTRUCTION LENDING AGENCV: ❑ I hereby affirm Nat thera is a construction lending egency tor t�e peAortnance of Ihe work for whic� Nis pertnit is issued. (Sec. 3097, qvil Code). Lentlers Neme: Lendels Atldress: Sipneture: Date: OWNER-BUILDER OECLARATIONS: I hereby efllrm that under penely ot per�ury thet I em E7(EMPT FROM TNE CONTRACTORS �ICENSE LAW for the lollawing reeson (Sec. 7037.5, Business entl Professions Code: Any Gry or wunry which �epWres e permlt to consWct, elter, Improve, demolish, or repeir eny strucWre, pdor to its Issuance, elso requires t�e appllcant tor such pormit lo lile e slpnetl slatement thai �e or s�e Is Ilcensetl pursuent to the proNsions ot Ihe Cantrectors License Lew (Chepter 9(commencinp wl�h Secilon 7000) of Divlsion 3 0l ihe Business anO Professions Code) or thal he or she is exempt Iheretmm and the basis for the alleged exemption. My violetion of Sectlon 7031.5 by eny applicent for e Dermit suD�ectv ihe applicent to a civil penalry ol not more Nen five hundred dollars �5500).�: ❑ I, es owner ot ihe properry. or my employees with wages as their sole wmpensation, WILL DO THE WORK, antl ihe structure is not intended or oHered for sele (Sec. 7044, Business antl Profess�ons Code: The Contrectors Llcense Lew does not appy to en owner of properry who builds or Improves thereon, entl who does such woM himselt or herself or throVgh his or her own employees, provitletl t�at such improvemenis are not Intended o� oMeretl tor sale. If, however, Ihe bullding or Improvement is sold within one year oi completlon, Ihe owneo-builder will �ave the burden of proving Ihat he or she tlid not build or improve for purpose oi sele.). ❑ I, es owner ot tha prope�iy. em EXCLUSIVELY CONTRACTNG WfTH LICENSED CONTRACTORS to Construct the proled (Sec. 7044, Business and Pmtessions Code: The wntractors U�ense Law does not apply to an owner of property who builds or improves thereon, entl who contrects for such project wit� a coMrector(s) Ifcense pursuanl lo Ihe Contrectors license Wws.). ❑ I em axempt untler sec. Signeture: Owner ID verifietl by tlriver's Ilcense. ❑ Ves ❑ No Business and Professions Cotle for �his reeson: Vedlicatlon ol Ownershlp by (rype at tlacument, I.e. - pmperty tex tlll or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: Dr'rvefs License No. Date: Expires: ❑ I hereby certity thet no ex�eveHon five (5) or more feet In depih Inro which e person is required Io descenQ wlll be made In connectlon with work euthodzed by Ihis permil, and thet no building structure, acallolding, felsework, or demolitlon or tlismaNling theroof, wlll be moie t�en thlM1y-six (38) leet high. (Chep. 3.2. Grp 2, An 2, Sec. 341, 71t1e B, Cflllfomia Administretive Catle). ❑ As awner-builder, I wlll n0� employ enyone to do work which would require e pertnit from the Divislon of Industrlal Safery, as notetl ebove, unless such pereon hes e permit to do such work Irom the tlivision. Sipnelure: Date: Division of Indusirial Safery Pefmi� Number. CERTIFlCATE OF COMPLIANCE AND AUTHORVJITION OF ENTRV: I certily under penalry ol per�ury thet I have �ea0 this appllcation end state thet the infortnetlon given Is correct. I egree to camply with all stete lews end ciry ordinances relating Io building consWclion, antl eutharizo representatives at Ihe Ciry af Costa Mesa to enter upon the eDove-CescdbeC propefty for inspectlon purposes. I egree not to occupy or allOw occupancy ot any bullding euthadzeA by Nis permlt untll finel inspeqion. Slgneture Ot Legel Owner(s) Y/Yyi � ,e-� .qPO/Or AUl�odzetl Applicant I4•7-037�I:F99 idl:9: �N7q 1616 Fixed Sysiem Final File Prevention 1268 Pool Spa F{nal 200 Flnal Re-Rooi 201 FInaI8locWRetaininp Wall 202 Final Fectory Fire Place 203 Fnal Sipn 204 Flnel Demoli6on zaase � IN7IDE� Dete Z- / Z Date GO�E I INSPELTION TYPE 208 Finel Mechenlcal � 20B Finaf Plumbing 210 Final ElecMpl 212 Finel Fire Prevention 220 Finel Plannin8 MP�oval 222 Final Si�e 250 Finel Bulidlnp/Ocwpency `� � ADP��ant to /ill in all spaces exce0t those within �eavy EorCer Iines anC sign all apo�oDriate tleelarations. C TY O� COSTA MESA CONSTRUCTION PERMIT PERM12�� TRACT NO. LOT NO. UNIT NO. 2363 2/ �]/B] I O•BO j ProjectAddress .3eZ3% //VD//4NA i4VE Applitenl'S Mailing AddfESs 32 37 /�j�//4NA i� ✓E TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,q�t 2on8 Owner's Name ��{��/V •� -S�ERFLS phonaTh�f 77Cj DESCRIPTION OF WORK/USE OF BLDG. Address �3� //✓�J/9A//4 BVF e,/y• S MainBuilding: AccessoryBuiiding: E Z Arch/Eng, LicenSeNo. TVPEOFPERMIT GRADIrvG FOUNOATION STRVCTURAL T Front p Addres5 ❑ TENANT ❑ EIECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear N ❑ OTHER Contracmr'sNum � Phone C Right N PROJECT DESCRIP710N S4. FT. OCCUaANCv K G Addresslmailing) CON5�1'RUCTIONTVPL vALUATIONS g Left R City LiCenSeNo. 20NE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION Ping. Ref. 9W Parking Fieq./Provided E � 1 hereby affirm lhat I am licensetl untler O�oviSions of Char[et 9(commencing Remarks: Planning Notes: M with sec[lon 7000) o/ Division 3 ot t�e Businesz antl Protessionz Cotle, antl my II<enze is in full force antl etiect. T S Licunso Class Llcense No. Date Si9�ature PLUMBING FEES ' WORKERS' COMPENSATION OECL/1RATION BarSink ShoWers 1 hereby al/irm that 1 have a certitiwte of consent to self-insure or a certitiwte ELECTRICAL FEES of Workefs' Compen5diion Insurance, or a ceftltletl copy tllefeof (SeCtion BdCkfIOW Pf¢vEnt¢f S¢IviC25ink 3800, l.ao. c.) Automatic Washer Transformer ❑ 15-50 KW Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. � 50+ KW CertltieE copy i5 hereby turnisnetl. Certl�iod coDY is filetl wi[h the city Builtling DfviSion. Bdthtubs � $¢w¢f COnO¢CtiOn COOking Unit M¢tE� ❑Up to 1�0 dmp5 Date APplicanl EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifie�5 $olar COlIeCtOrs DishWasher Metet �over 100 amps (Tbis seclion naetl not De compleletl if th! permit I5 for one buntlretl (E100) or less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric � Sub Panel 00 I certlfy that in the perbrmance ot tho work tor wnlcn tnis perm�t is issuetl, I shall not employ any person in any manner so as beco e bject to tho Drinking Fountains Solar Tank Fan Motors 00.1 HP 01 h- 8 Workers' CoTo en Uon Lawz ol Calif Date �-/ 7-�Zsiqnature � Floor Drains Swimming Pool wlSpa F.A.U. Inc. Solar �9�15 HP �16-15+ NOTICE: If, alter making this tlecla�ation, y ShOUItl become subjec[ to the — Wo�kers' Com0en5alion p�ovi5ion5 01 th0 bor Cotle, you mu5t forthwilh FIOO�SinkS U/i�el z Fi%[u�¢5 MiC�Ow3vC comply wit� such p�ovision5 or t�iz pe�mit Snall be tleem¢tl revoke0. CONSTRUCTION LENDING AGENCV GaSServiCe OuUeti WaterClose[ DeviceBozes 1 hereby alli�m tnal lhere is a mnSVuclion lentling agency fOr Ihe performanco POI¢ Light of [ha wo�k tor whlCh Ihis permit ii ISSUCE (Sactlon 309] Clv. CJ IOI¢�G2pt0�5 Water Hea[er � �'�' Outlets Rdng¢ �entler's Name �enae�'s Aaarass Kitchen Sink Water Service � Switches - Sign OWNER BUILDEH OECLARATION . I hereby alflrm that I am exempt from lhe COnl�acto�'S LIC¢nse Law for th0 LevetOfiES AUfO-WdSh Garba C Di5 0521 following reazon (Section ]031.5 Businass antl Prolessional Coae: Any city or 9 P Standing Sections counly whicn requiros a permit to tonstract, altar, improve, tlemolish or repair P-Trap Laundry Trays GeneratOr �0�5 KW �5�15 KW Trash Compactor any Slruciuro, prbr to Its i55uanCC, alm �equires Ine applicant tor such parmil to lilo a si9natl statement Ihat he/sne Is Iicensntl purzuant to Ihe provisions ol Roof Drains ' Ihe Contractor'S Liconse Law (Chapter 9(�ommancing witn Section ]000) oi DivlSion 3 OI tho Business antl P�ofe55ions Cotlo) Or t�at he/sne is ezomOt there/rom antl ihe basis tor the alle9etl exem0��on. Any violation ot Seclion . 7031.5 by any applican[ fOr a permit zubfects tne appli<ant to a Clvil �enalty o/ not mor¢ lhan tive hun0�etl tlolla�s (5500�. I, az ownor ol the property ' o. Reinspection Fee 515 Issue Fee 5 3 en___.�^=wiu tla Ihe work, antl the sirucWre is not intentletl or olteretl Rainspaction Fee $15 Issue Fna 5 3 lor sala (Seclion ]o4a, Business and Profezsional Cotle: The ConVactor's MECHANICAL FEES Licens0 t�w tloe5 nOl aOV�Y �a an ownel of d prOperty who bulltli Or Impwvas t�oreon, anE who tloes such work himsel�/horzoli or tnrougn his or her own Hood Or Type I ❑ DEVELOPMENT SERVICES REQUIREMENTS: emplOyees, provltletl that such imProvemnnts are not intentletl or of/¢red fo� BOiIC� ' sala. If, nowever, tne builtlin9 or impravamant is sola witnin one year ot com- Canopy Type II ❑ Zaning Approved By Dnte � plOtiOn, th¢ Ownor will have ttta bu�dnn 01 proving he/5M1e tlitl nol builtl Or Im- Duct - Under Ground Building App�OVed By DdtB prove 10r lM10 OurpOSu of sale). ❑ I, as owner o� tne orooerty, am excWsively contractlng wich Iicensetl con- Duct -Strucmral Refrigeration System Appliratian luued By Dat lractor5 t0 consiruct tne prolect (Setllon ]044, BuSiness antl Profe55ion5 Codo: Tho Contractor's License Law tloes not aoP�Y to an owner ot properry who Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARV OF FEES builtl5 or ImOroves lhereon, antl who conVacts �o� sucn projects with a con- tractor(s1 ucunse pursuant to the Contractor's Llcanse�Law). I am aware that Exhaust System ❑ Multiple ❑ System flepair/Alteration BUILDING PEFMIT $ $MIP $ praof o! thelr Worker's CompenwHon insurance shoula be provl0etl m mo. _ PLAN CHECK S PERMIT ❑ 1 am exempt untler Sectlon B. d P. C. mr this reason Firepl/Fact Blt. ICBO # Fire Dampers PLUMBING $ ISSUANCE S oate �- owner Heating System & Ducting Registers pLqN CHECK 25% $ ENERGV P.C. 3 i hereby certlly tnat I have reatl this a piiwtion ana state that tha abova ❑0700,000 BTU �700,0006T ELECTRICAI $_��$'Q_ GRADING S Informatlon Is mrrecL I agree to comv� '�'��h all clry antl <ountY ortlinances antl state laws relatin9 to Daimin9 construcUon, antl nereby authorize repre- PLAN CHECK 50% $ MICROFILM $ sentallve5 0/ thls cily to nter upon ¢ above-mentlOnetl prop¢rty tor ��% inspectfon ur es. � MECHANICAL 5 l"� •� Siqnature � Dai��/7��7 TOTALFEE 5 Drivrfs' License or � ' Reinspection Fee $15 laue Fee $ 3 PLAN CHECK 25% $ CMF OB65-46, rev. ]0/84 White - Builtling: Canary - Applicant; Pink - Accountin9: Goltlenrotl � Assessor CONSTRUCTION ANDPLANNING POOL&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. Elec[rical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVALTO 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, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 71. 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 i6. Rough Electric Wiring ��G_�� 67. Fencing & Access Approval 17. Rough Wiring Sign ' 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SVSTEMS 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. Produc[ Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Struc[ural) & 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 31. 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 � 38. Final Plumbing - 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final � 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation . 46. Handicap Regulations , . 47. FINALSTRUCTURE&BUILDING � 48. Special Requirements Completed 49. Electric Release to Edison . 50. Gas Release to Southern California Gas Co � 57. CERTIFICATE OF OCCUPANCY. No. Date ' , ;� r' CITY OF COSTA MESA � : � ' BUILDING DIVISION , � OWNER-BUILDER VERIFICATION A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the retum of, an ownerbuilder verification. Attention Property Owner: An 'owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. � Yes ❑ No 2. I(have/have not) F%VF signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name ��A Address City Phone ( 1 Contractor'S Lic. No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name �f% Address City Phone ( 1 Contractor's Lic. No 5 I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name . Address Phone � Type of Work I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of California Health and Safety Code and have completed the above information to the best of my personal knowledge, in compliance with this State law. Signed: Date: � —� 7 � � � Name: /�l .CVi/1/ �/� o5'/FREL 5 (Printed or Typed) C.D.L. #or S.S. # �� 7545273 CMF 3042-46 OWNER S�TF�� M�• ROGER ' DATE 2-23-61 JOB ADDELESS 3276 Ind'iana AV2. BUILDING PERMIT A�O. 13 9 GENERAL CONTRACTOR E. Guenther Masnnarv VALUE S�nn nn AP. No. INSPECTIONS OCCUPANCY LOT ( T12ACT � FIAE ZONE DESCRIPTION OF WORK $lOCk W811 DATE GROUP TYPE ZONE R1 .G. WafOi I PERMITS ISSUED ---I SUBCONTRACTOR Form 110—SM-11�59 S-B P Y.,u��i Z 13896 �� 9`�� ' $��:�� .� Q�AY � 6 taso L COSTA MESA BUILDING-SAFETY DEPARTMENT F��j�,a`CE DEPT. P. O• BOX 977 C09TA MEBA. CALIFORNIA ��n oE cosra r�Es. For Applicant fo Fill In Compleiely APPLICATION FOR PERMIT TYPE OR PRINT sua�iN� BUILDING ADDRE6S A COSTA MESA CALIFORNIA For Offite Use Only InC• PECEIPT NO. ��RWA�T NQ<J OWNER Vermont Avenue Land Co. ��u MAIL l, �+ n � rtecc�vvv�� av oerE qeCerveo 1 o�re iesrve196I ADDRESS 419 L' • Zltih St• � .�i�i�n��/I �I111V l NO. L1H].1 ADORE65 & , Tu,t,' COSTA MESA, CALIFORNIA FIRE t,,Lo E. i�tn st. ZONING C�SU 'rv$a ZON[�_� I NO.OF � I IISE OF� ay� vur+s aui�oin y 7%z93 NO. I+l. 8-1159 Leoe� D68CRIPTION ' 1 NO. OP BLDGOTi NOW ON LOT 1VQ e p p NO. IIOiSE 98TBACK LINC FRON CEHIea On s''REET �O � REAR YARD O� 61DH YARD I LEFT � I RIGHT B� pESCRIPTION OF WORK OYPROVED W L. D. WALL I ROOF F'r.i1f:Q0 COVERII ❑LDING AND WORK TO BE I HeREBV ACKNOWLEDGe TH�T 1 X�VB HBAD THI6 APP4IGTION TXE AMOIIM BXOWN UNDER VqLUAiION IB FOR TH6 ANO eTATE 1HAT TXE �BOVE 18 GORPEGT AND AGREE TO COM- PUPPOBE OV EBTABLIBH�NC A PERMIT FHH ONLY. PLY WITH Au CITY OROINANGE9 AND B1ATH LAWB HEOULATNG BUItDINo Coxe'rttucno VALUATION 81GNATURE OF `� PERMIT FEE $ 36� N PERMITTE n $ 16 101• PLAN CHECK $ lp� AUTHORIZEP AGENT Dike & olegrove� II1C• � � TOTAL FEE LL