HomeMy WebLinkAbout2758 PORTOLA DR - Building Permits� �-.
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(714) 754-5273 • Fax (714) 754-4856
Job Address:
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Parcel Nunmber:
CITY OF COSTA MESA
BUILDING DIV/SION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
2758 PORTOLA DR
SIDE OF HOUSE
14130223
ELECTRICAL PERMIT
Applicant: TWITCHELL, GLENN
Address: 2758 PORTOLA DR. -,�, r'.' �" �
CA - r- ` -�� � ", 'Phone:
COSTA MESA• � � " �-� , � , Zip:
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owner. "TWITCHELL, GLENN�& MONICA
Address� �2758 PORTOLA DR.�� �'��� -� �
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/ i % , COSTA MESA! Zip:
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PERMIT NUMBER
E99-00864
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 09/14/1999
Issued: 09/14/1999
ISSUED BY:
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(714) 557-3870 '"'-. � �� �..y-'..
92626 /� j - � �.�
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(714) 557-3870 �� � �� � . ; % � \ ��
92628 � ��� �� . � i�\� A
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'�� V �� ` : - � SCOPE OF PERMIT \ � ��� � •�
�^' �' � REMOVE EXISTING 70 AMP ELECTRICAL SERVICE & INSTALL NEW 200 AMP ELECTRICAL SERVICE @.
,� ' ' �� SIDE YARD (SOUTH SIDE OF�HOUSE). " � ' -
,. � , ,. � _ _... ` _' - . _ ��_�,_ �� � r- .
_
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� ,,�ISSUE FEE $23.50
� � Temp service test•,�...' $0.00
-,',Res.a/cpackage,.,.���-� $0.00
New Res (1-2 units) ,`�,\ $0.00
New Res (3+units)`. ��,'�.�.. $0.00 �
Pool / Spa � � �- , \ $0.00
Lighting Fixts '. � _ $0.00 ,
ReceptOutlets � �t"��.,$0.00
Switches`, >> � � ��-$0.00
Non Res'Appl, , � � � � $0.00
ResAppl � - ' '$0:00�
Service to 200a_ �= $30.50 : -`
\
Service to 1000a .i\ � � � $0_00�'�
Service over 1000a� � � � � ' -$0.00
Motorsto 1hp ��� �� � � $0,00�
Motors to 10hp � �� � � $0.00 �
Motors to 50hp � � $0.00
Motors to 700hp - $0.00
Motors over 100hp $0.00
Communication drops $0.00� .
Sub panel to 200a $0.00
Pole Light Pkg � $0.00
Sign Circuits $0.00
Temp Pwr Pole $0.00
Intermed Pole $0.00
FEE SUMMARY - �> � '�
Quantity��.',,.�., . _ - - _ , ", _�f.�,� �., Quantity'.� -'�_i .it;
- � - � - _7emp Dist"System / Lighting- %. $0.00 0 ' . � ��„
- � � - � Busway/700�ft f ' � -' �$0.00 0 /';', � � � �
�
St d' S f� $0 00 0 f• � � �'
0
0
0
0
0
0
0 " �
-..0. . ^_•�'..
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0
` 0
0
0
0
0 .
0
0
0
0
0
0
0
an mg ec ion . . �! , ,
Misc Electrical�Equipment -� $0.00 Q�'�' � �'�� �
Trensformers up to 1 kva/kw � - $0.00 �0; � ," � � �� �;�
................up to 10 kva/kw .1 $0.00 %0 = � ; �. , .� �` � , ,
._ ..............up to 60 kva/kw - $0.00 ,�.. . -_, � ..�. ;
<.,0 ,
.._..�..:........up to 100 kva/kw $0.00, "-; ; �0 � ,
.:............':..over 100 kva/kw ,�. $0.00��' � 0 .
Low Voltage Equipment, . � $0.00 0 �.
Low Volt Wiring System / Ckt-,'� ��$0;00 0 ` --
Misa Conduit - ; a, � �� •_ -� :$p:00, , .` 0 �i ��,
Misc Conductor`- %"$0;00' li 0
� Circus ( gen or ride) � - � $0.00 � � 0 . ' '
. Circus (mech ride or lights) "-�$0.00 � 0-, "�
" Christhroas-Tree Stand � � . $0:00 �0 � ". "
FireworksStand , $0.00 � �0�
Other Electrical Fee � $0.00, .
Investigation Fee . , � $0.00
Plan Check Fee $0.00
� Reinspection Fee � " $0.00
TOTAL CALCULATED FEES E54.00
COMMENTS / SPECIAL CONDITIONS
t ",`
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days. ,
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply wi�h all applicable codes, and all
required inspectlons and tinal approval must ba obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
POR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSATION DECLARATION:
I hereby aHirtn untler penalry of parjury one of the following tleclerations:
❑ I heve antl will maintain a canificate of consent to self-Insure for workers' compensation, es providetl tor by sedion 3700 of ihe Lebor Cotle, for ihe peAormence of �he
work for which ihis permi� i5 i55ued.
❑ I have antl will maintain workers' compensation insurance, as requiretl by section 3700 of the Labor Code, for Ihe peAormance of the work tor which this permit is issuad.
My workers' compensation Insuranca carrier and policy number are:
Carrier: Policy Number.
(TM1Is section neetl not be comp/eletl i/ the pe�mit is velued et one hundred dollers ($f 00) or /ess.)
❑ I certity thet in Ihe performance of lhe work tor which ihi9 permit is i55ued, I 5ha11 not employ eny person in any manner so e5 to hecome subject to the workers'
compensation laws oi Califomia, and agree that it I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply wit� these provisians.
Applicam SignaWre: Date:
WARNING FAILURE TO SECURE WORKERS' COMPENSATIqJ WVERAGE IS UNLAWFUL AND SHnLL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
iHOUSAND OOLLARE (5100,000), IN ADDITION TO iHE WST OF dJMPENSAiION, DAMAGES AS PROVIDED FOR M SECTIIXJ 3]O60F THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aflirm that I am licensetl untler provisions ot Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business antl Professions Code, and my license is in full
force end effect. lic, k qass N
Coniractofs Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby attirm thai Ihere is a construciion lending agency for Iha peAormance ot t�e work for w�ich Ihis permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lendels Address: �
SignaWre: Date:
OWNER-BUILDER DECLARA710N5:
I hereby affirm ihat untler penalty ol perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for �he tollowing reason (Sec. 7031.5, Business antl Professions
Code: Any ciry or counry which requires a pertnit to wnswct, alter, improve, demolish, or repair any siructure, pnor to its issuance, also requires tha applicant tor such permit
to tile e signad statement that he or she is licensetl pursuant to the pmvisions of tha Contracto�s License Lew (Chapier 9(commencing with Section 7000) of Divislon 3 of the
Business and Professions Code)'ar,lhat he or she is exempt iheretrom and ihe basis for the elleged exemption. Any violation of Section 7031.5 by any epplicant for a permii
sub�ects ihe epplicant to e civll penairy of not more than five huntlred tlollars ($500).):
�+.g• # .'�rv Y nYr�� _
�/ I, es owner of the property, orrtly,employees with�wages es their sole compensation, WILL DO THE WORK, and the structure is noi intended or oNerad for sale (Sec.
�.�� 7044, Business and Pmfessions CoAerThe,Contrectors License Law dces not apply to an owner of property who builtls or improves ihereon, antl who does such work
� himseif or herself or through his or her own em`plo�ees?;provitled that such impmvements are not intendad or oHered tor sale. N, however, ihe building or improvement is
soltl within one year oi completion,,the owner-bulltler will have ihe burden of proving that he or she did not builtl or improve for purpose of sele.).
❑ I, as owner of the property, em E%CLUSIVE6V�CON7RAC71NG WITH LICENSED CONTRACTORS to conswct the project (Sec. 7044, Business and Professions
Code: The contrectors License Law does not epply to en owner oi properry who builds or improves thereon, and who comracts for such prolect with a coNractor(s)
license pursuant to the Conirectors license Laws.).
❑ I am exem�under_spf.
Signature: /J•7i c—�L
Owner ID verifietl by dnvers license. ❑ Ye5 ❑ No
Business and Protessions Code tor this reeson:
Verification of Ownership by (type of Cocument, i.e. � property tax bill or tleed):
Driver's License No.
Expires:
DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION:
❑ I hereby certify Ihat no excavation five (5) or more feet in deplh inlo which a person is required to descend, will be made in connection with work authorizetl by this
pertnit, antl that no building slrucNre, scaftolding, falsework, or demolition or dismantling thereof, will be more Ihan Ihlrry-six (36) feet hig�. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Califomia Administrative Cotle).
❑ As owner-builtler, I will noi employ anyone to do work which would require a parmit from �he Division of Indusinal Safety, as notetl above, unless such person has a
permit to do such wark from ihe division.
Signeture: Date:
Division of Indusinal Safery Pertnit Number:
CERTIFICATE OF COMPLIANCE AND AUTHORVATON OF ENTRY: I certity under penalty of perjury ihat I have reatl this appiication and state that the intormation given is
correct. I agree to comply with all state laws and ciry ordinances relating to 6uilaing consiruction, and authorize representatives ot the Ciry of Gosta Masa to enter upon ihe
above-tles ' ed pr urposes. I agree not to occupy or allow occupancy of any builtling authorized by this permit until/f/inal in ti� n.
/ �� � T—
� Signature Ot Legal Owner(s) Date '
AntllOrAuthonzed Applicant Date
CODE �. INSPECTIONTYPE
1816 Fixea System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRe�aining Wall
202 Final Fectory Fire Placa
203 Final Sign
204 Final Demolition
2ba8-46
QRTE ff(�ALS �D�E1 INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electncal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Builtling/Occupancy
pRTE NTI RIRLS
�
Owner.
Resident:
Site Address:
City/Zip:
Parcel Id:
Location:
iVeighborhood:
Legal Desa:
Usage:
Style:
Construction:
Year Built:
Stories:
Bdrtns:
Baths:
Heating:
Cooling:
Irr. Lot:
Tecrain:
Water:
Sewer.
Sqft lst
Sqft Total:
Market Value:
Assessed Land:
Assessed Bldg.:
Assessed Total:
Tax Semi Ann.:
Sale Date:
Sale Amt.:
Deed Type:
Volume & Page:
Seller:
Title Company:
Mul[i-Parcel:
CITY OF `STA MESA PROPERTY DETAII 'EPORT
2758 Portola Dr
Costa Mesa, CA 92626-5819
Twitchell Glenn Monica
2758 Portola Dr
Costa Mesa / 92626-5819
141-302-23
Costa Mesa City
Unknown
N Tr 3749 Lot SO
122: Single Family Residen[ial
Unlmown
Unknown
1960 TotRins.:
1 Esmt. Type:
4 Bsmt. Fin.:
2 Full Gar. Type:
Unknown GacSq.Ft:
Unknown Roof Ma[er.
Unknown Roof Style:
Unknown Attic Type:
Unknown Condition:
Unknown Lot Dim:
Lot Size:
1418
$190,741
$124,835
$65,906
$190,741
$1,08530
Phone:
Phone:
Tax Address:
City/Zip:
Own. Occ.:
School District
Census Tract:
7
Unknown
Unknown
Attached Garage
Unknown
Unknown
Unknown
Unknown
145 acres
2758 Portola Dr
Costa Mesa / 92626
Yes
Newport-Mesa Unified
063904
Blk[op Paving:
Concrt Paving:
Carport:
Deck:
Patio:
Pole Barn:
Pool:
Fireplace:
Gas:
Electric:
Gross Tax Semi Ann.:
HB920 Credit Semi.:
RB Credit Semi Ann.:
RBA Credit Semi.:
Homestead Exemption:
Spec. Assmt. Semi.:
Feb-06-1998 Mortgage Date:
$180,000 Mortgage Amt.:
Corpora[ion Mortgage Type:
VoWme & Page:
S[a[e Street Bank & Trust Company Trstee Lender:
Unknown Mortgage Term:
Y Mortgage Rate:
Unk.
Unk.
No
Unk.
Unk.
Unk.
No
1
Unk.
Unk.
$1,08530
Feb-06-1998
$183,600
Va
Wmc Mtg Corp
2028
The in(ortna[ion is deemed reliable but is not guarantecd. 200L2002 Tax Year Copyright 2002 Haines Printed Aug-09-02
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M�W BuIICInpSa�elyDNlelon
CITY OF COSTA MESA
r.a eox isoo
CASTA MESA, GLL60RNU Y262&1200
ADORESS SERVICE REOUESTED
fee due 70C
First-Class Mail
Postage and Fees Paid
USPS
Permit No. G-10
;� ��_..�. _�
``' � �' ,.�,� .., .. . �
R E G� ��/ t� Glenn & Monica Twitchell
CI7Y OF COSTA MESA 2758 Portola Dr.
q� p{ qING �������nN Costa Mesa, �%A 97fi9fi
TWST)99 7�3S3h3009 t70a A.l �19/l4/02
PUNM 374)
IiU G� G 2002 TW=TCHELL
139 VCNETSA DR
LONG BEHCH CH 90809-9940
3252biSB19 10 ' ��������u��n�����nu���u��i����u�u����uu���u����u�i�
:;
(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Jobnddress: 2758 PORTOLA DR
Suite:
Vicinity: RESIDENCE & ATTACHED GARAGE
Parcel Number: 14130223
Zoning: R1 R1
Applicant: ADELIZZI, KEN
Address: 19115 E ORANGEPATH ST " . � '" .
" ��� � Phone: 626335-6098 �
GLENDORA,.CA . , : � - Zip: 91471 .
Owner: TWITCHELL, GLENN & MONICA - �
Address 2758 PORTOLA DR.� �� � ' �
= CA", � , � - - - ' . �. Phone: (774) 557-3870 �. "
COSTA MESA� . Zip: 92626 '
Contractor. 'ADVANCED�ROOFING TECHNOLOGY
Address: 19115 E.OR4NGEPATH ST
� - � Phone:: � 626335-6098
GLENDORA,CA
Zip: , 91471' License: , 777164 �
Arch :
Address:
Zip:
. , � ' _ ; Phone:
�- ��
License:
Eng:
'. Address:
� � SCOP
- '�
� ,.' REROOF: T/O EXISTING ONE LAYER OF COMP, REPAIR Sf
30-YEAR CALSS A COMP SHINGLES. APPROX 22 SQUARES
Status: ISSUED
Applied: 10/Ot/2001
Issued: 10/01/2001
ISSUED BY: �
�. ��
Plione: ,
'.
Licerise:
�h PrKMIf.;- - ' , ' .
AS NEEDED,'1-LAYER�30#,UNDERLAYMENT, INSTALC �
_. . . . ...__. . , i
FEE SUMMARY
Plan Check: $0.00 -- � Calc Valuation: 83;eoo.00
Permit: $97.25 i Claim Valuation: g3,aoo.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00 _ , � . - , � ; � .
• 1.. � • � _ ' i
, Total: , $97.75
�i. . ., , z: � -�
--�-�� � . _ � ., - - . � ' . . . ; � , , i
SETBACKS� �
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0 �
PARKING Ezis[inq: o
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
PLANNING & ZONING
Left 0- 0
Left . 0- 0
Proposed: 0
Right
Right
� �:
0- 0 ,
0- 0 ,
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related I
regulations. (Ord. No. 92-28, § 1, 12-27-92)
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 consitlered legal, such work must comply with all applicable codes, and all
required inapectlona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626 I
2d66-66(&90)
WORKERS'COMPENSAnON DECLARAnON: '
I hereby aflirtn under penalry ot pehury one of the tollowing declaretions:
❑ I have entl will meintain e certiFicate of consem to selFlnsure br workers' compensation, as provided for by section 3700 of the Lebor Code, for the pertormence of ihe
�� w rk for which this permit is IuueQ �
ave entl will mainteln workers' compensetlon insuranca, as requiretl by sectlon 3700 oi Ihe Labor Coda, for the Oedortnance oi tha work for which this pertnit Is luued.
My workers' compensation Insurance caMer and policy number are:
Carrier: Policy Number:
(Th/s section need not be comp/eted il fhe pemrif is velue0 et one hundred Oollars ($100) oNess.J .
❑ I cenity that in tha pertortnance of the work for which this permit is issueQ I shall not employ any person in any manner so es to become subject to iha workers'
compensetlon laws ot Califom' , entl agrae Ihat i� I should bacome sub�ect to the workers' compensation provislons o1 Saction 3700 of the Lebor Cotle, I shell forthwith
comply with Ihese provis' . /� /% / /
Applicant Signature: 76 sti. r.f,n[! �/z�� � Date: �� —� d
WMNINO: FAILURE TO SECU E WORKERS' COMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBIEC� AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE MUNDRED
THOUSMlD OOILARE (5100,000). IN ADOITION TO THE WST OF COMPENSNTION, DAMNGES AS PROVIDED f-0R IN SECTION 3]OB OF TME LABOR CODE, IMEREST, AND FTTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby ettirtn that I am licensed untler provislons of Chapter 9(commencing with Section 7000) ot Division 3 of the Business and Professions Code, entl my Iicense is in full
force and eflect Lic. A Class a
ContractoYs SigneWre: � a— Dete: / D./— FJ �
CONS7RUCTION LENDING AGENCY:
❑ I hereby affirtn Ihat Ihere is a construction lentling agency for the performance of Ihe work for which ihis permit is issued. (Sec. 3097, Civil Code).
Lentlels Name: Lender's Address:
Signeture: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eftirtn thet untler penalry ot perjury ihat I em E%EMPT FROM TME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions
Code: Any ciry or counry which requires e permit to construct, alter, improve, tlemolish, or repair any stmcture, pnor to its issuance, also requires ihe epDlicam tor such pertnit
to ille e signetl statement Ihet he or she Is Iicensetl pursuent to the provisions at the Contrectors License Ww (Chapter 9(cammencing with Secllon 7000) of Divisian 3 of ihe
Business and Professlons Code) or ihet he or she is eaempt therefrom end the basis tor the ellegetl exemption. Any violation ot Section 7037.5 by any applicant for a pem<'
subJects Ihe epplicant to e civil penelty of not more ihen five hundred dollars ($500).):
❑ I, es owner ot ihe pro0erty, or my employees with wages as iheir sole comDensatlon, WILL DO THE WORK, and the structure is not intendetl or ottered tor sele (Sec.
7044, Business antl Protessions Code: The Contractors License Law tloes not apply to an owner ot property who builds or improves iheraon, and who does such work
himselt or hersetl or through his or her own employeas, providetl Ihat such improvements ere not Intended or oHered for sale. It, however, ihe bulltling or Improvement is
sold within one year of completion, the owner-builtler will have the burden ot proving ihat he or she did not build or improva tor puryose ot sale.).
❑ I, as ownar of the properry, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct the prolact (Sec. 7044, Business end Professions
Cotle: The wntractors License Lew does not apply to en owner ol pmperty who builds or improves Ihereon, antl w�o contracts for such project wlth a contredoqs)
license pursuant to the Contractors License Lews.).
❑ I em exempt untler sac. Business antl Professions Cotle for t�is reason:
Signe�ure: Date:
Owner ID venfietl by tlrivers liCenSe. ❑ Ves ❑ No Drivers License No. Expires:
Verificetlon oi Ownership by (type ol document, i.e. - property tax bill or deed):
DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certity that no excavation fiva (5) or more teet in depih into which e pereon is require0 to tlescend, will be made in connection with work eu�horized by this
permil, and that no building sirudure, scallolding, falsework, or demolition or dismantling ihereoi, will be more than ihirty-si: (36) feet high. (Chap. 32, Grp 2, An 2, Sec.
341, Title B, Califomia Atlministretive Code).
❑ As owner-builder, I will not employ anyone to do work which would require e permit irom Ihe Division ol Indusinel Sefery, es notad ebove, unless such person hes e
permit to do such work trom the division.
Signeture: Date:
Divislon oi IndusMal Safery Pertnit Number.
CERTIFlCATE OF COMPLIANCE AND AUTHORIZATON OF ENTRV: I certify untler penalry oi perjury that I have read this epD�ication and state that the intormation given is
correct. I egree to comply with all state laws entl ciry orainances relating to building construction, and authonze representatives of the City of Costa Masa to enter upon ihe
ebove-descnbed property for inspection purposes. I agree not to occupy or allow acupancy o� any building authorizetl by ihis permit umil final inspection.
Si r Le Owner(s) D te
< ��'.�.L �d- / - O/
And/Or Authonzed Applicant Date
COUE I. INSPECTIONTYPE
1616 Fixetl System Final Fire Prevention
1268 Pool Spa Final
200 Final Re-Root
201 Flnal8lak/RetainingWell
202 Flnal Fectory Fire Place
203 Finel Sign
204 Flnal Demoli�ion
.1 11 '
Ti /A. .1
COUE� INSPECTIONTYPE
206 Final Mechanical
208 Finel Plumbing
210 Final Electncal
212 Final Fire Preven�ion
220
222
250
Final Planning Approval
Final Site
Final Building/Occupancy
PLIE IrmnALS
�23�5
CC}STA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 COBTA MEBA, CALIFORNIA
For Appiicant fo Fill In Completely
- � ' TYPE OR PRINT
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COSTA MESA CALIFORNIA .
1. 3800 E. Coast Hi
432 Via
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No. oF
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STREeT '45 REAR YARI
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DESCRIPTIOId OF WORK
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FEE RECEi��Q
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BUILDING
ADDRE55 2758 POIt01$ Drive
COSTA MESA, CALIFORNIA
FIRE ` /
ZONE TVPE GROUP Y �
APPROVED �
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PLAN9 BU�LDING
LBOAL _ LOC OO__ �� __, _
YARDS
APPROVED
34 ��"Ters une
Residence
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p7-Y,
with attached garage
1 HEREBY ACKNOWIYO6E TXAT I HAVE RENO THIB APPL�GTION }HC AMOUNT BHOWN UNDEH VALUATION 16 POR THE
atto BTwTe TXAS THB ABOVE IB COR CT D AGREE TO CO pUPP08E OF EBTqBL16MING A P¢RMIT FEE ONLY.
PLY WITH ALL CITY Oq�INANCE6 AN 9TA LAWB LA G
eWLDINo coNBTNUct�oN. � VALUATION 34�00
SIGNATURE OF �'ERMIT FEE $
PERMI7TE
� � $ �1�4,563.�� PLAN CHECK $17'O�
AUTHORIZED AGEN7 - OjBCC M8088@i �
TOTAL FEE SL.00