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Home My WebLink About419 GLOUCESTER DR - Building PermitsApO�icant to till in all Ci7YOFCOSTA E CONST UCTION-PERMIT Project Address �Sii�'G�vve�ieSreR,. 1 9��a 7 Applicant's Mailin/g� A/dd 153.�} . �/Ne-�� Owner's Name /��T� - Phon y� 371i Address � mE Arch/Eng: � License No. � � Address ' � 1 � Convactor'sNamP��A/ZIS /.4UF11I�NLphone %aav�o Addresslmailin9) r � ` �%C City License No. `, �3 LICENSED CONTRACTOR DECLARATION I he�eby aftirm that I am licensetl untle� provi5ion5 of Charte� 9(commencing with section 7000) of Division 3 ot the Business antl Professlons Cotle, antl my licenseJ is in full orc�e ntl ef/ect. ^/�/�� Dalen�C�1�— —•59 t 4ic�nFeNo�Y GO �1( Pir�vui� WORKERS' COMPENSATION DECLARATION � 'ereby affirm that I have a cer[ificate ot mn5ent to selt-insure o� a certifica[e Workers' Compensation InSurance, or a certi etl Copy thereot (Section ,o, �b. �,�yBuo �cauc.P. ✓olicy No. Company rtifietl copy is hereby furnishetl. Dateert�)gtl�oqy/SJiletl wAPPhtanl(Y B�iydiq9 Diyiy 1� D/ U D'Y rPf �.f /i CLG</1✓60 EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This seclion neetl not be completetl if the permit is for one huntlretl ($100) or less). I certify that in the perfOrmance of the work tor which this permi{ is issued, I shall nOt employ any person in any manner so az to bemme subject to the Worke�s' CompenSatlon Laws o( Califomia. Date Si9nature NOTICE: If,'atter making this tleclaration, you shoultl become subject to the Worker5' Compensation provisions of the Labor Cotle, you mu5t torthwith comply with such O�ovisions o� this permit Shall be tleemetl revoketl. CONSTRUCTION LENDING� AGENCV 1 M1ereby affirm tM1al tM1ere is a construction lentling aqency for the pectormance of tM1e work Por whith thi5 permi[ is issuetl ($ection 309].•Civ. C.) Lentler'S Name Lentler's Atltlre55 - OWNER BUILOER �ECLARATION � I M1ereby affirm that I am exemp[ trom the Cont�actor's License Law fo� the iollowing reason (Section ]031.5 Business antl Protessional Cotle: Any tity or county wnicn requires a pe�mit to wnstruc[, alt¢r, improve, Oemoli5h or repair any struciure, prior to its issuance, also requires the applicant for such permit to file a si9netl statemenf Ihat he/sne is licensetl pur5uant to [he provisions o( the ContracrorJs License Law (Chapter_ 9.(mmmencing wicn Section'7000) of ,^�vision 3 of the Business antl Profe55mns CotlC) o� that M1e/she is exempt ,.'4',(e(rom antl the basis for the allegetl exemption. Any violation of Section �:':iy;u1.5 by any applicant tor a permit subjects the applicant to a civil ' ialty of not more than five huntlretl tlollars ($500). - �f L� I, as owner of the property or my employees with wages as their sole ' compensation, wili tlo the work, antl the shucture is not intentletl or offered for sale (Sec[ion 7044, Business antl Professional Cotle: The Contractor's License Law tloes not apply to an owner of a property wM10 builtls or improves thereon, antl who tloes such work himseH/herseli or through his or her own employ¢es, provitletl that such improvements are not intentl¢tl or ofteretl for Shce.Jt, howeveq the builtling o� improvement is soltl within one year of <om- pletion, the owner will have the burtlen of proving he/she tlitl not builtl o� im- p�ova for Ihe purpose of Sale). ❑ I, as owner of the property, am exclusively contractinq witn licensetl con- tractmsto construct fho project (Section ]044. Businessantl Profe55ions Code: The ConVactor's License law tloes not apply to an owner ot praperty wM10 builtls or improves thereon, antl who contracts for such Orojetts with a con- tractor(s) I¢ense pursuant to tM1e Contractor's �icense Law). I am aware tnat proof of their Wo�keYs Compensation insurance shoultl be provitled to me. ❑ 1 am exempt untler Section . B. & P. C. tor Ihis reason Date Owner I nereby certify that 1 have reatl this application ana state t information.is correct. I a9ree to comply with all city antl cou�. antl state laws relating to bwltling construction antl hereby ai sentatives of this city to 'enter upon the above-mentionetl inspec[ion pur . /� 1 � A Signature � � f� /5m� � oate I .Driver5' Licenze or 5� � ' ^ except lhose within heavY borGer lines antl sign all appropriale Eeclarations. ,, TRACT N0. LOT NO. UNIT NO. TVPE OFCONSTRUCTION LJ NEW U ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p # DESCRIPTION OF WOFK/USE OF BLDG. � S Main Buildi E TVPEOF�PERMIT GRaDirvG ❑FOUNDATION STRUCTVRAL T Front ❑ TENANT ❑ EIECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear ❑ OTHER . . - C Ri9ht PROJECTpESCRIPTION 5�. Fr. occuaarvCv K � CON_STRUCTION TVPE � VALUATION $ S Left ZONE � GRADING CU. VOS. ACRES� Ping. Ref. # Remarks: , ' ' . Planning Notes: Bar Siok Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas $ervice Kitchen Sink Lavatories P—Trap Roof Orains Reinspection Fee Showers Service Sink Sewer Cap Sewer Co'nnection � Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal QULIEtS Water Closet Water Heater . - - Water Service - A uto-W ash LaundrY Trays $15 Boiler Duct - Under Ground Duct - Strucmrel Duct - Ventilating Exhaust System ❑ MWtiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ' ❑0.100,000 BTU 0100,OOOBTi hainspection Fee � $15 CMF 0865-46, rev. 30/84 WM1ite - Builtling; Canary - qpplicant; Pink - Accouniing; Goltlenrotl - Assesso� Issue Fee Hood or � Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers . Issua Fae Automatic Washer Construction Pole Cooking Uni[ Dishwasher Dryers ❑Gas ❑ Fan f.A.U. Fixtures Device Boxes Zone Accessory Building'. Z O N 1 G R � ' Parking Req./Provided E Q M T S.. ELECTRICAL _ Transformer ❑ 15-50 KW =� 50+KW . Meter ❑up to 100 amps Meter �over 100 amps Suh Panel Momrs OO-1 HP �1'/:,,8 IncSolar �9-15 HP �16- Microwave ' Pole Light Range Switches- ' - ' Sign` � Gar6age Disposal � Standing Sections Generator �0.5 KW �5-15 KW Trash Compactor $� Reinspection Fee . $15 Issue Fee FEES �� DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By Buildin9 Approved By ^ Aoolication luued BV � � � $ 3 � � � SUMMARV OF FEES � � � BUILDING PERMIT $ �SMIP $ , PLAN CHECK , $ � PERMIT � _ �. PLUMBING $ .� ISSUANCE $' PLAN CHECK 25% $ ENERGV P.C. $ ELECTFiICAL $ GRADING $ __�� PLAN CHECK 50% $ - - MICROFILM� /� MECHANICAL $ TOTAL,F� ; '�� PLAN CHECK 25% $ „�✓.- � CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector � ' i 1�Temporary Electrical� rvice or Pole 52. Pool & Equipment Location 2� Soil Pipe-Undrgrnd. . 53. Steel Reinforcement . 3. Electrical Conduit Utility-Undrgmd. 54. Forms � t�n 4. Electrical Conduit-Undrgrnd. ' 55. Electrical Bonding ' 5. Steel�Reinforcement � 56. Rough Plumbing & Pressur.g�Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVERGUNITE •--- 7. Footings � - 58. Electrical Conduit-Undrgrnd. 8. Foundation �; 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipi tUndrgrnd. 60. Backwash Lines, P-Trap, �Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK �L� � 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 Electrica6Conduit 66. $olar System-Final � 16. Rough Electric Wiring _ 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace - � APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Produci Piping � Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing . , 73. Undergmd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing � 74. Overhead Hydro � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � 27. Frame and Flashing �� 76. Dry Standpipe . 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT � i. 31. Plaster Brown Coat . 79. FINAL INSPECTION ,�, 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED � 33. Final Electric Notes: �_ ��Y [�p,�- �(jj,_ (�ir.�J + � � 34. Final Heating & Air Conditioning � _.�J , 35. Final Gas Pipe-Test 36. Hood or Canopy . .. � ) 37: Final Factory Fireplace � - ' ,: i� r 38. Final Plumbing �-!)_�j( L:tO . - � � 39. Water Service-Final � y , _ � . �40. Gas Service-Final ' - • ' � - - . r- :41. Solar pomestic-Final � � � . � - ' -i 42. Backflow Preventer ' . � •-� - �v 43. Backflow Irrigation :�. - '�- � '4'4. .Landscape Irrigation System � - � • � �� r '45. Sound Attenuation � � L ' � V 46. Handicap Regulations , , � "� . � -� ��,% 47. FINALSTRU�TURE&BUILDING � % �' ' . - � �. N , .�. 48.� Special Requirements Completed ^ 4 � , � •,'i �-�- e 49. Electric Release to Edison ' � � 50. Gas Release to Southern California Gas Co . � .,. 51. CERTIFICATE OF 0 PANCY � No. Date _ � � ' � . ��..�'� ti.� Yn. . . .. . .• . . -. . '! � ( � AoO�i<ant to fill in all spaces exceot thosa witnin heavy Gortler tines an0 sign aIl aooroo/�ate tleclarations. CITY OF COSTA CONSTRUCTION PERMIT 000nniT nin TancT n�n . LOT NO. iwil nin Praject Address ��1�11�'$�r' �A$� �Sd� �d 9�] Applicant's Mailing F� ee;s �ro$ irt rrru Owner's Name Phone Address P.O. Box 8064 Laquna Hills, Ca 92654 Arch/Eng. License No. Address Contractor's Name Vance & Assoc Rfq Inc Phone ��-32� Address (mailingl P-0. Box 10456 Costa Mesa, Cd 92627 City License No. �9�3 LICENSED CONTRACTOR DECLARATION 1 hereby afiirm that 1 am licensetl untler provisions oi Charter 9(commencin9 WIIh 52Cl1011 %0�0) Of pIVI510f1 3 of the Business dOtl Prof¢SSi0�5 COtl¢� dntl my license is in full f rc ntl etfect. License Class – �ense No Date. r–�l�ire WORKERS'COMPENSATION DECLARATION � he�eby a�(i�m t�at I have a certificate ot consen[ t0 selt-insure or a Certificat¢ Workers' Compensation Insurance, or a certifietl copy thereof (Section 0, Lab. C.) ��t^91�1!14!1�COn�o �r�v No. �.r¢W�pany I i� Mh�ial Tntiiranre eCertifietl copy iz hereby furnisnetl. - Certifietl copy is leQ wi the city uiltling,Division. Date �-17–�plicant ��r1fP 14 QCCM �1[� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection neetl not be completetl if the permit is tor one huntlred ($300) or Iess). I certify that in the performance ot the work for wnich this permit is Issuetl, I snall not employ any person in any manner so as to become subject to the WorkerY Compensation Laws of CdlifOmia. Date Si9nature NOTICE: H, aftet making this tleclaration, y0u ShOUItl become subject to the workers' Compensation provisions of Ihe Labor Cotle, you must forthwith comply with such provisions or this permit shall be tleemetl revoketl. CONSTRUCTION LENDING'AGENCV � � I hereby affirm Nat the�e is a construclion lentling a9ency tor the p¢rtormanCe o( Ihe work tor which, this permi[ i5 is5uetl (Section 3097 Civ. CJ Lentler's Name , Lenaer's Htltlress OWNEf1 BUILDER DECLARATION I hereby af(Irm that I am exempt trom the ContractorY l.icense Law for the following reason (Section 7031.5 BuSiness antl Pro(essional Cotle: Any ciry ar county which requires a permit to construct, alter, improve, tlemolish or repair any 5lrucWre, prior to ils is5uance, alm requir¢5 the applicant tor Such pe�mrt to file a signetl statement that he/she is licensetl pursuant to the provisions of the Contractor's License Law (Chaoter 9(rommenun9 with Section 7000) of r+�vision 3 of [he Business antl Professions Cotle) or that he/she is exempt 'ehom antl tlte basis for the allegetl exemption. Any violation of Sectlon 1.5 by dny applicant for a pe�mit subjects tne applicant to a civil alty of not more than five nuntlretl tlollars ($500). �J I, as owner of the property or my employees wiM wages as their sole compensation, will tlo the wo�k, antl th¢ 5t�ucture is not int¢ntletl o�-o(f¢r¢tl tor sale (Section ]044, Business antl Grofessional Cotle: The ConVactor's License Law tloes not apply [o an owner of a p�ope�ty who builtls o� imp�ove5 thereon, antl who Coes Such wo�k him5elf/he�self o� th�ougfl hi5 0� he� own employees, provitletl that such improvements are not intentletl or offeretl for sale. Ii, however, the Cuiltling�or improvement is soltl within one year of com- pietibn, tne owner will have the burtlen Of proving he/she tlitl not builtl o� im- prove for the purpose ot sale). ❑ 1,'as owner of the vrooerty, am exclusively mnt�acting wlth licensetl coh- t�actorsto mnstruct the project (Se[tion ]044, Business untl Professions Cotl¢: The C,oniracto�'s License Law tlOes not apply to an owner of p�ope�ty wh0 builtls�or improves thereon, antl who contracls for such oroiCcts with a r.on- tractor(sl Lcense pursuan[ m ine Contractor•s License Law). I am aware that proof o� their Wo�ker'S Compensation in5urance shoultl be provitletl to me. ❑ I am exempt un0er Section B. & P. C. for this reason Date Owner _ 1 hereby certify that I have reatl this information is correct. I a9ree [o compl antl sta[e laws rela[in9 [o builtling cons sentdtives of [his city to e upon inipection purposes Signature � Drivers'-License or 55 �_ _� Date u �E OF CONSTRUCTION LJ NEW U ADD LJ ALTERATION L�' (REPAIR ❑ GONVERSION ❑ DEMOLISH ❑ OTHER � DESCFIPTION OF WORK/USE OF BLDG. TVPE OF PERMIT LJ GRAOING LJ FOUN�ATION LJ STRUCTURAL ' ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PRQIECT DESCRIPTION 5�. FT. OCCUPANCv ' CONSTRUCTIONTVPE VALUATION$ �7n.3_� ZONE GRAOINGCU.VDS. ACRES nemarks: � Taar nff chakoc anrl ronlarc with f lacc R I-larrii Ch�Loc Preventer Irrigation Drinkirig Fountains Floor Drains Floor Sinks� . Gas Service � Outlets Interceptors Kitchen Sink P-Trap Roof Drains Reinspaction Fee $15 Boiler Duc[ - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Muliiple ❑ FirepUFact.8lt. iC80 # Heating System & Ducting ❑0.100,000 BTU 0100,0006TI Reinspection Fee $15 0865-46, rev. 5/88 White - Builtling Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor dBING ShOw¢rS Service Sink Sewer Cap Sewer Conneccion Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal �'idtCf CI052[ Water Heater Water Service A uto-W ash Isue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,OOOBTU ❑700, System Repair/Alteration Fire Dempers luue Fee ...�. �rr S Main Buildi E T Fron[ B Rear A C . Right . S . Left Ping. Ref. # Planning Notes: FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixture5 Device Boxes DUtIEtS Switches Garbage Disposal Generator �0-5 KW �5�' Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over100amps Sub Panel . � � Motors�0.1 HP�1�:5-8 � Ina Solar �9�15 HP �16-15+ Microwave , �. Pole Li9ht . � ' Range , Standing Section� 5 KW Trash Compactor � peinspection Fee �$15 I � Issue Fee $ 3 DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By FEES Building Approved By (" T i N 1 N G R E Q M T S. FEES $ 3 0 SUMMAqV OF FEES Sp BUILOING PERMIT $ �p� W SMIP $ � PLAN CHECK $ PERMIT BTU PLUMBING $ �SSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADWG . $ — PLANCHECK 50% $ MICROFILM $ _,`� MECHANICAL $ TOTAL�FEE $ _.�p�L PLAN CHECK,. 25% . $ , - -� $ 3 Di 00037755-D00377b6 �"ez'� E"s.SL OAfE: D?/?,i!$9 TIIiE: ;D:sf . _ _ c,� -�� -- �;' .. . � y " CONSTRUCTION AND PLANNING POOI 'PA 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. Electrical Conduit Utility�Undrgrnd. 54. Forms , �•� t� 4. Electrical Conduit-Undrgrnd. , � 55. Electrical Bonding �� 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test /'s� 6. Electrical UFER Grnd. ,� 57. APPROVAL TO COVER-GUNITE � 7. Footings '�� 58. Electrical Conduit-Undrgrnd. � 1 8. Foundation �� . 59. Gas Pipe, O Undrgrnd., Test � --� �i 9. Water Pipe-Undrgrnd. � Q 60. Backwash Lines, P-Trap, O Undrgrnd. 1 10. Structural Floor System 1 61. APPROVAL TO DECK - 11. Property Sewer Line & House Conn i ion 62. Backwash & Receptor-Final 12. Sewer Cap � �j 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. RoughPlumbing' 65. Electrical-Final- 15. Rough Electrical-Conduit 66. Solar System-Final 76. 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 1.9�. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 27. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & 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 ,�C 43. Backflow Irrigation �t/ 44. Landscape Irrigation System � 45. Sound Attenuation ` 46. Handicap Regulations 47. F�NAL STRUCTURE & BUILDING � l . � 48. Special Requirements Completed 49. Electric Release to Edison ' - .� 50. Gas Release to Southern California Gas Co ' -• �' � d �� 57. CERTIFICATE OF OCCUPANCY " ;� � No. Date - � • � � 2l065 COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 COBTA MEHA. CALIPORIYIA For Applicant to Fill In Complefely TYPE OR PRINT � � - ILDIN6 y�9 %�LQUC�TE� D-plV DRE55 (�- �� COSTA MESA. CALIFORNIA � M�:,o�aa 504 No. Newpart Blvd. 82E . OF LOT� USE OF ■ EXTERIOR melita, La�u e Series Inc. NO.OF eFr - :� 2'� I RIQHT DESCRIPTION OF WORK X ALTERATION ADD MOVINO �OHM >2 eq.ft.ROOM9 4 : .L I ROOF � FEE REGEIVED HOV 2 7 1963' fINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMfT BUILDING For Office Usa Only R8C61PTN0. 'I�T IPR� FIRE ZONE APPROVED ZONING NO.OP'� . I U66 ruHs ouu � "°"` Lot 11 Trac�5212 D86CRIRION 7� A. P. NO. l/ NOTE; NO EAVE OVERHAN6 SHALL BE LE55 THAN 80' Tp SIDE B REAR P. L. EAVES ALLOWED . (U:B.C.REQUIREMENT YARDSAPPROVED YARDSAPPROVED - . MAIN BUILOINO ACCESSORY BUILDING .�'�' Q FRONT C_ 1 t� �¢ R. 61D6 � � I G.61D 1 REAR 1 OISTANCE BET MAIN BLOGB. VAR. $� �s 1 c. u. P. it n._ BET. MAIN d ACCESS. BLI DATE . . � � � IO92 SQ. FT. � 1 HEREBY ACKNOWLEOOE THAT � X�Ve qEAD THIB APPL�CATION TX8 AMOUNT 6HOWN UNOER VALU�TION 19 POR THE F ANO STAT6 THAT THE ABOVE 19 CORIiECT AND AOpEE TO COM. PUflPO6E OF 86TABLI6HIN6 A PERMIT�FEE ONLY.' Q PLY WITH ALL CITY OFOINANC88 AND BTATI LAWB R80ULATINO � yqLUAT10N . ' m BUILDINO CONSTRUCTION. ' ^? • �O N SIGNATUREOP �IO� IOI.00 PERMITFEE. $�SJ PERMITTE �'�P� SLSi�:Ii-S� IAiC� m � LA C o0 0 AUTHORIZfiD A66NT .il��2,�CQ�,Q�a'�' �Jp �] u• TOTAL FEE' $ JJ. JO