HomeMy WebLinkAbout3009 GARFIELD AVE - Building PermitsPNOJECTPODPESS: 3009 GARFIELD AV
OWNEfl'SNPME: NGUYEN, KEfOA THU
;�ooaess: NGUYEN BICH C T
� 3009 G�,RFIELD AVE
COSTA MESA,CA 92626
i�
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AHCHIENGMEEP:
ADOflE55:
flEG.NO.:
UNIT:
UNIT:
PEHMITfEE: KHOA NGUYEN ( 714 ) 545-4862
NOOFESS: 30009 GARFIELD AV
COSTA MESA CA.92F�26
LICENSED CONTNACTOH OECUIflFTION: I �ereby a�firm thal I am licensetl untler pmvisions of hap�er 9(commencing with Sec�ion
7000) ol OiNsion 3 0l the Business antl Pm�essions Cotle. and my �icense is in fuli lorce and ellect.
CITY LIC.: STATE LIC.: GIASS:
Oaie: Signaiure'.
WONREXS' COMPENSATION OECIABRTION: I nereby atlirm Iha� I have a certifica�e o� consen� �o self-insure or a certificale of Workers'
ComOensanon Insurance, or a cerU�Btl copy Ihereoi (SecOon 3800, Lab. C).
POLICY NO.: E%P. OATE:
COMPANY:
� Certitietl copy is hereby �umished. ❑ Ceriitietl copy is tile0 with �he ciry Building Division.
.ete', ApDlicanf.
E%EMPTION fNOM WOBREflS' COMPENSATION OECLAPATION: Qhis section need not �e compleletl it�he permi� is forone huntlree (5100) or less).
I certity thal in I�e pertormance ol �he wark for which Ihis permi� is issued. I shall no� employ any person in any manner so as �o become
subleci lo Ibe WorkerY Compensalion Laws ol Califomia / �� � �,/[
Date: � � �' 9 3 Signa�ure: _ �-/��rn-�
NOTICE: II, a�ier makinq thi5 declaralion, you should become subjec� Io �he Workers' Compensation D�ovisions o� Ihe Labor
Code. you mus� �otlhwilA comply wiih such pmvisions or ihis permi� shall be deemea revoketl.
CONSTXOCTION LENOING AGENCY: 1 hereby affirm ��at �here is a tonslmttian lending agenty br �he pedormanCe of �he work �or
�I whlch �his permit is issued (Sec�ion 3W7. Crv. C).
LENOEN:
AOONESS:
OWNEB BUILOEH OECLl�NATION: I hereby allirm iha� I am exempi Imm ��e Conlrac�ors' S�aie License Law tor ��e following reason
i a rn
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06397
PERMIT NO: B 063971 PLAN CHECK NO: N GOVT; N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTZON : T/O OLD ROOE 6 REPLACE W/COMP.SHING SQ FT: 3,000
CLAIM VALUE: 3,000.00 CALC—VALUE: 3,000,00 GROUP OCC: R-3 /M-1
COMMENTS: T/O 6 REROOF 30005F W/COMPOSITE SHINGLES
�:xx***�r***�*�+r*�rr�e�r+t��r*r�r**x*�r*�r***+r+rr*�r�rrr+r*�r+r�r�r*�r+r*+rr*x�*�x�*�r+rxx*r*�r�r��r�r**�r
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT ZN
LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN
PARKING RE • PROV; PARCEL: 14113433 ZNE: REF NO:
PLANNING N 'PES>
.'
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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
ZONING APPAOVED BY DATE:
HUILDING APPROVED BY : DATE:
APPLICATION ZSSUED BY; ISATE; ��F��I�3
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MiFMMiFkNM1EiFIfiEfffFiEiF1FMiFiFiFifftMiFMMMMMMMififlEMlEitKiFff%KMiEMlF%iFiEiFMKM±FMMiFMMifMMMMiFMKK1EMMMiFfFiEiF1FiE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
�Seci�on70.37.5BusinessantlPmfessionalCode. nnyciryolcounrywmchreqwresapermnlocoretmct,arer,impmve, emois,or SLDG PMT PLUMBING ELEC�1'RIC MECHANIC FIRE SMIP/RES GRADING
repair any simcWre, prior Io its issuance, also requires Ne apo�ican� lor sucA permil ro �ile a signed statemen� Iha� he/sne is IicenseA P EiZM I T 5 4. � Q rj Q
pursuant �o Ihe pmvisions a� the Coniraclor5 State License Law (Chapter 9(commencing wi�h Section 7000) af Division 3 of �he Business SM I P/ NON-RES
anU Pmfessions Code� or Iha� he/she is eeempi ��ere�mm and �he basis for Ihe allegetl exempiion Any violation o� Section 7Q31.5 by PL�.]
any applicaN �ar a permil subjec�s �he applican� to a civil penalq of not more ��an �ive Aundretl Oollars ($500�. i f'js[JE FEE
��. as owner o� Ihe pmperty or my empioyees wi�h wages as their so�e comoensation, wi�l do �he work, antl ��e SUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTI�L PAID � DUE
structure is no� intended or offere0 for sale (Section 70aa. 9usiness ana Pmfessional Cotle'. ihe Coniracmrs' Slate License Law TOTALS ----> $ 4.$ � �. � � 0. � � $ 4, 5 0 $ 4,$ 0 , Q �
tloes nal aODly Io an owner oi a D�operly who builds orimD�oves ��ereon, antl who does suc� work himsel�/herself or�hmugh
his or her own employees, pmvided Iha� such impmvemenis are no� in�entletl or ottere� Por sale. If, however �he huilding or
improvemem is soid wimin one year o� comp�etion, me owner wi�� have ihe �umen o� vmving he/she dia nm buim or impmve RE VENUE D I V I S ION TOTALS --> COLL ECTED : 5 4. 50 OVER /SE{ORT : ' . � �
mrinePu�poseo�sa�e�. HLDG PMT PLUMBING ELECTRZC MECHANIC FIRE SMIP/TOT GRADING�PLAN—CHECK
I, as owner a� �he pmper�y, am exclusively conlrac�ing with licensea contrac�ors �o cons�mc� �he pwlect (Section 7044, Business rJ 4. 0 � , rj �
❑ ana Pmleuions Cotle: TAe ConUaciors' State License Law Aoes nol aODry to an owner oi pmDe�Y who builUs or impmves thereon
antlw�aconlrac�s�orsuchprojectswil�aconirac�or(s�licensepursuantbiheConVaciors'StateLicenseLaw�.lamaware **.****,****,**.*�,*****.�******�**,********,*�,�*.�******,�,�,***,*k,*�*,�,�,�********,**,******,**
Ihal pmol oi their WOBer's Compensalion insurance s�aultl be pmvide0 to me.
� I am exempt unaer Sec�ion: B. 8 P. C.
tar /Ih�is reason. p q ////
Dale'. —/ • � � � / J Owner: /ti� �--.� �
I tlo hereby ceNfy Ihat I am aware of anU underSlanA Ine requiremen�s o� Califomia Heal�� antl Salely Code Seciions 25505, 25533, antl
�25534 antllhai I or anylu�ure builtling occupanl wilVwill noi (circle ona) neatl ta comply wilh sai0 slale codes ana Ihe requiremenisfor a
Oe�mii for conslmclion or modifica�ion imm ihe Au Ouality Managemeni Oisiric�. flesiaen�ial can9mction a0�lica�ions are exemp� tmm
Ihese pmvi5ians.
oaie: noPr�a�c
I hereby ceriify Ihat I have read ihis application and s�ale �hal I�e above information is correci. I agree�o comply wi�� all cily and cowry
ordinances and s�ate laws relating �o bvilemg consimction and hereby auUorize represen�ative5 0l this ciiy to en�er upon Ihe above-meniionetl
prope��y lar inspeclion purpases.
�ate: �9__ �- SignaWre'. �'V�� r/Z i
�river's License or Social Sewriiy a�
164L<6 Whi�e—Bwldmg. Green—Coee Enlorcemenl; Canary—Applicanl: Pmk—Revenue: Goltlenrotl—Assessor
I N D I V I D U A L F E E H R E A K D O W N �
TYPE QTY D E S C R I P T I O N UNIT COST -TOTAL COST
SFR 3000 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 3,000.00
END OE FEES
9
0100146936—R014b937 T�=�T 54.SD
DATE: USf1`/43 TIf1c: ib:2�
, ' - i
ICONSTRUCTION ANDPLANNING P��� A
APPROVALS Permit,�_ Date inspecmr qppROVALS Permit,� Date lospecmr
� Z
� Temporary Electncal Service or Poie 52. Pool & EGuipment Locati�n .
2. Soii Pipe�Undr md. 53. Stcz! Reiziforcement �
'.�;1 -
�^C o' "`, ..
_;�,�ie�icalCondt`y�{n�lity�Undrgrnd. 54. Forms
^�J.�'.�.'4,'iec'21ca1 Condui � rgrnd. 55. Electrical Bonding ' i
�'�iJ �
`� 5� S�'�Reinforce�a'� 56. Rough Plumbing & Pressure Tes: °•'
�:. c..:. ..��.•� v
'�t.T:'.'. �!
�' �.'�-£9e;hica! UFEFt1�rr,Fi. 57. APPROVAL TO COVER GUNITE i
�.:�.����_.
� y�S��C,�ngs ' y 58. Electrical Cqndu'rt�Undrgmd. -
�- 'J
��� �, � FcZ�ndaUon `� 59. Gas Pipe, � Undrgrnd., Test �,5
^4't - i
i- 9. Lti.:ter Plpe-Untlrg�d. 60. Backwash �ines, P�Trap, � Undrgmd. �
� -�
I 70. Strucmrai Fioor System 61. APPROVAL TO DECK �
-� --j
, 1 L 7ropvrty Sewer LinC & House Connection 62. Backwash & Receptor�Fina)
i � Z. S°'Y� GaP �,, 63. Heater & Veni-Finai �
t__ -'__
13. Poaf Drains �c 64. PWm6ing System � F�na�
�-_
_. .,� i
I 14. R�unh �iumbvt5,,,� 1i 65. EIECtricai-Final �
� 15 Rou��� Eiectrio7Conduh 66. Solar System�Fina; {
�
� 76. Rough ElectriciJiring 67. Pencing & Acccss Appr�val � I
� 77. Rough \Viring Si&n 68. APPROVED FOR PLASTERING
18. Roc�h FlectriW'�?T Bar Cei���9 69. POOL/SPA SYSTE".15 PINAL
79. Rouyh Heating & Air Condtioning FIRE DEPT. REQU(REMEIVT
y--,=�=k, ' ^'s'd-3va .� 'x�--M."L�-� -� r.� p'-�hJ'r 3: # � 'J i
20.MioiOn r7a`cto7'�, FL•:epface � s•T •;"� * �� =� - :: T �APPR:?UAL�S"=>G'er��Tiit # " >' ti �
T 'S "7 � K��zy m � # '> -i C <' y. . � lT, '`�" .'i � E-+ • k C^ �- � I
21.�uC[i, I� -��. r.- ;.�.C``� > ti ' r r .� .� P'-�i-a �7� �
itiitr z�tut{.y �; I• x .^ C7 .-, 'r i'�0. Uaderg�:�„7� Hy,G;�a x
' -t:'-ci3 �-T ! :. -il' ' -F ' ,.' ' �
22. Dua?, VFinti:'atlnq'� *. '� �'" S �`�' "9+7. Procluct�r'�^�r� Ci r C'�}�I
S_ i 1 . 1 ¢ i:'� 1 ;1 `."1 � r'� � s�y .:t i�..' r9 � 1`�
;:,. '-+ I t� x C r� x\- ':t ; CTC�-+:X �,.�
2:s. ,�as`�Pipe�io�.+:jh &��fest ; .;. � ,. �y �- � , . •,.72. Undergr`oy_q� FIi;;.fr,v * E- J
.�_ --r. . '� � _ , - - �s'-?`�
24.oRoL:. Fri»'nin �• �if �. E•;� -: r ::� �� T ..� • � ti �t � �
, b _. ��, � J,'�3.`�Jndergrnd StorC.�.� �k ('��Gas G5, ;
25. Roc.wStit^�thing ,,.'y ;r v[„u=�3� �4� 7q•:j7yzrheadHydro�i`�"' :
1+-< _- S er---��-
� 26..c?�B�r, Ceiling �Stru;:Eurali & ;�Je�r:�coat J � '7 cTf « .ti 75.C]Jry Chemi`a� - �� `'` '� `''� �
� .. -r . c , a rl:- _ . C^ �-.� 'x [:j '
I 2�ame and Flashi � '^ .,., '' � * '•: � � �1�v C� Y + .`.: t�! z' �
-� . �+. r:7' w ::�+ K 76.'�ry Stand9+R` i-�•:J �r J
'� • � , �'T' `�`•-�.4r-a-1"7-c33-.r-.r
_-J8. Laiti7ng,$c Siciing,^t .. ��::�: =�: %� 77.'� FIXED S�'a'.?EA%'�f�NAL' �"
-� r c-. � ; 1 � .-i .-. C_� ( 1 4� fl i
1� a: � ti .. .. T i�l . 'X. � _7 � � 'A
29. Insulati�.'i ^. `�;, :, x ' i: � 78.,^=1RE PREV. FIPIF� >�> T>" � I I
�-+-�--.� . �. . ' �� . .,.-vv..^-�-
30. Drywall Naificsg `v: i y �*- i-+ i*+FALTH:t9EPT�fl$Qt'r1R�AE11T
s�y i� �- n:� � �-:
�1. PI25ter B'pwp.Co�"t � S j�,r� > i � t�9. '�INhL I�S.'s-_'P,jCTi(�SV �x "� J I � �
y_4T_ .-��„�-�_, . j . �_ __�-i"�X'.�._:--i_'Y:�_� �
V . ..
t32.^Electncal Po�.��r h9a:ef:'Final t a:� ±� 'a zi0.:�a�00D CERTIE IC`!t'f E IS�UED ,
^�-�-P '�.x-�J� - * _�_ > .� cr
33.r ir,�.�El�triCy .�� i-1 I �. fi Y � j_4 .� `'ZJoiKs: '_, ; n ` �y ��.� �
� v �
r�.C-t7TF' i S-:"TFiF7�II; + F�'G�' +'�--r- '� S- -)
i ^.i34.;'i'�n� He;tin97a rifi �oi�ruoP�_G !' � ^ � "I.> + :. S C�T, a: � ^_ O
�.le-1:-.x-�-�-.tii .... Li7 ' � ' h� `31_L-f i .'r� �' s .__jn i
35.`,�'in67G'�PiF4nTe�� ..'� '7 a r C� tl :�S x?� ::.0
.-, I �F � a x.:� o�. a -,�
�. �i r�-�•t' .. « , � .. -rt;-r-.------
�36.' Hoc � or �anoPY a� ., � Cr'� --� « C� i a< < ii�� i. t^ I
' ^J3-:3�:-+^.t:�• �_�+�JA' tn � _ u ... .-j.u___---__
�i7. .�ina1'Fa�Iory Fir'��u(�.��e � i E,,;ti � �� � n �. T '�' . .J �
,>x .. ..�.. �_' . i tr �t . � -;r----�---'� --- -
r.8. Fin".�i;Pl�gnbing �„< i a �: I e£ t S ,-� � O7 C:. �
:. .w-:_._rg-x�--v-r-w- , t �} �-. . ., 4�_ �
:�9. \'JateR Service�fin31:� . �� > � . . C� t::n ! cC p
. i J O ... a:� i i. CI'. � i8 *: a. '.. .a
-'t-x-.:.- N �- F�Y =YT��. iT7-;Ti� __�
! M90. Gas Ser,�e-F.'�ai ,'�,, r:� �:,,n, :: x;7 i � tr x O� -.�n; > _I
_ . - :..r._1r . � ._ ::.e �. ,.. - �
cl. Soiar poihesfs�Finat -� �� •' Y �=' � � � � vj'-' '"' ' I
� _ a . . :' �.c. c ? �' , �I
. �
� �L2.'��ackflow Preventery " 2; * j f'(, x � �� �-. . j t_+ :-, i
f.`-x-,w,--i=�--r "--F �-� --`-;-�.;G_%+u._a:.-: �
93. Backflow Irrl.�"`ation+. �5== � ,� x '� ,v �:�"�• �. � :1 •
��� " ' . _ 1
;r,�s' � s i--_..�'_ti��'r'3-� i .. �
��.,'.�4. Landscz� Ir;�qatio�System����� 1 '-y 4 p n� , ;� ;i; �_7 � i: �� �
'�"_::t--'�;n s '�_-r .P`S..'--'.xr '" ----�F . C�-'�r-�. ^ Fy,a.-- `-' --�
�5.G.ound Atter�ationt r,� F: *� N F k'� :% r+ r-+ •^=� xQ ` �
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47.�It�L STRCiCTUf7E & BULLDWG 0=`
. �: � � / �g`�3i � �; � 5::��� ��. Y � �<- ��
48.�� a"'�. x ' : I"'_ # :u'._"'Tr, ,Y- J._.�.
IN,.{LPLAIINING,-, - : :-�s I � �i a r:7 :, �:, � 'r• c,
:. :. �'v�-a: --1`x.�....r . _,
:,A9..�le�ttic Release to dison y ; `s � �' cc i * ': �:
�. . r ' �, � ; .. C- .F y� ' , n .� C
} � : 't .>:�'� '.1. . ,
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--x � - `� 7�a-ia---::- Ri._.c
"$1. CEH�IFICATEOF CCUPAi�1CY' � : + �:i„• �.;� ;Y ;, r� :�
No. Oate
OWNER
JOB AC
�� GFNER
� od
INSPEC
SOIL
V�\ GAS
\ werca
PHOP. SWR. LINE U HOUSE CON.
SPRINKLING SYSTEM
MISLELLANEOUS
ROUGH HEATING NND AIR CONOITI
TEMPORARY SERVICE OR POLE
UNDERGROUND � POwER �
ROUGH WIRING
TRENCHES FORMS STE
FLOOR SYSTEM
BON� BEAM ❑ STEEL HEINF(
SHEqTHING
FRAME AND FLASHING
�ATHING — IN I—I OOT I—I
DATE
DING PERMIT N0.
SUBCONTRACTOR
`�� � 34752
COSTA MESA BUIIDINGSAFETY DEPARTMENT
P.O. BO% 1200 COSTA MESA, CALIFORNIA 92628
For Applicant ro Fill in Completely
BUILI
ADDi
OWNI
MAIL
? ;,.PF1C0 to 6 5.04
(� L �'F tr:�Aut
f ^'
APPLICATION FOR BUILDING PERMIT
RECEIVED BV DATE RECEIV D DATE ISSUED
�aa-�.� �,��a-
A.P. NO. '� �
BUILOING
ADDRESS .�O
Z �v.i v� -
a v cirv�' � /�r No,o'r O-O�'%6 TRAC L31
ZZ
Q CONSfRUCf'ION
a m IENDER � /
7\
J 7 BRANCH
J � OWNER W �
m J ADDRESS
m ARCMITECT TEL.
Uy OR ENGINEER
Q FIRE
W K ADDRESS ZONE T
a W ' APPROVED
J � CONTPACTOR �LU��EQ� e� / �
m Z
J � ADORESS
Z F TE4. ZONE �I PO�rO�F �
CITV NO,
W 0 STATE CITV YARD9 APPROVED
y 2 IIC. NO. LIC. NO. MAIN BUILDING
� � SI2E / � /� � NO.OF BLDGS (FROM GL )
OF LOT (Q / %� /VO NOW ON LOT RONT F£
VSEOF ✓%SiD�y� �
EXISTING BLOGI� {
Z N'EWBLDG��'`"XD,�%ROOMS STORIES L.SIDE y PT
U EXTEflIOR WALL FOOF
COVERING COVERING REAq 2 FT.��
= US OF BUILDING ANO WORK TO BE FERFORMED DISTANCE BET.
a / M/1IN BLDfaS.
a
Q VAR. #
O C.U.P. �.
F APPROVED 1. ,L �
(A "V
Z
Q
VI hereby ecknowletlpe thet I hava read Mis eDP���ation and ivte
� thac tho ebova Informetion if corract an0 apree to comply wIM
� ell lawf requlatln0 builtlinp construction, and I shell not amploy
F eny person in violetion oi the workman i eompanution lawf of
y the Stete of Califomle.
? 1 haraby eertify thet I em proparly IlcenzaE cOntte or untle� S�, fT.
the Steta oT Celifornle Businesa entl Prof on� Cotle, Ivlsion 3, TNE AMOUNT SH01
Cheptar 9, end Nnt h Iicenms era I tull farce en atixt, or I TNE PURPOSE OF ES
am axampt from a rovislons of ffi0 tete oi Cel mle Bu�lnea yALUATION
entl Profasslon e, Divislon 3, C 9.
Sipnecu /�� _ S (�"�
Par G j-(4'[?
LOT /� BLOCK
�. w'vUNf./�
VALUE �
5 �O `�
GROUP
DATE� �� �
USE OF NEW (���' �
BUIIDING �
BET.- MAIN &
ACCE55. BLD
DATE
APPROVED
A�No�lzad Apant I� � I TOTAL FEE
�
�
O
i
¢
N
J
m
E
LL
�0 7, TRACT �z� FEE RECEe� ru
' �r�;�5 � ,,� SEP 271961
COSTA MESA BUILDING-SAFETY DEPARTMENT � FINANCE DEPT.
P. o. eox sn eosrw eaeee. eN-�roa++�w �►TY Of COSTA MESA
For Applieani fo Fill In Complefely APPLICATION FOR PERMIT
� TYPE OR PRINT li4��e � BUILDING
eui�o�Nc /�
ADDRE6$ � C�� Cf F
� COSTA MESA. CALIFORNIA For Office Use Only
RHG8IPT NO. PBRMLT�tjO.
owNeR K B� K DEVELOPMENT C0. INC. �I,��1�,�
MAIL ' - RECEIVlD BY I O TE PHC8IVHO OAT6 189U6D
AODRESS � PLACENT lA AVENUE ��p n n �ORi
cirr � NEWPORT �EACH No. MI E) 22 BUILDING �
ADDRE6S
nRCHirecT TE�. � COSTA MESA, CALIFORNIA
OR ENGINEER NONE N�•
AODRESS FIRE �
ZONE TYPE GROUF
APPROVED � ,
CONTRAGTOR W BY OATE
AODRESS PLACE TIA AVENUE ZONING
- ZON¢ NO.OF U8H OP NEW �'� ���
CITY WPO B CH R�r I PUN9 � I BUILDINO w
LIC.TNO. p ND. MI O Zz �EOAL Q_a/- // //1 y23 l
oescrtirriox �`-�/
BIZE NO, OR B1D08.
OF LOT � � xow oN LOT O A. P. NO.
USE OF YARDS EVES
EXIST NG BLOG APPROVED ALLOWE�
68TBACK LIN[ FROM 1I � �'1 �� «NTaR 4N¢ BTJ
eee+rert ov aTReHT 4 REAR YARDZ '+ FRONT �'s—FT. IN.
SIDE YARD I LEFf � �� ' I RIGHT 1�� R. SIDE -5 FT. • IN.
DESCR ION OF WORK L. SIDE 3 FT. � ,N.
NEW I IIALTERATION I IIADDITION I REAR � C FT. Y IN.
RFPAIR I IIMOVING I IIDEMOLI6H I BYPROVED �,/�' �/z�/<(
A � DATE
BUILDING NO. OP ���"
SRE OOM9 STORIES �
EXTERIOR WALL ROOF Ca•nPo
COVERING STUCCOICOVER�NG � �
USH OF BUILDIN6 AND WORK TO 6E PERFORMED
SINGLE FAMILY RESIDEN�E AND aATTAHCED G�D y
GARAGE /
i
1 HHRHlY ACKNOWLEDOE THAT 1 HAVB RBAD TH19 APPLIGTION }HE AMOUNT 3XOWN UNOeR VALUATION IB POR TXE
AND BTATE TXAT TXE 11BOVE 18 COIiRBCf AH� AGRBE TO COM- pUIiPOBE OF ¢9TABL18HING .� PBRMIT FEE ONLY.
PLY WITH ALL CIiY ORDINANC¢9 11N0 6TI�TH LAW! RH6ULATINO
0U1{,OINO CONBTRUGTION. VALUATION
SIGNATURE OF / ^`i //��.,'[� PERMIT FEE $ ��� H
PERMITTE $/�// �'�/ _/ P�AN CHECK $ /�i i�j � o
Z
AUTHORIZEO AGENT � 0
TOTAL FEE y