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Home My WebLink About1121 DEBRA DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT ,lob Address: 1121 DEBRA DR Suite: Vicinity: Parcel Number: 41207110 Zoning: R1 R1 Applicant: WARNER, RICK Calc Valuation: $7,600.00 Address: 22622 LAMBERT ST — - — - - Claim Valuation: $7,800.00 SMIP Res: STE 303 Phone: (800)499-1340 SMTP Com: LAKE FOREST, CA Zip: 92630 Owner: HEFNER, JOE R TR Address 25671 ROLLING HILLS RD - " Phone: • Notal: LAGUNA HILLS, CA Zip: 92653-7527 Contractor: ' BIENEK ROOFING PLANNING & ZONING Address- 22622 LAMBERT ST MAIN STRUCTURE Front -0-'0 STE 303 Phone: (800) 499-1340 - LAKE FOREST, CA Right 0-0 - PARKING Zip: 92630 License:' 651509 Arch Eng: Address: Address: ISSUED BY: Status: ISSUED Applied: 03/02/2004 Issued: 03/02/2004 Phone: Phone: Zip: License: License: SCOPEOFPERMIT REROOF; TEAR OFF SHAKE ROOF, INSTALL NEW SHTG, & EAGLELITE TILE ICBO#4660 7.2#. " NOTES: NOTICE: The work authorized by this 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 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 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 result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 244646 (6/00) FEE SUMMARY Plan Check: $99.61 Calc Valuation: $7,600.00 Permit: $153.25 — - — - - Claim Valuation: $7,800.00 SMIP Res: $0.78 SMTP Com: $0.00 Other: $0.00 Inspection: $0.00 • Notal: $253.64 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front -0-'0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front. 0-0 Rear 0-0 Left 0-0 Right 0-0 - PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this 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 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 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 result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 244646 (6/00) DECLARATIOMS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a cartifirrate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ^1�1ave antl will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 11C Carner: �L.-1�1-T(J"�cPcB `Number: 6 (This section need not be completed if the permit is valued atone hundred dollars ($100) or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these pr AppAcant Signe C��— D//ate: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CWL FINES UP TO ONE HUNDRED MOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that am license tl under rovisions of Chapter 9 (commencing with Section 7000) of Division 3.o1`e Business and Professions Code, and my license is in full force and effect. Lic. n G Sf S Pass a C39 tractors Signal - (tate: if CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 01 the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .............................. ...................................................................................................................................................................................................................................................................................I.......................... .................appli.................pres .. 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Ves ❑ No (Section 25533 of the California Health and Safety Code, with some excetions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equaPto or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........_.............. ._........._....................._.........._._................................................................_...._............._.._._....................... ........ _.__.._._..................................... .................... .............. ................ ._............... _............ ............. .................. 3 Does or will theappplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes 11No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .. .................................................................................................................................................................................................................................................................................... ............................................................................................. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this,.a�ppplication aQQermit for such construction or modification 8 from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (it 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ........................................................................................................................................................................................................................................................................................................................................................ 7 If a Oermit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? [:1 Yes El No .......................................................................................... ........................................................................................................................................................................................................................................................................................... 8 (If'yes". attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: 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 correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City 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 this permit until final inspection. Of Legal Owners) Date CTj—Z _tom U And/Or Authorized Applicant Date CODE f. INSPECTION TYPE gAIE INTITIALS CODE INSPECTION TYPE PATE INTITAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roo'�� f LeL 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 2134 Final Demolition 250 Final Building/Occupancy BIENEK ROOFING 22622 LAMBERT ST., 303 LAKE FOREST, CA 92630 949/951-3798 October 20, 2003 Building Dept. Re: Authorization to pull permits To whom it may concern, This letter is to authorize Rick Warner to pull permits in my absence, if you have any questions please call me at the number above. Dave Bienek Owner - oua'grtt Barrel 10.2 Asl PROJECT ADDRESS: 1 1 2 1 DEBRA DR OWNER'S NAME: REITANO, JOSEPH J ADDRESS: 1121 DEBRA DR COSTA MESA,CA 642-9181 ARCHIENGINEER: ADDRESS: UNIT: 92626 REG.NO.: UNIT: PERMITTEE: JOE HEEFNER (714)642-9181 ADDRESS: 25671 ROLLING HILLS RD LAGUNA HILLS CA 92600 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cotle, and my license is in full force and effect. CITY LIC.: STATE LIC.: CLASS: date: - Signature: IBKERS' COMPENSATION DECLARATION: I hereby affirm that I have a cetlificate of consent to self -insure or a certificate of Workers' npensalion Insurance, or a certified copy thereof (Section 3800. Lab. C). JUDY NO.: EXP. DATE: COMPANY: ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. Date: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred ($100) or less). I teddy that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become . subject to the WorkersCompensation Laws of California. Date: Signature'. NOTICE: If. after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shag be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097. Cry. C), LENDER: ADDRESS: OWNER BUILDER DECLARATION: 1 hereby affirm that I am exempt from the Contractors' Stale License Law for the following reason 1 ' An f n which requires a rmit to construct alter, improve, dealSh or (Section 7031.5 ure, prior and Professional . Cotle. y ch o county cpe D repair any structure, prior to its issuance. also requires the applicant for such permit to file a Section statement that helshe a Business pursuant to me provisions of the Contractors Slate License Law (Chapter 9 (commencing with Section 7000) la Division 3 ti the Business and Professions Code) or that he/she a exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by applicant fora permit subjects the applicant to a civil penally of not more than flue hundred dollars ($500). i. I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the YV structure is not to an owner offered for sale (Section 7044. Business and Professional Code: The Contractors' State License Law does not apply to employees, owner of a provided that who builds improvements are thereon, and who does such work himselever sellthe or throubuilding r his improvement her own employees, one year that such improvements are not intended de offered for sale. If, however the or impr ve for the purpose is sold within one year of completion, the owner will have the harden of Droving he/she tlitl not build or improve for the purpose of sale). , 1. as owner of the property, am excluswely contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' $late License Law does not apply to an owner of properly who builds or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be or vided to me. ❑ I am exempt under Section: B. 8 P. C. , for this reason: , Thf7e—reley cendy"hatI am aware of and understand tb nts of California Health and SafetyGide Sections 25505. 25533, and 25534 and that I or any future building occupant will/will not (circle one) need to comply with said stat odes and the requirements for a permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from these pmyisions. c ? . — /n , /- . //_ , I hereby ceiufy that I have read this appl ahon and ate' Fin the above information is reel I agree to comply with all city and ordinances and slate laws relating to build . di on and hereby authorize represe Ives of this city to enter upon the above-rim for inspection purposes. Date: _.. - motere. CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 054181 PERMIT NO: B 054183 PLAN CHECK NO: 03837-91 S GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ADD JOB DESCRIPTION 278SF OPEN LATTICE PATIO COVER SQ FT: 278 CLAIM VALUE: 4,000.00 CALC-VALUE: 3;836.40 GROUP OCC: R-3 / COMMENTS: NO OTHER WORK PERMITTED BE BE iE * * 3E iE 9E if 9E 9f iF .)E BE .)E 9E 9f OE -%3E 9E dE %iE if -9E iE OF jE 9E BE iE iE 9E 9E BE iE iE 9EiE iE iE iE )Edf 9L -9E iEiF BE NE 9E iE iE )FdF * iE 9E iE #Re BE if iE iE .)E.� 9F 9E iF Tf iE iE .)E iE NE BE 9E 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 BUILDING ---------- --------- ACCESSORY BUILDING-------- FRNT: FT IN REAR: 7 FT 6 IN FRNT: FT IN REAR: FT IN LEFT: 5 FT IN RGHT: 5 FT IN LEFT: FT IN RGHT: FT IN PARKING RE&(� PROV: PARCEL: 41207110 ZNE:.PDR- REF NO: PLANNING NiSTES> LATTICED PATIO COVER ADDITION, ONLY. > D E V E L O P M E N T S E R V I iC E S R E Q U I R E M E N T S' ZONING APPROVED BY (7p "C5- DATE, � �1 BUILDING APPROVED BY _ DATE: APPLICATION ISSUED BY: DATE: D o iF BE if iE*9E iE iE BE if TF BE iE iF 1E*iF iER*iE iE r ��E BE RE**iE iF iE** iF if 3E 3E iE Bk RE iF RF iF iE iF if if lE iE 9E iF 1e iE IF iF iE 4E*9EM BF RE iE iE 9E 9E iE iE if iF BF BF iE iE TF 9F iE 1E Bf ig BE 3F ie*iF M * Z' 3F iF iE if iE iE ik RiE BE 1E.*iF gg ie 3E iE 3E 3e iF LEGALIZATION:N F E E S U M M'° STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC E IC FIRE MIP/RES GRADING PERMIT 63.00 t. 50 PLAN 40.95'Z SMIP/NON-RES ISSUE FEE s. _ / BUILDING -DIV- > PERMIT ISSUE\ :PLAN H L PAID DUE TOTALS ---- > 63.50 0.00\' 0.95 .45 104.45 .00 REVENUE DIVISION TOTALS--> COECTED• 1S 104.45 OVER/SHORT:00 BLDG PMT PLUMBING ELECTRIC CHANIC ,.y FIRE SMIP/TOT GRADING PLAN -CHECK 63,00 t" i .50 40.95 i��(>• /. ih iO if- iE 9E iF if iE it 9F iE.iF iE Be 1F iE * fE BE iE iE iE M it Bf iE iE 9F 1k iE if if il- IE 9F iP3F�F4(iE iE IF 3f if iF iF iF iF i!-iF iE lE iE IF 1E iE 1E lF 1F 1EiF 3F iE if if iE 3F iF a(- iE iE 3f- iE lE if iF iF N3f I N D I V I D U A L F E E B 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 278 RES -PATIO COVER -POST 6 TRELLIS 13.80 31836,40 END OF FEES n 01 OUCTS471-00048473 T O T 10414 DATE: 04/30/91 TIME: 13:11 /Ir , jeP ml 4°/iIS/47, CO�S�UCTION AND PLANpy. ; APPROVALS Permit # Date Inspector )OL & SPA APPROVALS Permit # " Date, Inspector 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location > 2. Soil Pipe-Undrgrnd. - - 53. Steel Reinforcement ; 1." Electrical Conduit,Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55." Electrical Bonding 7`;1 --„5,,$teel Reinforcement 56. Rough Plumbing & Pressure Test ' . 6._ Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITP�' 7. -Footings ,- 58. Electrical Conduit-Undrgrnd. ' 8, Foundation 59.,Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,_P-Trap, 0 Undrgrnd. �. 10. Structural Floor System 61. _APPROVAL TO DECK 11. 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 Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval n 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electricdl-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT' r 'APPROVALS '.-Permit # ' i 20. Rough Factory Fireplace i 21. Ducts, in Structure - X70. Underground Hydro 22. Ducts, Ventilating' - - -- f71. Product' Piping E7 Gas ❑'Oil 23' Gas Pipe.Rough &'Gest ;;! .. , - 72. Underground Flush-- 24.�.Roof Framing -- -- S 73.' Undergrnd:StorageTank OGas ❑Oil -;� •y-'' l 25. Roof Sheathing - ; -74.=Overhead Hydro r .r 26. T -Bar Ceiling (Structural) & Monocoat - +. 75? Dry Chemical �' t, 27. Frame and Flashing, 76. Dry Standpipe '. ,' - 5 ? 28. Lathing & Siding- ., 77. FIXED SYSTEM FINAL r - 29. Insulation 78.. FIRE PREV. FINAL - •30. Drywall.Nailing HEALTH -DEPT. REQUIREMENT 31. Plaster Brown Coat: 79. -FINAL INSPECTION 32. Electrical Power Meter -Final - p; ' • 80. -FOOD CERTIFICATE ISSUED ! �•� , 33: Final Electric`- i `'Notes:;Z, ' 34. Final Heating & Air. Conditioning_ e- 35._Final Gas Pipc-Test '�• 36. -:Hood or Canopy .. - �'' - ' ' 37 -Final Factory Fireplace, ' .r ' " ' •• --T - `I - L' 38.;,Final Plumbing - 39. Water Service -Final - - -� - -• ' ;40. "Gas Service -Final �.41.Solar Domestic -Final'. �i 42: Backflow Preventer. _ -- �- •, /,^ '- ' 43. Backflow Irrigatio t - - - , 44. Landscape Irrigation System- ,45: -Sound Attenuation - .46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING -r=- 48:' FINAL PLANNING , - 49. Electric Release to Edison 1. . 50., Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY No. Date soz 450 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING I P- r-ri /'\ OWNER Properties West Development Cor nDDRESS 508 29th Street, Newport Beach, CA CITY Newport Beach, CA TEL. No. 675-491( CONSTRUCTION LENDER' BRANCH A.P. O. ADDRESS ARCHITECT j OR ENGINEER Frank S aannglar TEL. NO. Fi7.1-n9S ADDRESS 2240 Newport Blvd., Newport Beacl CONTRACTOR Ownpr I Gi I ADDRESS TRACT LOT '\ CITY TEL. NO. STATE LIC. NO. - CITY LIC. NO. SIZE OF LOT ADDrOX. 60' X 80' NO. OF BL. NOW ON LOT 0 USE OF Separate permits are required for electric, plumbing and heating work. OF BUILDING AND WORK TO BE PERFORMED Plan # 4 I hereby acknowledge that I have &6d this applVation and stets that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I em properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such.licenses are In full force and effect, or 1 am exempt from the provisions of the State of California Business and Professions Code, DivWon 3, Chapter 9. _ Serrature of Permittee l4L^ �af/fLlL� Authorized Agent J -!JG Ja-s+J %V 10-77PASA00 565* *** 122.611 APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY DATE RECEIVED DATE ISSUED Z PTO SIM A.P. O. I BUILDING �7 ADDRESS I Gi I TRACT LOT '\ BLOCK W A A v ' OWNERPrties West Development Cn7 Res. Atd. Gar. VALUE s 73.400. S FIRE ZONE PE GROUP APPROVED RY [AAA, DATE) YARDS APPROVED I YARDS DATE APPROVED THE AMOUNT SHOWN UNDERVALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION I PERMIT FEE E $ 73,400. TAX $ 5.14 • TOTAL PAID $ /' 7 /w