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Home My WebLink About952 DENVER DR - Building Permitsl � .i Job Address: 952 DENVER DR Suite: Viciniry: Parcel Number: 41808115 npp�icant: ISMAEL MOTA Address: 602 N. ALAMEDA AY AZUZA,CA owner: APTE, AVINASH R TR Address 952 DENVER DR COSTA MESA, CA Contractor: ISMAEL MOTA Address: 602 N. ALAMEDA AV AZUZA, CA Zip: 91702 Arch : Address: Phone: (714) 754-5273 • Fax (774) 754-4856 • v+v+w.ci.costa-mesa.��LDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 2oning: Phone: 626-806-6876 Zip: 91702 Phone: Zip: 92626 Phone: 626-806-6876 License: 523628 Eng: Address: Stalus: ISSUED Applied: 07272000 Issued: 0727I2000 ISSUED BY: �� Phone: 2ip: License: License: SCOPE OF PERMIT TEAR INSTqLL 2 LAYERS 15LBS FELT, 1/2" CDX AND 30 YEAR COMP, SHINGLES. FEE SUMMARY Plan Check: $0.00 Permit: $111.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $111.75 PLANNING & ZONING SETBACKS MAIN STRUCTURQ Front 0- 0 Rear 0. 0 ACCESSORY Front 0. 0 Rear 0. 0 PARKING Existinq: 0 Re uired: 0 NOTES: Left 0- 0 Left 0- 0 Propased: 0 Calc Valuation: 55.000.00 Claim Valuation: 55,000.00 Right 0. 0 Right 0. 0 NO710E: The work authorized by this permit shall comply with all applicable handicap accass requirements under California statutes antl related regulations. (Ord. No. 9$-2B, § 1, 12Q1-92) EXPIRATION: This permit shall automatically expire and become void il work is not commenced within t 80 days, or if work is suspended or abandoned for a penod of 180 days. ' INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicabla codes, and all required Inspectlona end final epproval must be obtained. Failure to obtain inspections antl final appioval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 / zaa5+s le�ool �/ /,' WORKERS'COMPENSAnON DECLARAnON: I hereby eHirtn untler panalry of perjury one ot the �ollowing tleclarations: ❑ I have end wlll meintaln e ceNlicate ot wn5ent to self-Insure tor workers' compensetion, as provitletl tor by sectlon 3700 of the Lebor Code, br ihe peAormance ot the work tor whicli Ihis permit Is issuetl. .� ❑ I �ave an0 wlll meintain workers' compensat(� insurance, as required 6y section 3700 of the Lebor Catle, lor the peAormance of the work for which tNs partnit Is Issued. My warkers' compensation Insurance carrlar antl policy number are: Cerder: Policy NumDer. (ihis section neetl nof be comp/eted i! the pertni! is valued et one huntlred dWlers (5100) or IessJ ❑ I cartity Ihat In t�e p ortnance ot t�e work �or whic� ihis permit is issueQ I shall not emplq any person in any manner so as to become suDject to the workers' compensetlon laws Callfomi , end egree � at it I shwld become subject to the workers' wmpensation prodsions ol Section 3700 0l Ihe Labor COEe, I shall tort�with comply with these p visians. � AppliCant Signaiure: �_ y//i � Date: �—Z 7 � WARNIN6: FNLURE TO SECURE WORKERS' COMPEN�IION WVEMGE IS UNLNWFUL AND SHALL SUBJEGf AN EMPIOYER TO CRIMINAL PENALTIES M1D CML FlNES UP TO WE HUNORED TFIOUSAND DOl1ARE (5100.0OO�.IN ADIXiION TO THE �T OF COAIFENSATION, OMMGES nS PROVIUED FOR IN SEGTIXJ 3lOeOF THE UBOR COOE, IMEREST, AND FTTORNEY'S fEES. LICENSED CONTRACTORS DECLARA710N: I hereby aHlrm Ihat I am Ilcensetl under provisions at Chapter 9(commencing wilh Secibn 7000) of Division 3 af the Business entl Prol�sions Code, entl my Iicense is In full IOfLB B�0 BflBC�. L1F N_ S%O �j � e�4i� CI099 N / i ComrectoYs SlgnaWre: �_.� � Dele: 7— 2 7'—'a v CONSTRUCTION LENDING AGENCY: ❑ I �ereby aflirm that Ihora is a mnstruction lontling agency br ihe peAormance of Ue work for w�ich Ihis permit is issuad. (Sec. 3097, Civil Code). Lentler's Name: Lentlels Adtlress: SipnaNro: Date: OWNER•BUILDER DECLARATIONS: I hereby eHirm ihat unaer penely of Derjury Ihet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Prafessions Code: Any ciry or coumy whic� requires a permit lo construct, alter, improve, demolish, or repair eny swcture, pdor to its Issuance, also requires the appliwnt for such permit to file e signBd 5fatement Ihel he or she is IicensBO pursuani to the provisions ot the Contractore Litense Lew (Cheptar 9(commencing with Sectlon 7000) of Dlvision 3 of tha Business entl Professions Cotle) or thet he or she is exempt therefrom and Ihe basis for the ellegetl exemption. Any violatlon ot Section 7031.5 by any applicant lor e De�it subjecis the ap0�icant to e civil penelty oi not more than five huntlretl Aollars ($500).): ❑ I, es owner of Ihe pwperry, or my employees wlih wages as thair sole compensation, WILL DO THE WORK, entl t�e s�mcture is not inlended or oMere� tor sale (Sec. 7044, Busineu and Prolessions Code: The Contractors Ucense Lew tloes not applY to an owner ol property who builtls or Improves Ihereon, and who tloes such work himself or hersell or ihrough his or her own employees, Orovided that such improvements are not intended or ofleretl for sale. If, however, tha builtling or improvement is soltl within one year ol completion, the owner-builder will have ihe burtlen oF proving thet he or she did not build or improve tor purpose of sele.). ❑ 1, es owner ot ihe propetly, am E%CLUSIVELV CONTAACTNG WYTN LICENSED CONTBACTORS to construct the Droject (Sec. 7044, Busine55 and Professions Code: The coniractors License Law does n0� apply to an owner of properry who huiltls or Impmves Ihereon, end w�o comracts for such projea with e contraaor(s) license pursuant to the Contractors Ucense Laws.). ❑ I em ezempt under sec. Signawre: Owner ID venfied by tlnvers licen5e. ❑ Yes ❑ No Business and Professions Code br this reason: Veriilcatlon of Ownerahip by pype ot tlwument, i.e. - properry tax blll or tleatl): DIVISION OF INDUSTRIAL SAFETY PERMR CEA7�FICATON: Driver'S License No. Date: Eapires: ❑ I hereby cenify thei no excavetlon tive (5) a! more feei in depih into which e person is required to tlescend, wlll be made in connectlon with work authodzed by t�ls permil, and thal no builaing slrucWre, scaRo�ding, talsework, or tlemolition or tlismantlinq thereol, will be more ihan thirty-six (36) feet hgh. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Tltle 8, Califomia Atlministrativa Cotle)� ❑ Ac owner-bullder, I will not employ enyone to do work which would require e Oertnit Irom the Division ol Intlustrial Saloty, es noteC eDove, unless such persan hes e pertnit to do such work Irom Ihe Oivision. Signeiure: Date: Division ol Industrial Satety Pertnil Number: CERTIFICA7E OF COMPLIANCE AND AUTHOR19.AT10N OF EMAY: I certity untler penalry of perjury ihat I have read this epplication end stata that ihe inlormation give� is correct. I egree to comply with ell stete laws and ��h' ordinances relating to building consiruction, antl aulhonze representativos ol l�e Ciry ot Costa Mesa to enter upon the abovo-doscribed propeny lor inspection puryoses, I agree nm to occupy or allow occupancy of eny building authorizad by this pertnit until finel inspection. Sig ture Of Legal rner(s) et �- �j -� ti AnNOr Authodzed Applicanl � Date CQOE 1. INSVECTONTYPE 1616 Fiaotl System Final Fire Prevention 1266 Paal Spa Finel 200 Finel Re-Roof 201 Final BIocWRetaining Well 202 Finel Factory Fire Place 20� Final Sign 206 :Final Domditlon Q�, INTIfIAlS /� � �� _�_ � COOE I INSVEITON TYPE 206 Final Mec�anical 20B Final Plumbing 210 Final Elecidcal 212 Flnel Fire Prevenilon 220 Finel Plenning Approval 222 Finel Site 250 Final Builtling/Occupency �eg u�eis (7ta) 75a-5273 • Fax (71a) 75a-a956 � www.ci.costa-mesa.ca.us n rnm unrve, wa i N mwr, �r ncoco ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: 952 DENVER DR 41808115 ISMAEL MOTA 602 N. ALAMEDA AV AZUZA,CA Owner: APTE, AVINASH R TR Address 952 DENVER DR COSTA MESA, Cq Contractor: ISMAEL MOTA Address: 602 N. ALAMEDA AV AZUZA, CA ISSUE FEE Temp service test Res. alc package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlels Switches Non Res Appl Res Appl Service to 200a Service to t000a Service over 1000a Motors to ihp Motors to tOhp Motors to SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole Phone: 62G806-6876 Zip: 91702 Phone: Zip: 92626 Phone: 626-806-G876 Zip: 91702 License: 523628 SCOPE OF PERMIT ADD 401 SF ATTqCHED BEDROOM AND OFFICE. REF B00-01129. 5 LIGHTS, 15 OUTLETS AND 6 SWITCHES. $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $5.50 E76.50 $6.60 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 �uantiry 0 0 0 5 15 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Disl System / Lighting Busway I100 ft Standing Section Misc Electrical Equipment Trenstormers up to 1 kvalkw ................up to 10 kva/kw .................up to 50 kvalkw .................up to 100 kvalkw ..................over 100 kva/kw low Voltage Equipment Low Volt Wiring System I Ckt Misc. Conduit Misc. Conductor Ciras ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Eleqrical Fee Investigation Fee Plan Chetk Fee Reinspedion Fee Status: ISSUED Applied: 07I27I20o0 Issued: 07I27I2000 ISSUED BY: � QuantiTy $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 80.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 80.00 $0.00 $0.00 TOTAL CALCULATED FEES E52.70 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicabla handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void ii work is not commenced within 780 days, or if work is suspended or abandoned for a period of 780 days. INSPEC710NS: In order !or the work aulhorized under this permit to be considered legal, such work must comply with all applicable codes, antl all required Inspeetions and final epproval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 75456$6 / 2sas-ee (6a) WORKERS'COMPENSATON OELLARAnON: I hereby aflirm under penalry 0� perjury ano of the tollowing declarelions: ❑ I have antl wlll meimaln e cenificete al consent to selt-Insure for workers' compensation, es providetl br by section 3700 of the Lebar Code, lor tho pedortnance ol ihe work lor whlch ihis pertnit Is issueA. ❑ I heve afld wW meintein workers' Compansa�lon InSurence, az requiretl by gpc(Ip� 3700 ot Ua Lebor Code, tor I�o perfortnance of Ne work for whiCh Nis pertnit is issuetl. My workers' compensetlon insurence carder antl policy number are: Certier. policy Num6er. (fhls secrion need rrof be canWefed i! (he perm/f is ve/ued et one hunOred ddlars (5100) a less.) ❑ I certity that in Ne perfom�ance ol the work lor whic� this pertnit is issued, I shell not employ eny parson in any menner so as to bocome sub�ecf lo lhe workers' compensation laws oi Ilfomia, antl egree that II I should becomo subject to l�e workers' compensation proNsions ol Sectlon 3700 oi t�e Labor Coda. I shell fonhwith cromply wi�� t�ese pr ions. ��p( /� �7 AppllcantSignature: C �. �[��/'�V Date: �' C- %�U u WARNING: FAILUflE TO SECURE �"10RKER5' COMPENSATION COVERAOE IS UNIAWFUL AND SHPLL SUBJECT AN EMPLOYER TO CRIAUNAL PENnLT1E5 AND GVIL FlNES UP TOONE HUNDREO THOUSAND DOLLARE �3100,000), IN ADDITION TO iHE COST OF COMPENSATION, DAMAGES AS PROVIDED WR IN SECTION 3�O60F TME LABOR CODE, IMEREST, AND ATfORNEVS FEES. LICENSED COKiRACTORS DECLARATION: I hereby aHirtn t�a� I am licens untler provisions ot Chapter 9(commencing with Section 7000) of Division 3 of the Business aJ'� QPr tej�ions Cotla, and my licansa is in full torce and eHect. llc. M � Z3 � z � Class M \/Gr�/ ComractoYs Signature: d Date: '�— G� d�— CONSTRUCTION LENDING AGENCY: ❑ I hereby aMirm ihat there is e construction londing agency for the Dertortnance of the work for wNch this Dermit is issued. (Sec. 3097, Civil Cotle). Londers Name: Lentler's Adtlross: Signature: __ Date: OWNER-BUILDER OECLARAnONS: I hereby aHlrtn that untler penA�ry of Der�ury ihat I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW lor the fWlowing reason (Sec. 7091.5, Business end Professlons CoGe: Any ciry or counry whicH requires a permit to construct, alter, impmve, tlemolis�, or repair any strucWra, pdor to its luuance, alw reQuires the eppllcaM lar such pertnit to file a signed statement thai he or she I5 Iicensetl pursuant to the provisions al Ihe Coniractors License Law (Chapter 9(commencing wit� SecOon 7000) oi Division 3 of the Business end Pmfessions Code) ar l�et he or ahe is ezempt therefrom anG l�e besis tor t�e alleged exemption. Any violatian ot Seclion 7031.5 by any applicant for e pertnit suhjects the applicant lo a civil penalry ol not more �han (ive hundretl tlollars ($500)J: ❑ I, es owner of Ihe properry. or my employees with wages as their sole wmpensation, WIIL DO THE WORK, and Ihe structure is not intentletl or oHeretl for sale (Sec. 7044, Business and Professions Cotle: The Contractors License Law dces not appty to an owner of properry who builds or improves Ihereon, antl who does such work �imself or hersetl or ihrough his or her own amployees, provitletl that such impwvements are not intentletl or otfered for sale. If, however, the building or impmvement is soltl wit�in one year of cOmpletion, the owner-builder will hava the burtlen of proving ihat he or she did not build or improva tor purpose ol sala.). ❑ I, as owner ot Ihe properry, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTOR510 construct the prolect (Sac. 7044, BuSiness and Professions Code�. Ttie contractors Lt�ense law tloes not appry to an owner ot pmpeny who Duitds rn imp�oves thereoq snd who coMracis to� such projed wlth a comrador(s) licensa pursuant to t�e Comractors License Lews.). ❑ I am e:empl untler sec. SlqnaNre: Owner ID venfied by drivefs liCense. ❑ Ye9 ❑ No Bu5in855 and Proteuions Cotle for Ihis reeson: Vedlication at Ownership Dy (type ol document, i.e. - pmperry tex bill or deed): DIVISION OF INOUSTRIAL SAFETY PERMIT CERTIFICATION: Dnvers License No. Date: Etpires: ❑ I hareby catlity ihat no ex�evatlon Ilve (5) or more feet In depih Into which e person Is requiretl to tlescenQ wlll be mede in connectlon with work authodzad by this permit, entl that no building siructure, scaMolding, falsework, or demolition or tlismantling IhereoL will be more ihan thiry-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Ttle B, Celilamia Administretive Cotle). ❑ As owner-builtler, I will not employ anyone to tlo work which would require e pertnit trom the Division ot Indusiriel Safery, es noted ebove, unless such person has e pertnit to tlo suc� work irom t�e tlivision. Signatura: Date: �ivision of Industnal Satety Pe�mit Number: CER7IFICATE OF COMPLIANGE AND AUiHORIZATION OF EMAY: I cortify untler Denalry of perjury that I have read ihis epplication entl state �hat tha inlormetion givon is correct I egree to wmpy wilh ell state laws entl ciry ordinances rela�ing to builCing wnswction, end authorize represemetives ol the City af Costa Mesa to enier upon ihe ebove-descnbed O�operry tor inspectlon puryoses. I egree not to occupy or ellow occupancy al eny building aulhorized by ihis pertnit umil linel inspectlon. 519natu OI Legel O er(s) Dale ( �—Z7_ �� qnNOr Authonzatl Ap0licant Date COUE I, INSPECTIONTYPE 161fi Fized System Final Fire Prevention 1266 200 207 202 203 Pool Spa Finel Final Re-Root Flnal BIocWHetaining Wall Final Factory Fire PIaGe Final Siqn 204 Finel Demditian � It�lS COOEI INSPECTONTVFE 206 Final Mec�anical 208 Final Plumbing 210 Final ElecMtal 2tt Finel Fire Prevention 220 Final Planninq Approval 222 Final Site 250 FinalOuiltling/Occupency Pd¢ I[�L4 mn.. �%� (714) 754-5273 • Fax (714) 754-4856 • wvnv.ti.costa-me58.ca.u5 // rHln UnI V C, I.VJ i r. m�o�+, �.n ncom Job Address: 952 DENVER DR Suite No Vicinity: Parcel Number: 41808115 npp�icant: ISMAEL MOTA Address: 602 N. ALAMEDA AV AZUZA,CA owner: APTE, AVINASH R TR Address: 952 DENVER DR COSTA MESA, CA Contractor: ISMAEL MOTA Address: 602 N. ALAMEDA AV AZUZA, CA Arch I Eng : Atldress: MECHANICAL PERMIT Status: ISSUED Applied: 07/27/2000 Issued: 07127/2000 ISSUED BY: / 1" � Phone: 62fr8066876 Zip: 91702 Phone: Zip: 92626 Phone: 62&806-6876 LP: 91702 License: 523628 Phone: Zip: License: SCOPE OF PERMIT ADD 401 SF ATTACHED BEDROOM AND OFFICE. 1 FACTORY FIRE PLACE , 1 GAS PIPING. REF B00-01129. ISSUE FEE Inst FAU �700 k BTU Inst FAU >700 k BTU Repair I Alt Cooling/Heal Inst / Rep. Recess Wall Htr Refrig Sys <700 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relowte Appl Vent Air Handlers < 10000cfrn Air Handlers > 10000cfm Floor Furnace Floor or Suspend Heater $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $6.15 $10.65 $0.00 $0.00 $7.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 0 0 0 t 1 0 0 t 0 0 0 0 0 0 0 0 FEE SUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillation System Evaporative Cooler Commercia l I ncinerator Domestic Incinerator Compressors / Absorotion Svstems Upto3hpl100kBTU 3To15hp/500kBTU 15 To 30 hp I 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp I Over 1,750 BTU Boilers Up t0 3 hp 3To15hp 15to30hp 3010 50 hp Ov¢r 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Quantity ao.00 0 so.00 0 $0.00 0 50.00 0 so.00 0 $0.00 0 50.00 0 $0.00 0 ao.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 50.00 0 50.00 $0.00 $0.00 547.55 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 7, 72-21-92) 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 1 BO days. INSPEC7IONs: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspeetlona and tinal epproval must be obtained. Failure to obtain inspections antl final approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (774) 7545826 2d4&46 (6W) WORKERS'COMPENSATON DECLARATON: I hereby eMirm un0er penalry oi perjury one of the following tleUarations: ❑ I �ave and will maintain a cenificate of consent to sell-Insure for workers' compensetion, es pmvided br by section 3700 0l the Lebor Code, for Ihe peAormenca ot the work br which lhis permit is issuod. ❑ I �ave and will maintain workore' compensalion insurance, es required by section 3700 0l the Lebor Code, for the pedonnanco ol Ihe work for which this pertnit Is Issuetl. My workers' compensation Insurenco carrier antl palicy num6er ere: Cerder. Policy Number. (Thi seclion nsea nof be comp/eled i/ Ihe permil is velued et are �undred dWlers (5700) ar IessJ I cortify that in t�e peAormance ol Iha work for wnich tMs pertnit Is issuetl, I shall not employ eny person in any manner so as to becorne suh�ect to the workers' campensatbn laws of Calllamle, enA agree that il I shoultl become sub�ect to the workers' compensation provisions of Section 3700 of the Labor Gode, I shall forihwlth compty with thesa provisions. Appliram Slgnature: Date: WARNINO: FNWFE TO SECURE WORKERS' COMPENSATION COVEMGE IS UNLAWFUL PND SHALL SUBJECT AN EMPLOVER TO CRIMINRL PENALTIES AND GVIL FlNES UP TOONE HUNDRED TFIOUSPND Dd1ARE �5100,000), IN ADDITION TO THE C0.ST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]060F THE LABOR CODE, IMERESi, ANO ATfORNE`fS FEES. LICENSED CONiRACTORS DECLARA710N: I hereby aHirtn that I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business and Proteuions Code, and my license is in tull torce and eHecL Lic. it Class k Contractofs Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby ettirm that there is a constmction lentling egoncy br Ihe pedormance oi 1he work tor whic� ihis permit is issuetl. (Sec. 3097, Civil Code). Lentlor's Name: LenCers Address: � Signature: Data: OWNER-BUILDER DECLAFiA710NS: I hereby aHirtn Ihet under penalty ol perjury that I em EXEMVT FROM TME CON7RACTORS LICENSE LAW lor Ihe tollowing reason (Sec. 7031.5, Business entl Professions Code: My ciry or counry wNch requlres e pertnit to consWcL elter, improve, tlemdis�, or repair eny sWcture, pnor lo its issuance, also requires t�e aDDlicanl far such pertnit to Ille a signed stetemem t�at he or she Is licensed pursuani ta the proNsions ol Ihe Cantrectors License Lew (C�apter 9(commendng with Seclion 7000) of DlNslon 3 01 Ihe Business entl Professions Cotle) or t�at he or she is exempt lherefrom antl the basls for the ellege0 axomption. Any violation of Sectlon 7037.5 by any applicant tor e permit sublects the applicam to e civil penelty ol not more than live hundred dollars (5500).): ❑ I, es owner of ihe pmperty, or my employees with wages es t�eir sole compensation, WILL DO 7HE WORK, and the sWCWre is not intentletl or oMered lor sale (Sec. 7044, Business antl Protessions Coda: The Comracmrs License Lew does noI epply to an ownor ot pmpeny who buittls or improves thereon, and who does such work himself or hersetl or through his or her own employees, provitled Ihat such improvements are not Intantletl or oNered �or sele. If, however, the building or improvemeni is sold within one year of completion, ihe owner-builtler will have the burden of proving that he or she did not build or impmve tor purpose of sale.). ❑ I, as owner of the properry, am EXCLUSIVELV CONTRACTiNG WITH LICENSED COMRACTORS to construct the project (Sec. 704a, Business antl Professions Code: The contractors License Law tloes noi apply to an ov.•ner ol property who bulltls or Improves thereon, and who conirects lor such project with e crontrector(s) license pursuant ro the Contractare License Laws.). ❑ I am exempt under sec. Business antl Professiau Code lor this reason: Signature: Date: Owner ID veritietl by tlr'rveYs licenso. ❑ Ves ❑ No Drivers Ucense No. Expires: Vedficetion at Owners�ip by pypo ot documenL I.e. - propeny tex blll or AeeA): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certity Ihet no excavetlon live (5) or more feet in tlepth iNo which a pereon is requiretl to descend, will be matle in connection with work eut�odzeG by thls pertnit, end that rw builtling siructure, swNoltling, lalsework, or tlemdition or tlismantling thereof, will be more then �hirty-six (36) leet high. (Chep. 32, Grp 2, An 2, Sac. 341, Title B, Califomla AdminisiratNe Cotle). ❑ As owner-builder, I will not amplay enyona to tlo work which would require e pertnit trom the Division of Industnal Satery, as noted above, unless such person �es e pertnit to do such work trom ihe division. Signatura: Date: Division at Intlusirial Safey Pertnit Number. CERTiFlCATE OF COMPLIANCE AND AUiHORIZATION OF ENTAY: I cenity unAer penalry ol perjury that I have read Ihis appliwtion and stata Ihet the inlortnation given is correct I egrea to comply with ell state laws and city o�tlinances rels�ing to building construction, antl authorize represencatives ol the Ciry of Costa Mesa ro enter upon Ihe ebovo-described propeny for Inspectlon puryoses. I agree not to occupy rn sllow occupancy ot arcy builtling anihorizetl by this permit unlif tinel inspection. Signeture Of Legal Owner(s) Date An0/Or Au�horizetl AppliCent CODE �, INSPECTIONTYPE 7616 Fizetl System Final Fire Prevention 1266 Pool Spa Final 200 Flnal RaRoof 201 Final Blak/Reteining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demdition l Qd¢, INiIf1AL5 COOE 1 INSPECTION TYVE 206 Final Mechanical 208 Final Plumbing 210 Finel Electncal 212 Final Fire Preventlon 220 222 250 Final Planning Approvel Final Site Final Builtling/Occupenry �.I UII. 11i ;► � : JobAddress: 952 DENVER DR Suite: Vicinity: Parcel Number: 41$08115 Applicant: ISMAEL MOTA Address: 602 N. ALAMEDA AV A2UZA, CA Owner: APTE, AVINASH R TR Address 952 DENVER DR COSTA MESA, CA Contractor: ISMAEL MOTA Address: 602 N. ALAMEDA AV AZUZA,CA Zip: 91702 Arch : Address: Phone: (7�a) �St-5z�3 • Fax (714) 754-4856 • wwv+.ci.costa-mesa.��LDING PERMIT �� hAIH UHIVt, GV51 A MtSA, GH tlLOLO Zoning: Phone: 626-806-6876 Zip: 91702 Phone: Zip: 92626 Phone: 626-806-6876 License: 523628 Eng: Address: Status: ISSUED Applied: 07/27/2000 Issued: 07/27/2000 /]'Z � ISSUED BY: �/ ' Phone: Zip: License: License: SCOPE OF PERMIT ADD 401 SF qTTACHED BEDROOM AND OFFICE. INTERRIOR MODIFICATION FOR DUE TO NEW ADDITION AND REPLACE REAR WINDOW. Plan Check: $320.29 Permit: $492.75 SMIP Res: $3.43 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $816.47 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existinq: o NOTES: Rear 0-0 Rear 0. 0 Required: 0 FEESUMMARY PLANNING R ZONING Left 0- 0 Left 0. 0 Pro osed: 0 Calc Valuation: Claim Valuation: Right 0. 0 Right 0. 0 S3a,2es.so so.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and ralated regulations. (Ord. No. 92-cB, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned tor a period oi 180 days. INSPECTIONS: In order for the work authorized under this pertnit to be considered legal, such work must comply with all epplicable codes, and all requlred inspeetiona anp finel epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this parmit. FOR INSPECTIONS CALL: (714) 7545626 � zaaaas (erool L / WORKERS'COMPENSATION DECLARATON: I hereby aHirtn untler penalry of perjury one of t�e �alowing deUaratlons: ❑ I heve end will maintein e certilicate of wn8ent to sell�lnsure lor workars' mmpensation, es provitled lor by sectian 3700 of �he Labor COAa, for the pertormance at tne work for which Ihis permit Is Issued. ❑ I heve antl will maintaln xrorkers' compenSaUon Insurance, as requiretl by sqcyion 3700 oi t�e Lebor Co�e, lor t�e peAortnance of Ne work fw wlikh Ihis permit Ls Issued. My woMeB' compensallon Insurante carrier antl poliq num�er are: Carrier: Policy Num6er: (T�is sectlm need no! be pompleted I! (he permlNs velued ef one �untlretl dd/ars (5100) or IessJ ❑ I certily thet in the peAormence of Ihe wark for which this permit is issueA, I shall not employ any person in eny mflnner so as to become su6joct to Ihe workars' compensetlon laws ol Celif la, end egree lhet H I s�oul becwna sub�ect to Ne workers' compensallon provlslons of Sectian 3700 0l the Lebor Code, I shell lorthwtlh comply with �hese provl5io AppllcantSiBnature: ��Ai1 Date: % —z7�� WARNING: FNLURE TO SECURE WORKERS' WMPENSATION COVERAGE IS UNUWFUL AND SHALL SUBJECi M! EMPIOVER TO CRIMINAL PENALTIES AND CML FlNES UP TOONE HUNDRED TFKKISANO OdlARE (5100.000), IN qDDITION TO THE GOST OF CAMPENSATIIXJ, OMMGES /S PROVIDED FOR IN SECTIpJ 3106 OF THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn that I em licen� under provision5 o� Cha ter 9(commencing with Section 7000) of Division 3 0l the Business and Professions Code, and my license Is In full fOroe en0 BflBCi. UC. M C i�i � Z.� Cless p_�'�Z,� Contrectors Signawre: •�r�i� Date: �= z 7�d `� CONSTRUCTON LENDING AGENCY: ❑ I �ereby aNirm I�eI �hore is e construction le�tling egenry tor t�e peAormance ol Ihe work br which this permil is issued. (Sec. 3097, Civil Cotle). Lenders Neme: Lendefs Atltlress: Signature: Date: OWNER-BUILDER DECLARA710N5: I herehy eNirm that untler penalry of perjury that I em E%EMPT FROM THE CONTRACTORS LICENSE LAW lor the following reason (Sec. 7031.5, Buslness entl Prolessions Cotle: Any ciry or counry which requires e permit �o construd, alter, improve, tlemdish, or repeir eny s�mcture, prior to its issuance, also requires ihe epDlicant tor such permit to file a signed stetement that he or she is licens9tl pureuaN to the provisions ot the Contrectors Llcense Law (Chapter 9(commencing with Section 7000) ol Divislon 3 of Ihe BuSiness end Pr0lessions Code) or lhel he or 5he is exempt Iherefrom and Ihe basis lor Ihe elleged e:emplion. Any violelion ot Seclion 7031.5 by eny eppllcenl lor e po�mlt su6�ects the aOD��ent lo a clvll penally of not mora t�an five hundred tlollars (5500).): ❑ I, es owner ot the property, or my employee5 with wages as ihair sWe wmpensation, WILL DO 7ME WORK, entl the s�ructure is not intentled or oRerad for sele (Sec. 7044, Business and Professions Code: The Contractors License Law does not apD�Y �o an owner of property who builtls or improves thereon, an0 who does such work himself or herself or through his or her own employaes, provided that such improvements ere noi intended or otteretl for sale. If, however, �he building or improvement is sold within ona year of wmpletion, the owner-builder will have tha burden ol proving that he or she did not build or improve for purpose ot sale.). ❑ I, es owner ol t�e property, am E%CWSIVELV CONTRACTING WI7M LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contrectors License Law does nn� apply to an owner ot property who builds or improves ihereon, and who coniracts tor such prolect wit� a conlrector(5) license pursuant to ihe Conirectors License �.ews.). ❑ I em e:empt under sec. Signatura: Owner ID vonfie0 by tlrivet9liCen50. ❑ Yes ❑ No Business end Prolessions Code for Ihis reeson: Vedficetion ot Ownership by (type ol aocument, i.0. - p�operry taz bill or deed): DIVISION OF INDUSTRIAL SAFETY VERMIT CEAT�FICATION: OAvers License No. Oate: Expires: ❑ I hereby ceNfy ihat no excavatlon live (5) or mora teet In depth into which a person is required lo descend, wlll be made In connection wiih work euthorizetl Dy ihis permit, antl Ihat no builtling sifucture, swttolding, talsework, or demolition or Oisman�ling Ihereot, will be more than t�irry-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Calilamla AAministretive Cotle). ❑ As owner-builder, I will not employ enyone to do work which woultl require a permit Irom ihe Division ol Intlustrial Safery, as notatl above, unless such person hes e pertnit to do such work Irom the division. SignaWre: Date: Divisian at Industnal Safety Permit Number: CERTIFICATE OF COMPLIANCE AND AUTHORILITON OF ENTRY: I certify untler penaly ot perjury lhet I heve read this flpplicatian and siate that lhe intormation given is wrrecL I egree lo wmply with all stete lews and ciry ordinences relating to building consWciion, end eu�honze representatives of the Ciry ol Costa Mesa to en�er upon tha ebova-doscnbed property lor Inspection purposes. I agree not to occuOY ar ellow occupency of eny building euthorized by this permit until tinel inspection. SigneNra Le al wneqs) 7- � a � And/Or Authonzetl APPIi W nt Date COUE �. INSPECiION TYPE 1616 Flzetl SyStem Final Fira Prevention 1266 Pool Spe Final 200 Final Re-Root 201 Final BIocWRetaining W ell 202 203 Final Factory Fire Place Final Sign 204 Final Domdltbn � It� COOE I INSVECTION TYPE 206 Finel Mechanical 20B Finel Plumbing 270 Finel Electrical 212 Flaal Fire Prevention 220 Finel Planning Approval 222 Final Site 250 Finel Building�Occupenq PdIF V�ELS i.� �n1� i � �� cns � W r1TER �FOUGH PLUMB�NG �PROP. SWR. LINE [� NDUSE CON. [ SPRINKLING SVSTEM t��MISCELLANEOl15 �ROIIGM HEATING ANO FIR CON�IT101 TEMPORARY SEFVICE OR POLE UNOEAGROUNO � POWER � ROUGH WIRING � TRENCHES � FORMS STEEI 'C FLOOR SYSTEM �BONO BEAM � STEEL REINFOR� SHEATHING yFRAME AND FLASHING LATHING - IN ❑ OUT n PLASTEP.BROWN CORT STRUCTURAL, FINAL H� 'G. VENi.. REFRIG. AND A.C. Pl ,ING, FINAL AN� GAS TEST [ ELECTRIC, FINqL �fw BUILOING, FINAL " SPECINL REOUIREMENTS rrrs:a�i� BUILDING PERMIT N0. VALUE SUBCONTRACTOR - ..� 424i0 COSTA MESA BU�LDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUIL�ING � • �I✓w!7 ADORE55 uG�•� OWNER MAl l ADORESS � y ,�� A��i � TEL. CITV ir�M Y�Y 1J��r NO. �i [zl 4 Q � h s F Q Ca � Q 7 } ..1 C W G. 0 CC a. Z W S 3 BRANCH AODR ESS ARCHITECT OR ENGINEER ADDRESS CONTFACTOR TEL. STATE�� S,V , �tN� CITV LIC. NO. /�� IC. NO � SIZE � NO.OF BLDGS. OF lOT NOW ON LOT USE OF EXISfING BLDG. Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFOFMED varp 1UG -5•76ca,, 00 62B'} *:; � : �:5.54 APPLICATION FOR STRUCTURAL PERMIT ECEIVEDBV OATERECEIVED nnrciceimr. BUILDING fiDDRESS ER E ZONE ' N PI VARDS APPF MAIN BUIL (FROM C/L STR PERMIT VALUE OF /) I USE OF NE NS L� BUILDING � � �� FOVED BUILDING l �. l. SIDE FT. FT. REAR FT. FT. DIS7ANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. VAR. � DATE C.U.P.�W /� APPROVED APPROVEy� 7� ��L/ O S ��/� 6Y.. �-(iU'Y/�i nnTF O li. I hareby acknowledge t�at I have reatl this application and state , thet tha above intormetion is correct antl a9ree to comply with all lews reBuleting bulld�n8 consirucNon, antl I ahall not employ a�Y Derson in violatlon of tho workman's companzatlon laws of the Stete ot Californie. I hereby certify thot I 9m properly Iicensetl es a contractor untler SQ. FT. She Stata ot Cellfornle Businass and Profassions Cotla, Division 3, THE AMOUNT SMOWN UNDER VALU Chapter 9, antl that such licenses ere In tull torca antl effeci, or I THE PURP�E OF ESTABLISHING A PER1 am examp2 Srom iha pVovisions ot U+a State of Callforn{a Business VALUATION und Protessions Cotl/a, Divlzion 3, Chapter 9. PERMIT FEE S Slpnatura ot A/� �� J �� PLAN CHECK 5 Parmittee �� Y $ TAX 5 Authorizatl ABent TOTAL PAI D S n m i d m N IS FOR m ONLV: b � a J� m �' n 0 LL f U OWNtH gTSCHSFCK CONSTRII�TION UAIt q_4-7h _ JOB ADDRESS q5� no,,..o,- n.t�.o BUILDING PERMIT N0. 40893 W ATER �('� ROUGH PWM9� PROP. SWR. LINE LJ HOUSE CON. {�(f SPRINKLING SVSTEM MISCELLANEOUS POUGH HEPTING NND AIR CON�ITtONING TEMPORRFY SERVICE OF POLE UNOERGROUNO � POWER � ftOUGH wIRING TRENCHES FORMS STEEL RE F�OOR SVS EM BOND BEAM � STEEL FEINFORCE [ SHEATHING FRAME I.N� FLASMING LATMING - IN OUT PLASTE0., BROWN CORT Si��iCTUR4l, FI 1 NG, VENT. REFR VALUE SUBCONTRACTOR F�+ 5 a Q y y _ F n a c .i a > r � m w a °a a z � x 3 .�t,89�� COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING �^ /� /^ � ADDFESS � �i � .yJI�V(/�'y/1 OWNER �,�/J�Jf C�J 4-flNJ ..C��//G ADDRESS �� ryD� ��'� CITV ✓A.C��/�" /�,J/��/ NOL/�.JJ GG BRANCH ADDRESS � fOC N ��' — ADDRESS CONTRACTOR rjLCJi7'f� ADDRESS � TEL. CITV � NO. � STATE � CITV UC. NO. � C. LIC. NO. SIZE �� /�b/•� NOWONLOT OF LOT � J �< <� USE OF EXISTING BLDG. Separate permits are required for electric, plumbing and heating work. USE OF BUILOING AND WORK TO BE PERFOfiMED � I �ereby aeknowlatlpe thet 1 hava raetl thia applicetlon antl state Mat the above Informetion ia eorract entl eprae co comply with ell Inws regulatinp bulltlln0 �onrtructlon, and 1 �hell not amploy any Oetwn in violatlon of Ma workman's campenxtion Iaws ot the State of Californle. I haraby certity thet 1 em provarly Ilcansetl aa a contrecoor untlar Me Smta of Californle Bu�ineaa entl Profanlon� Cotla, Dlvislan 3, Chaptar 9, enE that such Ilcan�e� ara in tull forca enG affoct, or I am exempt from the Oro3itlont of tha Stete of CelHornia Buainau ana Profeaslo�ns Cotla; Ivialon 3, Chopmr 9: Sipnetur�o�/� ��_ �rf �//�, � Permittea r� .�L��— Authorizad ABant R APPROVED VARDS MAIN VAR. qF c.u.P.� „OV?4-75�,s�00 918� *=**89.1� FOR STRUCI'URAL PERMIT v�� I�/} VALUE r' I $ TVPE' GROUf DATE OF USE OF NEW NS � BUILDING Z'-�/j VED VAHDSAPP NG ACCESSORV :T�// �..�.. & r )LD FOR SPECtA REQUIREMENTS ' n m i �/ / m /�/�(JSQ.PT V-- �!/ - n YHE AMOUNT SHOWN UNDER VALVATION IS FOR m THE PURPOSE OF E5fABLISHING A PERMIT FEE ONLV: � VALUATION PERMIT FEE S d N m PLAN CHECK S "� /y�/�� /.(' ^�/ 0 S (/(/V TAX 5 ✓� �7 LL f U TOTALPAID E . /� ' � � �tD � COSTA MESA BUILDI G-SAFETY DEPARTMENT r.n. anx �200 COS7A MESA. CALIFORNIA 92626 F C W o. Q y y S F .,M14 -4-7Fra��OO 21�1 c''i,r,r,r �HS' 17Z.CO APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RECEIVED BV DATE RECEIVED DATE ISSUED BVILOING ADDRESS � PERMIT NO. OWNER A.P. NQ. MAIL BUILDING � ADDRESS ADDRESS TEL. TRACT LOT BLOCK CITV NO. CONSTRVCTION P LENDER BRANCH OwNER ADDRESS VALUE AflCHITECT TEL. S � ' $ � OR ENGINEER FIRE ADDRE55 20NE TVPE GROVP APPROVED CONTRACTOR BV DATE ADDRE55 TEI. ZONE NO.OF VSE OF NEW CITV NO. Pl.ANS BUILDING STATE CITY �'ARDSAPPROVED VARDSAPPROVED LIC. NO. �IC. NO. MAIN BUILDING ACCESSORV BUILDING SIZE NO.OF BLDGS. (FROM C/L STREET) OF LOT NOW ON LOT FROM FT. FT. USE OF E%ISTING BLDG. I FT Separate perrtilts are required for L. SIDE FT. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DI5TANCE eET. BET. MAIN & MAIN BLOCS. ACC65. BLDGS. �. VAR. qW DATE C.V.P.� APPROVED APPROVED I hereby acknowladBa that I hava reatl this epplicallon end staca that the ebove informaSion Is correet and agrae So comply with � ell lewz reg�letinp buildinp constructlon, entl I shall noi employ eny person in vlolatlon of the workman's eomponsation laws of tho Steie of CalifOrnla. I hereby cerNiy cpat I am properly Iicensatl as e eonttactor under SQ. FT. the Steta of Celifornla Businesa entl Prafeuion� Cotlo, Dlvialon 3, THE AMOUNT SHOWN UN�ER VALUATION IS fOfi i Chapror 9, antl that such Iicenies era In full forca enG effect, or 1 THE PURPO6E OF ESTABLISHING A PERMR FEE ONLV: am exemp2 irom tha provislona of Me Stnte ot Celifornie Buaineu VALUATION PERMIT FEE entl P�Ofessiona COde, DivislOn 3, Chapmr 9. s � i SIB�etura ot PLAN CHECK E Pe�mlttae § I TAX E Au[�orizetl Apant TOTAL PAID 5 � r 5 W a a � h 2 F G ❑] � ..1 C, � �" ..1 a w a O a O. � W S 3 qul9 10/23/79 25.25 � •COSTA MESA BUILDINGSAFETY DEPARTMENT APPUCATIOI�FOR STRUCTURALPERMIT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 R VE PERMIT *}p 49020 For Applicant to Fill in Completely — Use Ink Only �r BUILDING ` A.P.NO. !O I�I ADDRESS 2 ' G� V /V OWNEROR / � BUILDING SZ ' C�/� C�C IL TENANT ADDRE55 d � UNITOR MAIIING SPACE NO. HDDRE55 ,S'2 �o LO([ TR.f�jO�j/O LOT� BL T�'3'i- 9 8' �o o �� CITY ST ��.s N NEW ADD AITER REPAIR MOVING DEMOLISH CONSiRUCT10N LENDER x BRANCH OWNER � ADDRESS VALUE ARCHITECT TEL. USE ��0 S �� OR ENGINEER N ADDRESS ZONE TVPE GROUG ^/ '� APP "') � � CONTRACTOR/ � �O�( �[.WIN BV DATE D �J � AODRESS ( � LL I Y � TEL. ��T� ,v r N 3S-Y9S'O STATE (� CITV APPROVEDSETBACKS LIC. NO.C� 3 Y b LIC. NO. SIZE NO.OF BLDGS. / (FROM C/L S EET OF LOT NOW ON LOT ( ONT USE OF � �-s �� EXISTING BLDG. /� `�� / t Separate permits are required for L. SIDE �"� FT. electric, plumbing and heating work. } 5� REAR 1 •"FT. U OF �UILDING v O W�ORK TO BEG� ROFORMED � PLANNING ACTION c. DATE S'C pe/./.� ' � N QVP/S=K �. AH'ROVED ^ "A�L7i � APPROVEf� / lo �� I huraby acknowletlpo that 1 hava rend this epplication entl stere °i n that the above Information (s corroct and a8ree to comply wlffi nll lews reBulaNng builtling consvuction, entl I shall not emplay � any person (n violation ot the workmon's compansation lews of m the State of Celitornie. m 1 hereby certify that I am properly Ilcensetl aa a convactor untler SQ. FT. �+ tha State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDEfi VAIUATION IS FOR m Chapter 9, and that such licensas are in full force antl eftect, or 1 THE PURP06E OF ESTABLISHING A PERMIT FEE ONLV: � am exampt from the O�ovisions ot the Stete of Celitornia Business antl Profeuions Cotle, Division 3, hapter 9. VALUATION PERMIT FEE b�� O� y m PLAN CHECK S "� Signacure ot � � � � �sD�. � [�� Q � o Perm�ttee I/�UVu�"� L� � TA% S /v u AuthorizetlAgent Date (��"�� O TOTALPAID §ZS �� TL