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Home My WebLink About435 GLOUCESTER DR - Building Permitsqvplicant to till in all spaces except those within neavy Eortler Iines ana sign all aoaropriate aeclarations. CI7Y OF COSTA mESA CONSTRUCTION PERMIT �� Project Address 435 gloucester GO�ta MESa Co 9�627 Applicant's Mailing Address Owner'sName 7hePmbros�Co Phone 714—�1i-19( Address P 0 8064 Laguna Hills, ('.� q9�.54 Arch/Eng. � License No. Address Contracmr'sName �d�C2 � i�ce(xlr�tPc R(]()f1f10 1pi:wne %�4—(�CIF—ii� Address lmailing) P.0_ Box 1(14.�,(, fntt� M=ca,Yrd q%F7J C�ty �icense tvo. 005913 LICENSEO CONTRHCTOR DECLARATION I'hereby alfiim tnat'I am licensetl untler provisions oi Charter 9(commencing with section ]000) of Divislon 3 of the Business antl Protessions Cotle, antl my Iicense is in (ul1 force antl effecL ' License Class icense N . Dale 9 ure WORKERS' COMPENSATION DECLARATION � hereby atlirm that 1 nave a certiticate oi consent to self-insure or a cerHficate Workers' Compensation Insurance, or a certified copy thereof (Section J0, Lab. CJ non - � Nolicy No. _�y�,��Qgmpany I ilwvkv Mh ol Tne v�� BCertifietl coOY �5 hereby fumishe0. . , Certifietl copy is filetl with the city Builtling Divisian. Date_?—��—�plicant ��o�ry�_a_�j��_ EXEMPTION FROM WORKERS' COMPENSATION D LA I N (Thissection neetl not be comple[etl it the permit is for one huntlretl (5300) or less). ' 1 certify that in the perfo�mance of Ihe work for which this permi{ is issuetl, I shall not employ any oenon in any manner so as to become subject to the Workers' Compensation Laws of Calitomia. Date Si9nature NOTICE: If, aite� making this tleclaration, y0u 5houltl become 5u0jec[ to the Workers' Compensation Orovisions of th¢ Ldbor Cotle, YOu must forthwitM1 comply,with such provisions or this permit shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV � I hereby affirm that ihere is a mnsVuction lentling agency for tne performance ot the work for which this permit is issuetl (Section 309] Civ. C.) Lentler's Name � Lentler's Atltlress OWNER BUILDER DECLARATION ' I hereby affirm lhat I am exempt from tne Contractor's License Law tor the following reason (Section 7031.5 Businezs antl Professional Cotle: Any city or county which requires a pe�mit to const�uct, alt¢r, improve, tlemolish o� �epai� any structure, prior to its issuance, aiso requires the applicant for sucn permit to file a signetl statement [hat he/she i5�licen5etl pu�suant to lhe Provision5 ot the Contractor's License Law (Cnao�er 9(mmmencing with Section 7000) of nivision 3 of [he Business antl Professions Cotle) or that he/she is ezempt refrom antl tne basis tor [he allegetl exemption. Any violation ot Seclion :1.5'by any applicant tor a permit subjects the appllcant to a civil .�alty of m[ more than five buntlretl tlollars (g500�. u I, as owner of the property or my'employees with wages as their sole compensation will tlo Ihe work, antl the structure is not intentletl or offeretl for sale (Section 7044, Business antl Professional Cotle: The Contractor'S License Law'tloes no[ dpply [o an owner of a property wno builtls or imprOves Ihereon, antl who tloes such�work himselt/her5elf or througM1 his or h¢r Own empioyees, provitletl that such improvements are not intentletl or ofteretl for sdle. If, nowever, Ihe Cuiltling or improvement is soltl within one year ot com- pletion, the owner will have ihe burtlen oi proving he/she tlitl not builtl or im- �rove tor the purpose of sale). ' 1, as own¢r Ot the property, am exclu5ively cont�acting with IicenSetl Con- . tr ctorsto wnsVuct the project (Section 7044, Business antl Protessions eotle: The Contractor's License Law does not apply to an owner of property who builtls or improves thereon. antl who conVacts fo��such oroiects with a con- tractor(s Lcense pursuan[ ro me Convactor�s License Law). � am aware thac �. proof o� their Wo�ker's Compensation insurance shaultl be provitle0 to me. I❑�1 am exemp[ untler Sectlon B. & P. C. (or this reason 13 3�t 303 � � - � TYPEOFCONSTRUCTION . NEW ADo ALTERATION ❑ CONVERSION ❑ DEMOLISH ❑ �THER DESCRIPTION OF WORKNSE OF BLDG. , TVPEOFPERMIT ❑GRADING ❑FOUN�ATION STRUCTURAI ❑ TENANT .❑ ELECTRICAL .❑ PLUMBING ❑ MECHANICAL ❑ OTHEI3 PROJECT DESCRIPTION SQ.FT. oCCUVANc��O3 CONSTRUCTIONTVVE VALUATION$ � ZONE GRADINGCU.VDS. ACRES __ Remarks: TeGY� Ulf Sf�C11�E: (3I�C'� YEi;.I�l�_E: 4:1ti1 C1355 B Hardi Shakes REPAIR Preventer Irrigation Clarifiere . Dishwasher Drinking Fountains Floor Drains Floor Sinks . Gas Service � Outlets Kitchen Sink Lavatories P—Trap Roof Drains Showers Service Sink Sewer Cap Sewer Connection Solar Collecrors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Laundry Tra'ys A.P. # S Main Buildi E T Front B Rear A � Right . K . Left S Ping. Ref. # Plannin9 Notes: FEES � Automatic Washer Construction Pole Sub. Cooking.Unit Dishwasher Fan F.A.U. Fixtures Device Boxes �Utl¢t5 SWILCIICS Garbage Disposal Generator DO-5 KW Zone Bu Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW � � 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel � ',i Motors �0-1 HP �1 %- 8 ' Inc.Solar�9-15HP��16-15+ Microwave , � Pole Light � � •i : Range _ ' Standing Sections 5 KW Trash Compactor . Reinspection Fee ' $15 Issue Fee $ 3 DEVELOPMENTSERVICESREQUIREMENTS: Reinspection Fee $15 laue Fee ' � Zoning Approved By . MECHANICAL FEES Building Approved By Boiler Duct - Under Ground Duct - Structural . Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # �Oate Owner Heanng $ystem & DuMmg I hereby certi(y that I have reatl this application antl state that the above - ❑0-100,000 BTU �100,OOOBI information is correcL I a9ree to comply with a11 city antl county ortlinances antl State laws �elatin9 to builtling const�uction, antl he�eby autho�iEe repre- s¢ntatives of this cit�� ente upon th above-mentionetl p�op¢rty for inspection purposes. �_,�,L� Signature i Date Reinspection Fee $15 �Drivers' License or 55 � ��-� ' 0865-46, rev. 5/88 White - Builtling; Canary - qpplicanq Pink - Accounting; Goltlenrotl - Assessor Hood or Typel �� CanOpy Typell ❑ Refrigeratlon System ❑o-ioo,000eTu ❑ioo,000 System Repair/Alteration Fire Dampers Registers luua Fee S 3 SUMM RV OF FEES BUILDING PERMIT' $ � SMIP PLAN CHECK $ PERMIT ' PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.C. ELECTRICAL $ GRADING PLANCHECK 50°h $ MICROFILM MECHANICAL $ TOTALFEE PLAN CHECK Z5% $ O N i N G R E � M T S. FEES �� ooa�a��: 000a��*z �c�-r . �a_sa 6RTE: U?!I3/8? TI�E: 20:i? . . . ci \ '- � " ` CONSTRUCTION AND PLANNING P�� PA - �'� APPROVALS Permit # Date Inspector AppROVALS Permit # � n�te . 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 � ,-� 4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding !�j 5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test r 6. Electrical UFER Grnd. �. 57. APPROVAL TO COVER-GUNITE �/' 7. Footings �? 58. Electrical Conduit-Undrgrnd. C S. Foundation �� 59. Gas Pipe, O Undrgrnd., Test ��`, 9. Water Pipe-Undrgrnd. � � 60. Backwash Lines, P-Trap, � Undrgrnd. FJ� 10. Structural Floor System %� 61. APPROVAL TO DECK 11. Property Sewer Line & House Con�eciion 62. Backwash & Receptor-Final 12. Sewer Cap i 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 i 6! 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. Product 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 (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 � � 43. Backflow Irrigation ; �� 44. Landscape Irrigation System ' �� :j 45. Sound Attenuation '� �-` 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING �, �l 48. Special Requirements Completed 49. Electric Release to Edison , . � ,,; 50. Gas Release to Southern California Gas Co L-j , 51. CERTIFICATE OF OCCUPANCY " � : � - �] No. Date __ t Applicant to fill in all spaees exceD� those witnin heavY Dortler Iines ane sign all appropriate Geelarations. CiTY oF COSTA ESA/� CONSTRUCTION PERMI? ��t�u' —_^ TRACT NO. LOT NO. I UNIT N� ProjectAddres's ��N�'DUG'PS�'c-{y Applicant'sMa�Addr��-�� i Owner's Name P one�S�Y_79� Address !� �/S:�i O /LN� G� l�Cti 9�-�,3�/ ArchlEng. License No. Address i Convactor's Name � � - Phone�%'�--3'�� Addresslma'I'nn1�Sj3.�/ itirE,f/✓ /f-,+/R-h�cim " • �.�3� � . Ciry License N�o. � ' LICENSED CONTRACTOR DECLARATION � I hereby a(firm that I am licensetl under provi5ion5 of Charte� 9(commencing with section �000), ot Oivision 3 of ttie Business antl Professions Cotle, antl my license is in full tofr� an fiect. � /�� S Licen 1 `- "�� •�?enge Np.� Date �'3' c'nnar-. Cl � WORKERS'COMPENSATION DECLARATION � M1ereby affirm tM1at I have a certiticate of consent to self-insure or a certificate ' Worker5' Compensation Insurance, o� a certifietl coDY tne�eot (Section 300, Lab. C.) L � -� Poiicy No. ��a �U Company ��)P_FiV�/2 ,Lr�S. eFtifietl copy is hereby furnishetl. Cert� ie co y is fileE with the city��y iltlmg i sio Date ��-�7 Applican[�1f� �� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section neetl noi be comple[etl it the permit is for one huntlretl ($100) or Iess). I certify tha[ in the per(ormanCe o/ Ihe wo�k to� which tM1is perm�t is issuetl, I 5M1a11 nat employ any person in any manner so as to become subject to the Workers' Compensatlon Lawsbf Calitomia. Date Si9na[ure �NOTICE: If,.atte� making�[his tleclaration, you shoultl bewme subject to the Workers' Compensation provisions ot the Labor Cotle, you must forthwith comply with such, provisions o� this Oermit sM1all be tleemetl revoketl. CONSTRUCTION LENDING AGENCV � I hereby affirm that there is a canSGuction lentling agency for the performance of the work for which this permit is issuetl (Section 309Z.�Civ. GJ Lentler'S Name Lender's AtlEre51 - � � � OWNER BUILDER UECLARATION I hereby 5ffirm that I am exempt from the Contractor's License Law Por the following reason (Section �031.5 Business antl Professional Cotle:.Any city ar <ounty whiCh rCquires a permi[ [o const�uct, alter, improve, tlemolish or repai� any 5[ru[ture,'p�ior to Its issuance, also requireSlhe applicant for'such pe�mit to flle a siqnetl statement that he/she is licensetl pu�suant to [he p�ovisions ot the Contractor's Liwnse'Law (Chapter 9(commencing with Section ]000) of ' Division 3 of'the Business' antl Professions Cotle) or lhat he/she is exempt =refrom and lhe basis for the allegetl exemption. Any violation of Section 31.5 by any applicant for a permit subjects [he applicant to a civil .nalty of not more tban five huntlretl tlollars ($500). L� I, ds ownEr of the property or my employees with wage5,as their sole mmpensation, will tlo the work, and the structure is not intentletl or offeretl for,sale (Section �044, Business andiProfessional Cotle: Tbe�Contractor's License Law tloes not apply to an owner ot a property who builtls or improves Snereon, antl who does such work himseli/herselt or through his or her own employees, provitletl that such improvements a�e not intentletl or offeretl tor sdle. If, however, the-builtling or improvement is Soltl within one�year of com- pletion, the owner will have the burtlen ot proving he/sM1e tlitl not builtl o� im- prove fo� the purpo5¢ Ot sale). . ❑ 1, as owner of ihe property, am exclusively <ont�acting with licensetl wn- tractor5 t0 wns[ruct [he p�oject (Section 7044, Business antl Professions Cotle: The ConVaclor's License Law tloes nat apply to an owner of Oroperty who builtls or lmp�oves the�eon, antl who conVacts for Such p�ojecls with a mn- tractor(5) I¢en5e pursuant to the Cantracior'S License Law). I am aware that proof,of.thei� Wo�kev's Gompensatlon insu�ance shoultl'be provitletl ta me. ❑�I am exempt untler �Section . B. & P. C. for this reason Oate Owner I hereby certify Ihab I have reatl.this.applica[ion antl state that the above information is correcL.l'agree to comply,with all city antl county ortlinances antl state laws relating to builtling wnstructlon, antl hereby authorize repre- sentatives of� ,his city to en er n the a ove-mentionetl property for inspec[ion 'a5 5. � <i3�7. Signature �" oaie • � Drivers'�License or 55 � TVPE OF CONSTRUCTION IJ NEW L1 ADo ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. — ALTERATION REPAIR TVPE OFPERMIT LI GRADING U FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL� �PLUMBING ❑ MECHANICAL ' ❑ OTHER PROJECT DESCRIPTION ' Sq. FT. � oCcuPa.rvCY CONSTRUCTIONTVPE • � VALUATION$ ZONE GRADINGCU.VDS. ACRES Remarks: � Sink 'rtflow Preventer kflow Irrigation Clarifiers Drinkin9 Fountains Floor Orains Floor Sinks GasService . � Outlets Interceptors ' Kitchen.Sink . . Lavatories P-Trap Roof Drains ' � Reinspection Fee' � $15 oiler )uc[ - Under Ground Duct - Ventilating Exhaust System ❑ MWtiple ❑ Firepl/Fact.8lt. ICBO # Heating System & Ducting ❑ 0-100,000 BTU � t 00,000 6T Reinspection Fee .� '" $15' CMF OB65-46, rev. 10/84 White - Builtling; Canary - qpp�icant; Pink - Accounting: Goltlenrotl - Assessor Showers - ' Service Sink Sewer Cap Sewer Connection � Solar Collectors Solar Piping � Solar Tank Swimming Pool w/Spa Urinal Water Closet � Water Heater Water Service Auto-Wash Laundry Trays Issue Fee Hood or Typel ❑ Canopy , Type I I - ❑ Refrigeration System , ❑o-, oo,000 er u `o, oo,000 System Repair/Alteretion � Fire Dampers � Registers laue Fee ES A.P. #. . S Main Building: � E T Front ARear C Fight ' ' K : . Ping. Ref. # Planning No� 0 8129 5/19/87 , _� � Zo�e Accessory Building: Parkirig Req./Provided ELECTRICAL Automatic Washer _ Transformer ❑ 75-50 KW ConstructionPoleSub.� • �50+KW Cooking Uni[ Dishwasher " � � - Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes � Outlets Switches Garbage Disposal ' Generator �0-5 KW �5-15 KW � Meter LJup to 100 amps Meter ❑over100amps Sub Panel , . Motors OO-1 HP O1 %- 8 Inc.Solar �9-15 HP �16-75+ Microwave � Pole Light Range Sign ' - Standing Sections Tresh Compactor $ 7 Reinspectian Fee $15 Issue�Fee � FEES DEVELOPMENTSERVICESREQUIREMENTS: ' � � �Zoning Approved By Dai '" Building Approved By Da� _ .. . . . . _ . . . /1 _ � 5.00 TI. Z 0 N I N G R E Q M T S FEES $ 3 . SUMMARV OF, FEES � . ' BUILDING PERMIT $ " - SMIP $- � PLAN CHECK � $ PERMIT � � PLUMBING $ � ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ �ELECTRICAL � $ - GRADING � $ � . � PLAN CHECK 50% $ - . MICROFILM $ c� MECHANICAL . ' $ TOTALFEE $ � 1''� PLAN CHECK 25% $ . � , � CONSTRUCTION AND PLANNING _. , FOOL & 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. Electrical 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-Undrg7nd. � � 8. Foundation - • 59. Gas Pipe, � Undrgrnd., Te9t , 9. Wa[er Pipe-Undrgrnd. 60. Backwash Lines,P-Trap,�C7��Undrgrnd. 10. Structural Floor SYstem 61. APPROVAL TO DECK �, . 17. Property Sewer Line & House Connection 62. Backwash & Receptor-Fiiial 12. Sewer Cap _ � 63. Heater & Vent-Final � 73. Roof Drains � ' ' 64. Plumbing System - Final � 14. Rough Plumbing � . 65. Electrical-Final � 15. Rough Electrical-Conduit �66. Solar 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 FINA� ' . 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS - Permit # _ 21 i Ducts; in Strucwre ' � 70. Underground Hydro , � 22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing � 73. Undergrnd.StorageTank OGas ❑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��NSPECTION � 32.. Electrical Power Meter-Final 80. FOOD CERTIFICAjE ISSUED � - 33. Final Electric Notes: � , . 'r 34. Final Heating & Air Conditioning � ,' 35. Final Gas Pipe-Test . , 36. Hood or Canopy , 37. Final Facto'ry Fireplace �_ - 38. Final Plumbing �S� ,�(J 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. Elearic Release to Edison - . � � ,� 50. Gas Release to Southern California Gas Co � �. � • - - 51. CERTIFICATE OF OCCUPANCY � No. - Date � � .. � � i o�� "`COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 817 C06TA M66A� CALIFORNIA � For Applicanf fo Fill In Complefely TYPE•OR PRWT . eu��o�N6 yJ7s GLDUG�sTE.i ��/✓t� ADORESS COSTA MESA, CAI`IFORNIA OWNER C`cI E SeZ�leS I]�C., � � MAIL 504 No. Newport Blvd. ADDRE98 ��.�, Newport Beach No b46-939 �RCHITHCFFo Brent J'. '1'ObeV w��•Hy469E CONTRACTOR Ca e Serle'S InC. . AooRE$8 504 No. Newport Blvd. � Ty Newport Beach , LIC.rNO.��ZJJ ko b46-9341. OF LOT 39. 83x44. 33 I NOW ON LDTa O �SE oF . none EXISTING 6LO6. � LINB FROM �� ' O F erxecr �6C�1'ff181�gqR YqR4 �� ' RD I LHFT � I Z RIQHT ��/ � DESCRIPTION OF WORK I X II .. _ee._.�� I II ..._._._.. I �r SIZIEDIN61OHOSC�. fC. ROOMB 4 BTpR1H8 1 S EXTERIOR WAl4 _ . � I ROOF . . . _ e - FEE RECEIVED HOY 2 z 1963 ' fINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Oiiice Use Only R[CHIPI NO.. I �1. R6C61V$D sY K/ OATE189UFD /r,?-�-L ZONING zo ,� no. oe Uet OF N[W I PLANe.� BUILDILt0.xJI_g M C d (X ;so��,�,,„ Lot 19, Tract 5212 A. P. NO. � NOT6: NO !AV E OVERHANO SHALL BE LE35 THAN � 80' TO SIpB 8'R6AR P. L. fiAVEB ALLOWED fU.B.C.RE�UIREMENTI YARDSAPPROVED YARDSAPPROVED MAIN BUILDIN6 ACCESSORY BUILDING VAR. �C DATE C. -G 1080 e4. �. 1 HEREBY ACI(NOWLEOOe TX/�T 1 XAVe q�D THIB APPLIGTION TM8 AMOUNT 9HOWN UNDER VALUATION 19 FOq THB ANU 6TATE THAT TXE ABOVe 16 COqp6CT ANO A6REH TO COM. PUFP036 OR HSTABL�eHINO A PEFMIT FEE ONLY. PLY WITH ALL CITY ORDINANC68 AND B}ATB LAWB q[OIILATING � " VALUATION � BO1O1NO `°"eTRpGT1ON. �Jp.�� $9990. �� PERMIT FEE s 32. 97 •oIGNATUREOFGA'i�� JF'fG[fS�S I�G � FOMITTFF ' - . _ _ NAUTHORIZED AGGNT j%j� `J�� y _ � s