Loading...
HomeMy WebLinkAbout2377 PURDUE DR - Building Permitsp5(a ME . � 0 t r 6 J'�o,�,�fi PERMIT TYPE � 1 ` • � � CITY OFCOSTA MESA B!I/LD/NG DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-0856 • �vww.ci.costa-mesa.ca.0 FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBE B07-00919 B_ROOF2 STATUS: ISSUED DATE ISSUED: 09/04/2007 ISSUED BY: SOK JOB ADDRESS: 2377 PURDUE DR CM SuitelUnit: - Vicinity: ROOF � - _ ` 1 x �� -, � " � ,�; Squares: 2800 r�_, , , -,.��� : ,'�r al on: 9,500.0 ! SCOPE OF WORK: TEAR OFF EXISTING INSTALL 1 LAYER OF 30# FELT, 7:12 PITCH, LIF ME GAF GRA UOIA #D3462, AND REPAIRIREPLACE SHEATNING AS NEEDED. 28 SQUARES. .� OWNER: CASINO, STEVEN C � PHONE: � ' - � � APPLICANT: DREW CAMPBELL � PHONE: 949-770-7663 � � CONTRACTOR: BEST VALUE ROO�ING Address: 22365 EL TORO RDUnit: City/State/Zip�. LAKE FOREST, CA 92629 ARCHITECT: ENGINEER: FEE SUMMARY Reroof Plan Check: Reroof Permit Fee: Reinspection Fee: TOTALFEES go.00 $151.25 $0.00 $181.25 Address: 2377 PURDUE DR � � � . City/StatelZip; COSTA MESA, CA Address: 22365 EL�TORO RD Gity/State2ip: LAKE POREST, CA PHONE: License No. - License No. , License No. 678356 949-770-7663 CELL: PHONE: PHONE: Unit Unit: : NOTICE: The work authorized by this pefmit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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 and final approval must be obtained. Failure to obtain inspections and final approval will resWt in the expiration ot this permit. LO�EI INSPEC110NTYPE OATE INTITIplS WOE/ INSPEC110NTYPE OAIE IN7IilALS 1676 Fized System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final � 208 Final Plumbing 200 Final Re-Roof � 2t0 Final ElecMcal 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Appmval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy __ WORKERS' COMPENSATION DECLARATION: � � � hereby aKrm untler penalty of perjury one of the following declarations: ❑ I have and will maintain a cehifcate o( consent to sel4lnsure for workers' compensation, as provitletl for by section 3700 of the La6or Code, (or the performance of �he work for which [his permit is issuetl. r�]—I tiave antl will maintain workers' compensation insurance, as required by �sectbn-3700 of the Labor Code, (or the pedormance of [he wurk (or which this permit is issuetl. My workers' compensation Insurance carrier and policy �umberare: � �__�.. Carrier. (ihrs sectun need irol I�e compe�le^e n GMe ce�� �s vaWed at one huiM�¢dddlars (Sf o0) a �ess ) CPolicyNumberr���O��J a"a6��o ❑—I certi(y that in Ihe performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject t0 the workers' compensation laws of Califomia, and agree that if I should become subject to the workers' compensation pmvisions o( Section 3700 0( th abor Co e. I iall fo hwith comply with these p�mvis�i�ons�.� ApplicanCs ignaWre� " Dal�l+-``�'e—���— WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 70 ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVlDED FOR W SECTION 3706 OF THE LABOR CODE, tMEREST, AND ATTORNEY'S FEES. I.ICENSED CONTRACTORS DECLARATION; I hereby affvm ihat I am licensed untler pmvisions o( Chapter 9(commencing With Section 7000) of Division 3 of Ihe Business antl Pro(essions Code, and rtiy licenrse +is�in full force and effect. Lic..#--b-G �� i—Class# L—� ,�s - �`♦ � 0 � �CqnUaclors$i nalure-. +p3te-- .._ ......_ _ .. -. _ CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrm Ihat t�ere is a cons[mction lending agency (or the perfortnance of the nork fa which this permit is issued. (Sec. 3097, Gvil Code). Lender's Name: Lender's Address: SignaWre Date OW NER-BUILDER DECLARATIONS: � herehy affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the lollovring reason (Sec. 7031.5, 6usiness antl Professions Code: Any ciry or cpunry which requires a permil to mnstrud, aNer, improve, demolish, or repair any structure, prior to its i55uanCe, also requires the applicant for such permit to fle a signetl statement Ihat he or she is licensed pursuant to the provisions o( the Contractors license Law (Chapter 9(commencing with Section 7000) of Division 3 of the F3usiness and Professions Code) or [hal he or she is ezempt therefrom and Ihe basis for the alleged exemption. Any violation o! Section 7031.5 by any applicant for a permit subjects the applicant [o a civil penally of not more [han five hundred tlollars ($500).�: ❑ 1, as owner of the properly, or my employees with wages as their sole Compensation, WILL DO THE WORK, and the structure is not intended or oRered for sale (Sec. 7044, Business and Professions Code: The Contracrors l_icense Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or [hrough his or her ovm employees, provided that suc� impmvements are not intended or oHered for Sale. If, however, the bhilding or improvement is sold within one year of Completion, the owner-builder will have the burden of proving that he or she tlid not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the pmject (Sec. 7044, Business and Professions Code: The coniractors License Law dces not appty to an owner of pmperty who builds or improves thereon, and who contracts for such prqect with a contracta(s) iicense pursuant to the Contractors License Laws.). ❑ I am exempt untler sec. � 9usiness and Professions Code for this reason: SiB�aWre Date JOS]-G6�]I0�) ' . � Ovmer ID verifed by tlriv e. ❑ Yes ❑ No Driver's License No. Expires: Verifcali0n o( Ovmership by (rype o( documen[, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFEN PERMIT CER7IFICATION: ❑ I hereby certAy that no excavation fve (5) or more feet in depth into which a person is required to descend, will be made in wnnection with work authonzetl by this permit, and Ihat no buifding sWcture, scaRdtling, falsework, or demofition or dismantling thereof, will be more than thirty-six (36) tee[ high. (Chap. 32, Grp 2, M 2. Sec. 341, Title 8, Califomia Administrative Code�. ❑ As owner-builder, I will not employ anyone to do vrork which woultl require a permit from the Division of Industrial Safery, as noled above, unless such person has a permit to do such work fmm the division. Applicenfs 9goature Dgle Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: i. Will the applicant or present or fuNre building occupanl neetl to file antl certify a Business Plan (or emergency response to release or threatenetl release of a hazardous material? ❑ Yes ❑ No (Section 25505 of Ihe Califomia Health and Safery Code requires, with some exceptions, tha[ a Business Plan be filed with (he Costa Mesa Fire Department by every business which has at any one time dunng a reportetl year a quantiry o( hazardous materials equal to or greater Ihan 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 (uture building occupant need to file a registra[ion form (or acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Heallh and Safery Code, with some exceptions, requires �egistration wilh [he Costa Mesa Fire Department by each business which at any one time has on hantl a quantity of acutely hazardous ma[erials equal [o or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas at standartl temperature and pressure). 3. Does or will ihe applicanl or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for aculely hazartlous materials)? ❑ Yes ❑ No (Section 25534 of Ihe Califomia Health and Safery Code provitles ihat the Costa Mesa Pire Departmenl may require the preparation, certification antl filing with [he Fire Department of an RMPP by businesses which are requiretl to register awtely hazartlous materials wiM Me Fire Deparlmen[. 4. If an RMPP is presently required, has Section 25534 of the California Health and Sa(ery Code heen (ully complietl wifh? ❑ Yes ❑ No 5. Does or will the applicant or present or fu[ure building occupant require for the vrork which is tha subject of this ap01ica1ion a permit for such construc[ion or modifcation from Ihe South Coast Air Quality Management District or from any other air pollution control dislric( or agency? ❑ Ves ❑ No (Sedbn 658502 of Ihe Califomia Govemment Cotle requires that the reques[ed in(ortnation be fumished on applications fa non-residential building pertnits). 6. Will any part of the tacility to be constructed untler this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If'yes", the (acility must meet the requirement of Sections 25534 and 42303 of lhe Califomia Health and Sa(ety Code). 7. I( a permit from the Sou[h Coast Air �ualiry Management Distric[ or olher air polWtion control district or agency is required for the work which is the subject of this application, hava all of the tlisdosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf "yes", attach certificate ot compliance (rom the 2ppropnate air pollulion control officer). � CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the in(ormation given ahove is correcL I agree to comply with all state laws and city ordinances regardi�g Hazardous Materials and Emissions. .� SignaWre 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 correcL I agree to comply with all state laws and city ortlinances relating to building consWction, and authonze representatives of the Ciry 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 ihis permit until final inspection. Signalu o L'egal pr(s D te o p'� �� An0/or ul�otlze OPli�n� � Oale OWNER JERAL No. ROUGM MISCELLANEOUS ROUGM NERTING �ND AIR CONDITIONING TEMPORRFV SEFVICE OR COLE � ROUGM WIRING ` �TRENCNES F !O FLOOR SYSTEM � BOND BEAM [] .� SNEATHING FRr1ME r1N0 FLAS r LATNING - IN r � PLASTER, BROW N (liSTRUCTUpAI, FII MERTING, VENT., �o NS U STEEL NEINF TEEL REINFOHCE ❑ G OUT ❑ AT �RIG. AN� �.C., FINA� 10 GAS TEST I-I OATE SUBCONTRACTOR COSTA MESA BUILDINGSAFETV DEPARTMENT APPLICATION FOfl�Rl2Q'[����. PERMIT 36. P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 � � REC I PERMIT Ai0 51315 � For Applicant to Fill in Completely — Use Ink Only 1�� ADIDRESS �37 � /–(9/Qji(J � �/�1� A.P.NO� �' � — � OWNER OR / L I G SF ADDRE55 �LU Z� TENANT l� UNIT OR MAILING SPACE NO. ADDRE55 '�'.3%'% PU�O � �Ql(/L� /' � �y/ T� LOT � C BLK. CITV L-I/ S� / /ES� Nosyoll�73 �•L �.J NEW ADD LTER REPAIR MOVING OEMOLISH CANSTRUCTION . LENDER BFANCH OWNER �- ' ADDflESS USE � VALUEsr/ //'� ARCHITECT TEL. � � �� OR ENGINEER ��1, ADDRESS ZONE TVPE V GROUqqqP �_/ ���_��/J� APPROVED � Z �/ CONTRACTOR '7/C`K�i BV DATE ADDRESS TEL. CITY NO. STATE CITY APPROVEDSETBACKS IIC. NO. LIC. NO. SI2E NO.OF BLOGS. (FROM C/L STREET) OF LOT NOW ON lOT � ROf�fT � FT. � VSE OF '/ EXISTNG BI.OG. /�O fljF Separate permits are required for L. SIDE S FT. electric, plumbing and hea[ing work: REAR FT. USE �F BUILDING AND WODRK TO B P CBV�D PLqNNING ACTION DATE APPFOVED �� � 1 hereby acknowlatlge that I have read this eppllcation entl rteta , that the above intormation is corract antl aprea io comply wit� all laws regulating buildin8 canstruction, entl I shall noc employ any perwn in violation of the workman's compensation taws ot ffie State Of Califomia. O eby certify thai I am properly licensetl as e eonira Eer SQ. FT. � th St t ^-'f a o.,.� d i%�"^� 3, TNE AMOUNTSHOWN UNDER VALUATION IS FOR �^-�–� ��^ ^ f 11 f ff qr I THE PURPOSE OF ESTABLISHING A PERMIT FEE NLV: �i S mTth p I t th e �^an VALUATI� PERMIT FEE E . OQ �-Wofessions Cotle, D' uion , Chaptanr 9. Signature of �� vf„ /�J � �� �/�O–� PLAN GHECK b `z. �(� Permittee �� .��•�i (�lli� � $ �(/ � – 4 TAx E O . S or Z— ,Z^ v� Authorized ABent Dafe TOTAL PAID 50 TL m i e m J m m e N m n F u "�PLICATION FOR A BUILDING PER'"'T BUILDING PERMIT NO. E�ecviw� Gl Tract y��7 Block Lot �� PormitNo. �, BUIIGing Plumbing � Atltlress N 3_ "� � �U D � �� PErmlt No. �p .s � � 7s D Cross �7UR�UF � Mechanical n Area CQ�'�, �JE's� ��ee� � D J Pormit No. a m Owner J ��� � F T pe ot Proiect: ❑ New ❑ Alter ❑ Atleition � h= Repair ❑ Converi ❑ Demo ❑ Occupancy Pmt. naa,as: 77 f�U D h' � ld,- Gty r/ A.P. $uP. DiSt./ C /✓/ GS 2ip9ti �26 Phon a„ y��3 Insp. Area � Architect/ �— Zone Spl. Pmt. No. Deslgner �— License No. Setbacks P/L Front GL SL Street Witlth Atltlress __ ------� Vartls Le Ight Rear CitY ZIP — Phone .—�, ave �o�. e g . . Engincer -- license No. — � . Park nq S ces equ �e /ovi e overe p, AAGress —� � � m City Zip — Phone — $trutt No.oi No.ot Height StOri¢s Fdmily Y Fee LICENSED CONTRACTOR'S DECLARATION Park Faes ves � Requiretl C.T. Receipc m I heraby affirm thet 1 am licensed under provisions ot Chepter 9 (commencing with Section 7000 of Division 3 ot the 8�sinass antl « Protessions Cotle, antl my liconsa is in full force antl effec[). Zoning Approvetl BY: Date �y �icenso Clas License Number T De[a Contracmr Misc. E Atltlress Proposetl Use ot Structure �y CityanG2ip �hone N CONSTRUCTION LENDING AGENCV � I hereby aftirm tha[ there is a consVvction lantling agency for the d performance of ihe work for which this permit is issuetl (Sec. 309], Occ. ype Cotle ' Civ. C.1. Class onst, vear d Leneer's Name USE/OC UPANCV SIZE SQ. FT. � Lender'sAddress_ J OWNEH-BUILDER DECLARATION y 1. I hereby affirm that I am axempt from the Contractor's License Law tO fo tha following reawn: ��I, as owner of the property, or my amployaes with wa9es as their 2. � solo compensation, will tlo the work, antl the sttucture is not r intended or offered for ,ale. 3 � ❑ I, as owner of the property, am eaclusively convacting with licensetl contractors to cons[ruct the projec[. d ❑ I am exampt under Sec.� , '�7f 8& Ifor t reawn 4' aDatx J7—.79��A Owner K/���6 �/ ��'� . E WORKERS' COMPENSATION DECLARATION Total Valuation jI haraby atfirm tFat t have a certiticate of conseni to self-insure, ❑ No or e cenificate of Workers' Compensation Insurance, or a certitied Cncroachment Permit RequlreG Ves C wpy thereof. G�atling Pmt. Gratling }S Policy No. Company Requl�etl ❑ Yes ❑ No Pmt. No. a ❑ Cortified copy is hereby furnished. Rou9h Gratling � Q ❑ Certified copy is filetl with Orange Co�nty, EMA. qpp�ovetl by: Date � Daie Applicant 3 CERTIFICATE OF EXEMPTION — Ffl�M WORKERS'COMPENSATIONINSURANCE Z (This section need mt be completetl if permit is tor $100 or less). � 1 certify that in thc performanco ot the work tor which this permit is 3 issued, 1 shall mt empioy any p¢rsan in any manner so as m become ry s�blect to tlre Workers' Comnensation 1_aws of California. PERMIT FEES Datn Applicant � NOTICE TO APPIICANT: It, af[er making this C¢rtificate of St/uctural S Plan CheCk Exemption, you sho�ld become subject to the Workers' Campensetion provisions of the Labor Code, yov must torthwith comply with such Electrirzl g SPecial provisions or this permit shall be Aeemetl revoked. Invest. I CEFTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO P�umDing S COMPLV WITH ALL COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBV AUTH- Mecnanical S ORIZE REPqESENTATIVES Of THIS COUNTV TO ENTER UPON TH AB E ENT�ED P PERTV FOR INSPECTION PUR- p�e.Gratle POS . ^ InsPection a �=`�g—�� Pre-Grade Permit Si nature ot Applicant or Agen Dare S Rec. No. Issue E u,� � I Ci/A "�F _ Print Applicant's/AgenYs Name (/4/�— �QtQsj'2 ( Plan Issuance All spaces within this boz must be completed to process Cneck By: Approvetl: CMF 0335-46 (BU-28) rev. 6/80 Ci _Y OF COSTA MESA CALIFORNIA �2826 P.O. BOX 1200 FROM THE OFFICE OF THE DIRECTOR OF BUILDINO SAFETV Project Address 2 r'j 7 7 PV �Q D v� 1%.�l l%_F Project Name ��)`!v _/li✓,O ���/!% Ca uE.2 OFmers Name ��S L. /� c(/ . G�� �f E Owners Address 2 3�% �u i2 O UE �/� I tJ � O.mers Z'elephone 7� y— S Y v'�f 7 7,3 ��„�t � S/ 3 /.S- �� City Use Only i���� �QJ ��i1/� as Owner,-6eRtraetor-, 8gea� (strike out all except one) do hereby attest that emplo}ment of any person, or persons,'is not anticipated at the time of see]cing the above-referenced permit. In the event that any person, or persons, are e�loyed under the provisions of this permit, I shall imrediately cause a valid Certificate of Worlonens Compensation to be filed with the Costa Mesa Building DiVision. I agree to defend at my own mst, arcl to inde�ify and hold harmless, the City, its officers, agents and/or �loyees, frcm and against, arry and all liability, damage, costs, l�ses, claims arid expenses, howscever caused, resulting directly or indirectly fran, or oonnected with the improvement under this perniit. I further state that I have read and fully imderstand the implications and re- sponsibilities of the above statements, and will crniply with all provisions of the Contractors State Licer�e Iaw found under the Business and Professions Code, Division 3, Chapter 9, of the State of California. �CES<iE l.�, GH�SF Print Name �f� (/`� � ��' ii�-p/w Signature CMF 0777-46 Z - 2 - S"/ Date '^PLICATION FOR A BUILDING PER'-'T BUILDING PERMIT NO. Eiectrmai Tract � B�ack - Lot �,j Permit No. BWtCin9 ^� /q p C Plumbin9 . Atltlress � 3 % / �U` � ,�l% E �L/l � v G � / � / � Permit No. Cross �% � c � R N d U Mechanical Afed cesrr� r��sa 5treet Pa D �� Permit No. Owner � ES �. (� (� , G�� R s' F T e of Project: ❑ New ❑ Alter ❑ Atltlition aamess � 3 77 PU R,D v c v/i� �� F � Pa�r ❑ convert ❑ cemo ❑ OC<upanCy Pmt. ci�r �D.ST!? /�FS'� ro fp126 anone S�/0^'i773 A.P. 5 5P. Alrea/. P�<hifect/ Zone SPI. PmL No. Designer Licenze No. Setbacks P/L Front WL SL Street WI tn Atltlress Vartls Left 9 ear Cjty Zjp Phone ave o�. e i9 En9lneer License No. C arkin9 Spaces Requ re rovi e vare p, Atltlress ry Sl�uct No. ot No. ot m City Zip . Phone Helqht Stories Fdmily Y LICENSED CONTRACTOR'S DECLARATION Park Fees v s Fee m I hernby sttirm that I am licensed untler provisions of Chepter 9 0.equiretl N QT. Rec pt t (commencing with 5eMion 7000 of Division 3 of ihe Businass and Zoning Approvetl By: D e Protessions Cotle, and my licenso is in full torce and eftectl. � License Clas Llcanse Numbe. > Dete Co�Vacior Mist. � Addrass Proposetl Use of Structure jy, CityantlZip Phone N CONSTRUCTION LENDWG AGENCV � I hereby atfirm ihat there is a consVuction lentling agency (or the a pertOrmence of the work for which this permit is issuetl (Sac. 309], �cc. Typ Cotle ' Civ, C,1, Class Cons Year C Lentler's Name USE/OCCUPA CV S12E SQ. FT. Landar's Atltlress J OWNER�BUILDER DECLARATION � I hereby at�irm that I am exempt from the Conttacmr's �icense Law 1� A tor the following rea5o�: � ❑ I, as owner of the property, or my employees with wages as their 2. sole compensetion, will tlo the work, and the structure is not �t„ intentletl or otfaratl tor sale. � � I, as owner ot the property, am exclusively contracting with 3� licensed conhactors tu consttuct t�e project. � ❑ I am exempt under Sec. —�--f% B&P tor reason 4� � Date Z'2^ 8�/ d./X/,t i�L �i a tlwne� E WORKERS' COMPENSATION DECLARATION Totai vaivation . SI hereby atfirm tha< I have a certi(icate ot consent to self-insure, Q ❑ yes ❑ No or a certiticate ot Workers' Compensation Insurance, or a cer[iiied Encroachment Permit Re Wr C copy theroof. Gratling Pmt. Gratlin � Policy No. Company Raqulretl ❑ Ves No Pmt. No n ❑ CerTitied copy is hereby furnishetl. Rough Gratling Q ❑ Certifietl copy is filed with Orange County, EMA. qpp�ovetl by: Date Date qpplicaM _ CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (This section neetl not be comple2etl if permi� is for $100 ar lessl. I certity tha[ in the pertormance of the work for which this permit is issuetl, I shall not err�Ploy any porw in a y manner so as t become s�bject to tfie Wor ers' Compens La v of Cal�i ,/n a. PERMIT FEES Data Z-7' �� Applitant "✓� '� NOTICE TO APPLICANT: It, after making this Certifiwte of Struttural $ Plan Check $ Examption, ya� should become subject to the WOlkers' Companzaiion provisiDns ot the LabOr Cotle you must forthwith cOmply with such Electrical g SPecial $ provisions or'[his perrPk sholl be deematl revoketl. Invest. I CERTIFY THAT 1 MAVE READ THIS APPLICATION AND STATE p�umbin E THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLV WITH ALL COUNTV ORDINANCES AND STATE LAWS fiELATING TO BUILDING CONSTRVCTION, AND HEREBY AUTH- Me<h ical S ORI2E REPHESENTATIVES F THIS COUNTV TO ENTER UPON THE OV ME�ED OPEFTV FOR INSPECTION PUR- pry. ratle P In ection $ � � � � 2 � �/ Pr -Gratle Perml[ Signature ot Applican2 or qgent Da�— � No. E 155ue $ �Es<�� u),_ CNf?s< S�F�-'f��/-�78w�f- Print ApP���anYs/Aqeni's Name vT7 / S� Lp� All spaces within this box must be completed to process Pian 15511dlIC¢ Ch¢ck By: Approvetl: CMF 0335-46 (BU-28) �ev. 6/80 '