HomeMy WebLinkAbout1962 FLAMINGO DR - Building Permits •
CITY OF COSTA MESA
I'
04.1 4C-
BUILDING DIVISION PERMIT NUMBER
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
^ais°;44 /399-01543
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1962 FLAMINGO DR Status: ISSUED
Suite: Applied: 09/27/1999
Vicinity: HOUSE&GARAGE Issued: 09/27/1999
Parcel Number: 13947103 Zoning: R1 R1 •
•Q
Applicant: DAN PETERSON SONSHINE RAINBOW ROOFING ISSUED BY: r7-
Address: 27 CANYON RIM ROAD
Phone: (909)622-8761
POMONA,CA Zip: 91766
Owner: IKEDA, MASAYUKI TR
Address 24351 LAS NARANJAS
Phone:
LAGUNA NIGUEL,CA Zip: 92677
Contractor: DAN PETERSON SONSHINE RAINBOW ROOFING
Address: 27 CANYON RIM ROAD
Phone: (909)622-8761
POMONA,CA
Zip: 91766 License: 395452
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF-T/O, INSTALL 1/2"PLYWOOD SHTG, 1 LAYER OF 30#FELT&NEW 30 YEAR ELK PRESTIQUE FIBERGLASS
SHINGLE ROOF.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $5,400.00
Permit: $125.25 Claim Valuation: $5,400.00
SMIP Res: $0.54
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $125.79
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections end final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
r=szzamilimaimilimossimmais
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
r0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit IS issued.
O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
AZ(I certify that in the performance of the$ywork 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 Ce' rnia,anddee that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these pro " n q
Applicant Signature: CIAN Date: 1 ` 7 7— 7 9
WARNING:FAILURE TO SECURE WORKERS' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S100,000),IN ADDn10N TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am liceg,sepyndgr ro isions of Chapter 9(commencing with Section 7000)of Division 3 of the Busines antl rofessions Code,and my license is in full
force and effect.Lic.N vv 7JVp 'i �f�� - Class# C" 37
Contractor's Signature: C4n-- Q Date: 9-2-7- ?q
CONSTRUCTION LENDING AGENCY:
o I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: - Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement 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 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).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not 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 through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that 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 Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feel In depth into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building Structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title B,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a,permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes L-I No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Calitomia Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
�Ign ure Of Legal Owner(s) Date
-., 7- 2.9- 9y
And/Or Authorized Applicant Date
COBE N INSPECTION TYPE g9IE INTITIALS CODE II INSPECTION TYPE gat INTITIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
/y
200 Final Re-Roof /r44 9y 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2446-46
A P P R O V E D STRUCTURAL APPROVAL ONLY
City of Costs Mesa Building Dept. SEPARATE PERMITS ARE REQUIRED
FOR ELECTRICAL; PLUMBING,
4r' "-.. .. .._.___ATF I HEATING, VENTILATING AND
THESE PLANS MUST BE ON JOB AT ALL TIMES REFRIGERATION WORK APPROVED
D
MAKE NO CHANGES WITHOUT PRIOR APPROVAL
• OF DEPT.
CITY OF COSTA MESA
THE ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL Permit # 5;0re • FLAPWWLi DEPT.
OF PLANS AND SPECIFICATIONS SHALL NOT BE CONSTRUED JUSJECT TO MOO DEPT, REG.
TO BE A PERMIT FOR, OR ANSAPPROVAL OF, ANY VIOLATION THIS NUMBER MUST ACCOMPANY
OF ANY OF THE PROVISIONS OF THIS CODE. NO PERMIT PRE• ALL INSPECTION REQUESTS / �p_�z�y B�
SUMING TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF THIS CODE SHALL BE VALID, EXCEPT IN SO DIRECTOR O� P4NMMIDY."a,
MR AS THE WORK OR USE WHICH IT AUTHORIZES IS LAWFUL FOR BUILDINGS WERE PERSONS ME TO BY /
THE ISSUANCE OF A PERMIT BASED UPON PLANS AND BE EMPLOYED, WE SUGGEST THAT TRE
SPECIFICATIONS SHALL NOT PREVENT THE BUILDING OFFICIAL INDUSTRIALUE OF CALIFORNIAEYBEDIVISION OF
FROM THEREAFTER REQUIRING THE CORRECTION OF ERRORS SAFETY BE CONSULTED FOR
IN SAID PLANE AND SPECIFICATIONS OR FROM PREVENTING gee, ��IDITIONAL REDLIIR y`
BUILDING OPERATIONS BEING CARRIED ON THEREUNDER WHEN )_
IN VIOLATION OF. THIS CODE OF ANY OTHER OROINANC ��Oi/ /��� ��
OF THE THECICITY, "°/ '
•
ci
. \\
\\N.:}N—
• •�� RESIDENCE 5 RESIDENCE RESIDENCE RESIDENCE
\t\I-
�' E � T 2 IA
_ /�i / 17'r STREET CE
,*7 72 ey 7//E- 2-7.. OWE
.
TYPICAL 611 CONCRETE BLOCK FENCE
Cement Coping Optional
'11 Channel Block With 1.3/8 Il irl GENERAL- NOTES
f Ell0 Horizontal Top of all r"' ---
Fences la MORTAR: One Part Plastic Cement, and
Three Parts Sand
GROUT : One Port Cement Three and
For Fences 5'or Less 8' a• i One Half Parts Stand
Vert.Bars 3/8••Oat 4' -0-0.c. al= }- I - _ COPING One Port Cement, Three
For Fences Higher Than 5• - 4 o i Ports Sand
Vert.Ban 3/8"Oat 32" O.C. >- w CONCRETE: well Mixed 1.2-I/2. 3 I/Z
= Max. of 7-1/2 Gallons of
Fill Cells Solid With Grout I I ; •>,z ` 1 I " ' Water Per Sack of Cement
Where Steel'Occurs >1- _ - - -
ReInforCing Steel Shall --, a to
1 . OF THE MAY BE POURED FROM THE TOP
Conform to Sec.A-15-39 u 0 OCCURS.
I
_ OF THE FENCE IN CELLS WHERE STEEL
III
V I-
CELLS AND AREAS OF HORIZONTAL REIN-
w n FORCEMENT SHALL BE CLEAR,CLEAN&
., All Steel to be Lapped 4 FREE OF ALL MORTAR DEBRIS.ETC.
24 or to CodeEl 1.11 I PROVIDE CLEAN-OUT AND INSPECTION
HOLES AT THE BOTTOM OF CELLS CON-
NATURAL GRADE I TAM•
PING VERTICAL REINFORCEMENT.
BONDS SHALL BE PROVIDED BY LAVING
'I _ w-`� y"V--\1C:.1 l:•. �' '. tI — _— ■■ ,�� -�, BLOCKS IN STRETCHER COURSES SO THAT
{ •
^
� /,`-. .\y- s a C - VERTICAL JOINTS ALTERNATE IN EACH
;
. ,` . (�- -0 _ 1 ° •• • ♦ COURSE.
3/8"0BARS cc—ill . I - • . • • t.
CONTINUOUS TOP I _ TO 16' 0 C MAX _ a
&BOTTOM 1-m--WIDTH
c L SEE CHART •
JALL STEEL MUST BE TIED IN I BELOW , OF PTHUfARTHTCOTHPLACE AT TIME OF TRENCH t • Ij3 THE HEIGTH Of FENCE
INSPECTION. 0 .- L BELOW eOT TOM OF FOOTING
i 1-61-90-140 2..•� SCALE: 1/2" 2 I'
i
I FOOTING REQUIREMENTS CHART
• WALL HEIGHT . 6 ' 5` . . . 4' . . 3'
WIDTH 14" . - - . . . . . I4" . . . . 12". . . . . . 12"
THICKNESS . . . . .10". 10" 8 ". . . . 8 "
DEPTH OF EARTHTOOTH . 24" . . . . . 20" . . . . 16" . . . . . 12"
SPACING OF EARTHTOOTH 12' . . . . 14' 16'. . . . . 16'
' ONNE NS NAME:
City of Costa Mesa, California pl'RMTADORE
NUMBER •
— _ —
Building Department SIGNATURE. — _
• arum, woo �P.✓c G
�I . o' -- 7, � p4 a,sJw+//
37
/3/ p 1-1-a— >
r 5.cjsr'i0v+G
gads e,
r
pwiry
Fl/9rni,✓6o Da. tar Y / 4cr 75115-.:B 1 • ko`,1ze , I. T.
s96 -4'ir9
•
arandS nzeizeize Ade. .02.1
g wo:Aunrie-AVB/40t
-COB7MaMLSA°MAth FORN IA
5407169 VU.
It
O wriest. — •atit �P�I
ppitoX cos %
•
•
J
•
•
OWNER JOSEPH J. ALFONZO DATE 6-26-81
JOB ADDRESS 196? Flamingo Drive BUILDING PERMIT NO. 52088
GFNIERAL CONTRACTOR Owner/Bui 1 der DESCRIPTION of WORK B1ockwal l
A 139-471-03 LOT 41 TRACT 2$9 FIRE ZONE VALUES 1,152.00
INSPECTIONS Signa Date TYPE GROUP ZONE R1
SOIL SUBCONTRACTOR PERMITS ISSL ED
GAS Data I Number Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE n HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND 0 POWER
ROUGH WIRING e Heating and Vent.
TRENCHES I� FORMS STEEL REINF. 8)4't
FLOOR SYSTEM
BONO BEAM L STEEL REINFORCE Miellak
SHEATHING •
FRAME AND FLASHING
LATHING - IN r1 OUT n
P' 'ER, BROWN COAT
S ,TURAL. FINAL 739"7 7-2t/-24 Electric
HEATING. VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST r]
ELECTRIC, FINAL
BUILDING. FINAL 571 7-24/_9L
4 .✓-a--Q� -i4 �lr�f -.^n .6'1 &)
/ _ i In
ciu �„pgyr — 0,,4 b-4-ok aea
•
4
" ' . COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT 32 TL
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 7.FOR Ci G/Q1 7t+
RE E D @Y $PERMIT Q
For Applicant to Fill in Completely —Use InknkOnly ..IICOJ))y2 4�J 5 ao P v
ADDRESS /72/ n OJ/1 .. A.P.NO. !✓7J l / / K-3
OWNERESS /910 2 Pi_ 4M J N&e9-
TENANRTOR c��c7� /�/���� ADD
UNIT OR
MAILING SPACE NO.
ADDRESS />� ,llJ'C-=..-.-,,,,,f-
5 �
TR.NO. �J LOT (mow. SLK.
t TEL. "..Z•8 I / I
CITYo���e� (� �/• NO.fjl��j� NEW ADD ALTER REPAIR (MOVING DEMOLISH
CONSTRUCTION ,/ �^ j X +I
LENDER Q/ .
BRANCH
OWNER 4-LFOni ? .(9- To s .
ADDRESS • VAI/lE
USE 61-Ock
ARCHITECT TEL. WALL $
OR ENGINEER NO. �Q
ADDRESS ZONE /\/ (TYPE GROUP
�r APPROVED
CONTRACTOR /may BY DATE
ADDRESS n/
TEL.
CITY NO.
I" STATE CITY APPROVED SETBACKS
LIC. NO. LIC. NO.
SIZE NO.OF SLOGS. (FROM CA.STREET)
C• OF LOT NOW ON LOT FRONT F .
Q USE OF
co EXISTING BLDG. R SIDE V'
En if frit'
FSeparate permits are required for L.SIDE
electric,plumbing and heating work.
Ia REAR T.
7 •
1.., USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
Q
"Z /
', 7B� J.aN1�r� DATE
APPROVED
Q
>-'
J' ( �/ —AAPPROVE DATE CSS--'ZY—.6/
.•1 [(
EE
lel
a.0 I hereby acknowledge that I have read this application and state n
p(, that the above information is correct and agree to comply with
fax all laws regulating building construction, and I shall not employ i
Z any person in violation of the workman's compensation laws of
Wthe State of California.
im„ m
I hereby certify that I am properly licensed as a contractor under SQ. FT. N
D
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 03
Chapter 9, and t .t such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e
am exempt fro • e provisions of he State of Calif. nia Business VALUATION PERMIT FEE S a
and Professions Co•e,Division 3, ha• r •. p'Q, SO n
// �� PLAN CHECK $ /3 3,Q.,_.LL
et
Signature of /l/ 11 /
Permorttee V $ t 1 Sa TAX S e CJ V
u
Authori.Yed Ag/nt Date / 4," — , TOTAL PATO S U
�•�__ `ea
I / V
1Lot � I � � rtt KU :LIVED 7
YAR 31 19F5
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT,
P.O.BOX 817 COSTA MESA,CALIFORNIA CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
For Office Use Only
' BUILDING
ADDRESS 1962 Flamin•to Drive
RECEIPT NO. • -V
COSTA MESA, CALIFORNIA '-' 1_
' RHCBIVJ{OBY DA;Hi6C87E0� APP
1ISSUED
4 1964
OWNER Pemba Subdividers Inc. �/" LI--Q7-7 F h
MAIL BUILDING
ADDRESSFIRE
2850 Mesa Verde Drive ADDRESS
TEL. ZONE TYPE ' GROUP (
CITY Costa Mesa NO. 54 90395
A' 7,,V
TEL. APPROVEDBDATE
C GINEER E. G. Kaltenbach ND. 547804
1832 E. 17th St. Santa Ana ZONING
ADDRESS S1L1 1• I': H.
ZONE I NO.OP I USE OF NEW
CONTRALTO
S4 to �_ R-1 PLAN82 SUILDINGW/ att gar.
LEGAL alb 1.
ADDRESS
DESCRIPTION Lot 41, Tract 5289
A.P.NO.
CITY
NOTE: NO SAVE OVERHANG SHALL BE LESS THAN
LIC.TN O. 187318 Na' 80"TQ SIDE @ REAR P.L.
EAVES
SIZE 70ya,) (61: 731 NOW PBLOT93 ALLOWED (U.B.C.REQUIREMENT)
OF LOT )yyL/-���T����rr
USE OF et O )- . 116 ,P-)J9" YARDS APPROVED YARDS APPROVED
EXISTING BLDG. MAIN BUILDING ACCESSORY BUILDING
q (FROM C/L STREET)
SETBACK LINE FROM 531 3 11 FRONT .S T. FT.
CENTER OF STREET REAR YARD - -
, SIDE YARD LEFT 5T I RIGHT 51 R.SIDE 5'F7. FT.
DESCRIPTION OF WORK L.SIDE SFT. FT.
-W X ALTERATIQN _ ADDITION REA� 7 FT. FT.
DISTANCE BET. BET.MAIN&
REPAIR MOVING DEMQLISH MAIN BLDGS. ACCESS.13,14)G@.
SIZE BUILDING 1 912 NO.OF 6 1 VAR.SC DATE
eQ{1�, p ROOMS = •RIES C.U.P. ; 1_� APPR•VED
EXTERIOR W L fl+lLL
sing ROOF 1 ' e .!\_ -
COVERING • Lel CCV COVERING in_le Rl
PEREEW
USE OF BUILDING AN WORTS BE PERF RM D
Single family withattaciieci garage
V.
House 1,450Csq.ft.
I HEREBY ACKNOWLEDGE
462E sq.ft. P1DnH51IS PPCCATION /�MO�NTQ 6HOWN UNO�� TION IS FOR THE B
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. o
O_
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION
BUILDING CONSTRUCTION L N
' SIGNATURE �pn %// ////I yyy ��-��, PERMIT FEE $ 5
PERMITTEE OF iPte 'L L/Gj�r B
/ $ 75-13/--� L CHE iO
AUTHORIZED A T - is.
cD
_ TOTAL FEE $ /i✓