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Home My WebLink About3139 DUBLIN ST - Building Permits• � CITY OF COSTA MESA � , BUILDING DIV/SION F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-0856 • v.v✓w.ci.costa-mesa.ca.us ° FOR INSPECTIONS CALL: (714) 754-5626 . �4q�m,p PERMIT NUMBER: BX09-00010 P�RMIT TYPE B MISC STATUS: ISSUED ApN: 41814108 DATE ISSUED: 01/09/2009 Zoning: R1, ISSUED BY: BJK JOB ADDRESS: 3139 DUBLIN ST CM ViCinity: PATIO COVER REAR SFD . Primary Occ: SQ. FT: 492 - � � _ �� .Valuation: Suite/Unit: 32 �� " _ � - ConstType :?? $7.931.04: . ` . . SCOPE OF WORK: ' 492SF SOLID PATIO COVER AT THEREAR�OF-AN EXISTING SINGLE-STORY SFD.,� �� .� '� O NER: DOAN, SAM VAN'� .. Address:: 3139 DUBLIN ST, �, �. , City/State: COSTA MESAj CA'; ; ' Zip Code: 92626 .; Phone: . APPLICANT: DOAN, SAM VAN �� .� � � Address: 3139 DUBLIN ST .-". City/State: COSTA N1ESA, CA ' '. Zip Code: 92626 Phone: 714-434-6540 '�� ' � � .. - . �� CONTRACTOR: OWNER-BUILDER . - � � � - License No. , 000000 �� ' Atldress: Unit: City/State: Zip Code: Phone , Ip . Cell ARCHITECT: ' :License No. Phane ` :`�, � ' ENGINEER: � �- � License No. - � � � Phone FEE SUMMARY Building Plan Check: $99.61 Building Permit:--. . ' . � ._ - $153.25 _. � .. , � � . Electrical Permit: � � . .-� $0.00� =�� - . . . ,. SMIP Residential - _ $0.00 -� � ... . � SMIP Commercial `, $0.00 Bldg Std Admin Fund $1.00 � TOTAL FEES ' � $253.86 r. " � Unit , Unit: NOTICE: The work authonzed by this permit shall compfy with ail applicable handicap access reqoirements under Califomia statutes and�related regulations. (Ord. No. 92-28, § t, 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 musl 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. S9oet, iNsrecnoxme o� iNnnn� c�o�� ixsrEcnoxrrne pn� ixmu�s 1818 Fi¢ed System Final Fire Prevention 2tlb Final Mechanical , 1288 Pool Spa Final 208 Final Plumbing ' Z00 Final Re-Roof 210 Final Electncal 201 Final 81ock/Retaining Wall 212 Final Fire Prevention 202 � Final Factory Fire Place 220 F'mal Plartmng Approval 203 Final Sign ZZZ Final Site � Z04 Final Demolition 250 Final BuiltlinryOwupanry � ^ �q WORKERS' COMPEN9ATION DECLARATI� . I hereby a(frm under penalty of perjury one of Ihe lollowing declarations: ❑ I have and will main[ain a certifica[e of consent b sel(-Insure tor workers' compensation, as provided for by section 3700 of the labor Coda, (or the perTormance of the worK for which this permit is issued. ❑ I have antl will maintain workers' compensation insurence, as required by seclbn 3700 of the Labor Code, fa I�e performance of the vrork for wfiich this permit is issued. My workers' compensation Insurance carrier antl policy num6er are: Carrier (This secfwr necd nW be comPleletl d Me pemrR is valued at one bundred �ollars (Ef00J or less ) Policy Numbec ❑ I certity that in [he performance o( Ihe work for which this permit is issued, I shall not empl0y any person in any manner so as to become subject b the workers' compensation laws of Calitornia, and agree ihat it I should become subject to Ihe workers' compensation provisions of Section 3700 of the Labor Cotle, I shall (orthwith comply wi[h these provisions. Applicanl's SignaWre Date WARNING: FAILURE TO SECURE WORKERS' COMPENSP.TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVI� FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACT�RS DECLARATION: I hereby aKrm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 ot the Business and Professions Code, and my license is in full force and eRect. Lic. # Class # Canlraclor's SignaWre Date CONSTRUCTION LENOING AGENCY: ❑ I hereby aKrtn that [here is a constmctbn lending agency for Ihe peAormance of the v.ork (ar wfiich this permit is issued (Sec. 3097, Civil Code). Lender's Name: Lender's Address: SignaMre Da�e OWNER-BUILDER DECLARATIONS: I hereby affrm lha[ unde� penalty of peryury tha[ I am EXEMPT FROM THE CON7RACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, aller, improve, demolish, or repair any sWcture, prior to its issuance. also requires the applicant for such permi[ to fle a signetl statemen[ that he or she is licensed pursuaN to the provisions of the Contractors license Law (Chap[er 9(wmmencing wilh Section 7000) of Division 3 of the Business and Pmfessions Code) or ihat he or she is exempt there(rom and lhe basis for Ihe alleged exemption. Any violation o( Section 7031.5 by any appliwnt for a permit subjects the applicant to a civil penalty ot not more than five hundretl dollars ($500).): �� I, as owner o( Ihe property, or my employees with wages as Iheir sole compensation, WILL DO 7HE WORK, and [he shucture is not intended or oKered for sale (Sec. 70Q4. Business and Professions Code: The Conlractors License Law does nof apply to an owner of property who builds or improves thereon, and who tloes such vrork 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 wilhin one year of completion, the ovmer-builder vnll have lhe burden of proving that he or she did not builtl or improve for purpose of sale.). . ❑ I, as ovmer of the property, am EXCLUSIVELY CON7RACTING WITH LICENSED CONTRACTORS lo construct the prqect (Sec. 7044, Business and Protessbns Code: The contractors License Law dces not apply to an owner ot property who builds or improves thereon, and who contracts (or such project with a contracta�s) Ncense pufsuanllo lhe Conl2ctors License Laws.). , � I am exempt under sec. Business and Professions Code for this reason: y � �SlqnaWre �" � ' Oa , I ]05]<6 (0I0]) � Owner ID venTied by Arive cense. Yes ❑ No Driver.'s�License:No. � Expires: Ve�ification of Ownership by (type of document, i.e. - property tax bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:� � ' ❑ I hereby certrfy Ihat no excavation frve (5) or more feet in dep[h into wfiich a person is required to descend, will be made in connecl'an with work authorizetl by this pertn0, and Ihat no building s[ructure, scaffdding, falsework, or demolli'ron or dismantling thereof, will be more than thiRy-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tlle 8, Califomia Administralive Code). ❑ As owner-6uilder, I will no[ employ anyone to do work which would require a permit from the Division o/ Indus(rial Safety, as no[ed above, unless such person has a permit to tlo such work Gom the division. Appliwm'S SignaWre Division of Induslrial Sa(ety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. W ill Ihe applicant or present or future building occupant neetl to file an0 certify a Business Plan for emergency response to release or threatened release of a hazardous ma[erial? ❑ Yes ❑ No (Section 25505 of the Cali(ornia Heal[h and Safety Code requires, with some exceptions, that a Business Plan be filed wilh the Cos[a Mesa Fire Department by every business which has at any one time duiing a reported year a quantity of hazartlous matenals equal to or greater than a weight o� 500 pounds, or a volume of 55 gallons, or 200 cu6ic feet of compressed gas at s[andard tempereture and pressure). 2. Does or will the applicant or present or future building occupant need b file a registra[ion (orm for acutely hazardous ma[erials? ❑ Yes ❑ No (Section 25533 of Ihe Cali(omia Health and Safety Code, with some exceptions, requires registration vrith lhe Costa Mesa Fire Department by each business which at any one time has on hand a quantity o( acutely hazardous materials equal to or grea[er tBan a weigh� of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperaWre and pressure�. 3. Does or will the applicant or presen[ or fuWre building occupant need t0 prepare an RMPP (Risk Managemen� and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Healih and Safely Code provitles that the Cosla Mesa Fire Depariment may require Ihe preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous matenals wi[h [he Fire Departmen[. 4. If an RMPP is presently required, has Seclion 25534 of ihe California Health and Safery Code been fully complied with? ❑ Yes ❑ No 5. Does or will Ihe applicant or present or future 6uilding occupant require (or lhe work which is the subject of this applica�ion a permit for such construction or modification from ihe SoWh Coast Air Quality Management Dislrict or from any other air pollulion control district or agency? ❑ Yes ❑ No (Sec[ion 658502 of ihe Califomia Govemmen[ CoUe requires that ihe requested information be fumished on applications ta non-residential building pertnitsj. 6. Will any part of the facility lo be construcled untler Ihis pertnit be wi[hin 1000 feel from the ouler bountlaries of a school? ❑ Ves ❑ No (If'yes", the tacility must meet the requirement of Sections 25534 and 42303 ot the Calitornia Health and Safety Code). 7. If a permit from the South Coast Air Quality Management District or other air pollution conirol disUict or agency is required for the vrork which is the subject of this application, have all of [he disclosures prescribed by California Health antl Safety Code Section 42303 been made? ❑ Yes ❑ No 8: Qf'yes", attach certificate of compliance froin the appropnate air pollufion control oRcer). � � - ' CERTIFICATE OF COMPLIANCE: I.certi(y that �under penalty of perjury the infortnation given above is cortecL I agree lo comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. - Sgnawre �a�e " CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that Ihe information given is covecL I agree to comply wi[h all state laws and city ordinances rela[ing to building construction, and authorize iepresenta[ives of the City of Costa Mesa lo enler upon the above-described property for inspection poses. I agree � to occupy or allow occupancy of any building authori this permit uniil�iyal inspection. _ I,I.L{I'e�/ /�tUr/A�1 �D Sigrialure oi Legal Owneqs) � - ie ' AnG/o� Au1�OnzM Appllwnl $'3 � n � APPROVED C111' OF COSTA MESA PLnNNING DNfSION SURJF C'1' TO BLDG. I�IiPT. REG. N( II F. .\1.)DITIONS. UIiLI:TIO\S. ��r. � � �iiiit;cTtons tiiini.t. t►t: AI'I'I:�'l�'i l� BY TtfE PLANNING DIV. BY: I�� `� UATE: � � � �j�-�o 313q �Vi3L►��' s � qs � � E� � � � � � � � Lattice Cover Rafter Header Solid Floor Cover I�– Roof Covering 26 Ga. �--Roof Sheathing �e PRAMING PLAN Flashin� Roofing 12" Sheathii � Lattice p ., ,... ♦ Header * Rafter— LJoist Hanger Ledger � � �� o eo 2% Slab " �O Slope to Drain 3 9 Lattice COV2f SPECIFY LUMBER: ❑ DF ❑ Redwood SPECIFY GRADE: ❑ No. 1 ❑ No. 2 CONCRETE: 2500 psi min. @ 28 days CONNECTIONS: ICBO approved or equal 1. Roof covering: �%a z � � 2. Roof sheathing: � Post c � � — Footing SECTIONS ❑ Hemfir Joist Hanger Ledger— Slab� Slope:�:12 Maximum spans: Solid Roof COVef � 2% Slope to Drain lattice: x_ @_" o.c.: 2x2 - 6'; 2x3 - 8'; 2x4 - 10' solid:- �" CCX plywood or _" lumber: 1" - 2' - 8"; 2" - 8' - 0" 3. Rafters: �x� @ I 6" o.c. ❑ Single ❑ Double ' 4. Header: �x� ❑ Single ❑ Double 5. Ledger: �Lx $ (2x min) 6. Fascia: �x�_ (2x6 min) 7. Post: �x (�. _(4x4 min) Raise 1" min above slab surface � 8. Footing: _x_ 12"x12" min for up to 66 sf tributary area; 18"x18" min for 67-150 sf tributary area " depth (Expansive Soil Zone � 9. Slab �_" thick (Expansive Soil Zone � 10. Connections: a. Joist lo Ledger - Metal joist hanger b. Joist to Header - Solid blocking with framing anchor a Doubled joist or header to post -(2) 1/2" dia. thru bolts w/ washers . d. Joist to Fascia - Metal framing anchors each side (min. capaciry = 0.5"joist span'joist spacing' 15) e. Header to Post - Column Cap f. Post to Slab or Footing - Metal AnchodPost Base �- g. .Roof Sheathing - 8 d@ 6" o.c. Edges and 12" o.c. Field �`. DETAIL OPTIONS Check the ones that appy: Lattice Cover: ❑A ❑B ❑C ❑D ❑E ❑F Solid Cover: ❑A ❑D ❑E ❑F Post Anchor Post 6' min . Footing DepN PAD FOOTING A 750# max �� POS� Post 6' min '� sv,e SLAB FOOTING B 2x6 Min Zx JoisJt Fascia / Exisling Anchors waiia Z-o• s'-o' I roar Max Max Span EAVE CONNECTION C 1/2' : 5' Joist Lag Screws p is' a.c. Existing Joist wall Hanger Ledger WALL CONNECTION D Lattice eoits Ratter , �ummy Post =Suppon Post � Beyontl RAFTER/HEADER E itoot5heathin9 or Latlice Rafter Freminq Anchar Each Block . Header 2 X Blocking Post Column Cap JOIST/HEADER F 2�33-06 back 19W UBC 2�334fi � °� L�¢ta ��%da �'uiE� �i�i¢�a BUILDING PLAN REQUIREMENTS FOR ATTACHED PATIO COVERS (Note: Detached patio covers require an engineered design.) ❑2 P.L. _ i ❑5 — — — C i 6 , f ,_ � � ��YPJ .<;�� . �"- `=�.. i 9 _� A PROPOSED S � Ed e of r � � � patio cover { L � I � i i i i i i i House i � J a I 02 I 0 Owner Address c N E d m w Garage ❑3 ❑2 ❑2 P.L. Street �❑ Feet ❑� 1 R ❑2 v r II T N N � _� � Scale: _" _ — INSTRUCTIONS - 3 COPIES MUST BE SUBMITTED Using this as an example draw your own plot plan on a separate drawing. �❑ Show owner's name, projed address, north arrow and scale. 2❑ Show and dimension all property lines, easements and driveways. 03 Show locations of existing and proposed structures, including all setback dimensions 4❑ Show dimensions of proposed structure. ❑5 Show sstbacks from property lines lo proposed structure. (3'-0" min.; veriTy if Planning Dept. requires greater setbacks) 6❑ Dimension overhangs � L� °� C?adta ��leQa �uiE'duc y Dicu�ia�L OWI�IER-BUILDER VERIEtC�T10N Permit # �� (�Q��V Disclosures & Forms for Owner- Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. DIRECT/DNS. Read and initial each statement below to signify you understand or verify this information. �1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. � 2. I understand building permits are not required to be signed by property owners unless they are re ponsible for the construction and are not hiring a licensed Contractor to assume this responsibility. �3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself �froln potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. �4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. �5. I understand if I employ or otherwise engage any persons, other than Califomia licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. �6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. �i. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unfess all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. �8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for ahy financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 1 of 2 r �I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small 8usiness Administration, the California Department of 8enefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or wvnN.cslb.ca.gov for more information about licensed contractors. �10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construciion activity at the following address: 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will ab e by all applicable laws and requirements that govern Owner-Builders as well as employers. � 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does noi have a ficense, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form nota�ization, or other verification acceptab/e to ihe agency is required to be presented when the permit is issued to veri(y the pr perty owner's signature. Signature of property owner �(�f�.f,(�{�� Date: �—��0� Note: The following Authorization Fo�m is required to be completed by the property owner only when designating an agent o( the property owner to apply (or a construction permit for the Owner-Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, i hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other veri(ication acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: 2 of 2 Pfl0.1ECTRU0NE33: �139 DUHLIN ST OWNEN'S NAME: SAM DOAN �DOHESS: 313�j DUHLIN ST COSTA MESA CA 92616 (714)434-6540 � �HCNIENGINEEN: � ROOBE3S: flEG.NO.: UNIT: UNR: � PEfIMRTEF: SAM DOAN ( 714 ) 434-6540 � AOONESS: 3539 DUBLIN ST COSTA MESA CA 92626 IICEN5E0 CONfMC70B OEClAMT10N: I �ere0y aHirm tAat I am Iicense0 unEer provisions ol CAaprer 9(commencinq xitA Sectun 7000) al Division 3 of t�e Busness an� Rafessions CoGa, anU my license is in full force an0 ettttt. CITY Llt.: STRTE llt.: CU83: Date: sianature: WOBNENS'COMPENSRTIONOECIAMTION: I�ereEy allirmt�allhaveacetlificataoiconsentmself-insureoracetlificateolWorkers' � Compensation Insuance, or a certifieA copy Ihereot (Section 38W, La6. C�. roucr xo.: ezv. o�Te: COMP�NY: � Certifie0 coOY �s hereby turnis�e0. ❑ Certiliea caDY is file0 wiih tha ciry Buildinp DiNsion. ..ate: ApDliram: IXEMP110N FBOM IVOHNERS' COMPENS�TION OEdAMT10N: (Riis section neeA nol be complete0 if the permit is for one hunErtE g100) or less�. I certity that in t�e p¢dormanca ol the wuM 1or whic� t�is pefmit is iuue0, I s�all nat employ any Oe«� in any manner sa d5 to 6ecome suble�� o ehe Workers' ComDensation Laws at Calilomia. Date: SiOnature: NOTICE: II, atler makinp this declaratlon, yau s�oultl becoma suhject ro tAe Worke7 Campensatian provisions oi Ihe Lahor � CaUe, yau must IorlhwltA comply with suc� OmWsinns or Ihis permit s�all he Aeemetl rewketl. CONSTBUCTION IFNDING �OENCY: I �erety amrm lhat IAem is a conslmciion lendinp apency lor tAe Dedormance ol Ihe xrork lor wAicA ihis De�mi1 is issueA (Seciion 3W7, Civ. C). LENOEN: IIOOPESS: OWNEN BUILDEN OECIAMT10N: I hare0y aMirm that I am exempt from Ihe Contractors' State License Law lor the fallowinp reasan (Section 7031.5 Business anE Prolessional CaOe: My ciry ol counry w�ich reQuires a permit to wnsWci, atter. impmve, demdis�, or repair any strucWre, D�or to iLs issuanca. also repulas ihe applic�nt for such permrt ro lile a siA�ee statement ttut ArJshe is Iicense0 pursuant to Ihe pmvisions of the Coniractars' State Licanse Law (CMpter 9(commencinq with Section 70W) of ONision 3 of the Busineu anA Pmleuions Cotle) or Ihal he/s�e is exempt tAerelrom antl ihe Uasis /ar t�a allepeA exemD�ion. Any violation al Section 7031.5 Ey any apDlicant tor a Dermit subjttts ina applicant lo a cMl penalry al not more than five �un0a0 Odlars (5500�. I, as owner ot t�e propeM ar my employees xit� wapes as tAeir mle wmpensation, will Eo t�a xrork, anE the ❑ simctura is not intenE¢d or ottemU lar ule (Section 7044, Business anU Pmfessional CoOe: The Coniractors' State License Law Oces not appry to an owner ol a DmDerty w0o huilOs or improves t�eaon, an0 w�o tices such woM �imsell/herselt or t�rouph Ns or her ovm employees, proNEed that such imDrovements am not IntenAeE or offereE for ule. Ii, however Ue GuilEinp or impravemeni a sol0 witMn ona year oi comD�etion, tlro owner will Mve t�e OurEen ot provin0 hUshe Ei0 not buil0 or improve for t�a Duryose of sale). I, as owner ot t�e Dmperty� am exclusiveIy coniractinp xit� IicenSeE contractars to wnstruct the Draject (SecGon 7044, Business ❑ aM Professipa CoOe: TM Contractors' State Liunse Law Eces wt apDN to an oxner of D�rty ��& ar imprmes Nereon an0 who canVacts lor suc� Drojocis yN a coniroctar(s) Gcense pursuant m Ne Contactors' State L¢enu Law). I am aware that praof ol their WaMer'S Comce�s:Fion insurence slroul0 �e pmvitle0 to me. � I am e�emo� uneer Section: y p'] � 4 4 B. 8 P. C. rorinareaso�: ALL WORK HY FAMILY 11� Date:� �� Q Umer. \��.��7.�� I Eo hereDy certiry ttut I am aware al an0 unEersunE the repuiaments of Calilornia HealtA anA Sahry COAe Sectlons 25505. 25533, an0 2553/ an0 Wt I or any tuWm Du1lUinp awpant wilUwill not (cirde one) neeE ro wmpry with uia state coGes ana the requirtments for a permit lar conswction ar moEiliwGon Irom t�e N'r�ualiry ManaOement District. HesiEential wnstmction applications are eKempt trom NeSe provisions. - Date: Applicant: I �ereCy cehiy t�at I have reaOlhis apDlication anE state t�at tAe above inlormation is corcect. I a0ree to compry wiN all city anE counry or0inances and sWte laws relatin0 �o EUItEInO constmctlon anE �eaby authoAze reD�esentativas oi t�is ciry to enter uDon the abova�mentioneE propeny for insDection purpoms. o Date:? �� Q� s�pnawm: \�11 �%�.a N lA omer's �icense or Sacia� Securiry x: i6ati6 W�I�e—BuilOinB; Oreen—Cotle Enlorcemem; Canery—Applicem; Pink—Revanue; GolEenroA—Assessor CITY OF COSTA hiESA —$UILDING PERMIT PERM NO: H 048179 PERMIT NO: B 048174 PLAN CHECR NO: N GOVT;�N"SUPP: N CONSTRUCTION TYPE; 5—N PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION : REROOF W/FIHERGLASS SHINGLES SQ FT: 2,000 CLAIM VALUE: 2,000.00 CALC—VALUE: 2,000.00 GROUP OCC: R-3 / COMMENTS: SMOKE DETECTOR(S) REQUIRED IN HOME. **#�**it*#**�**�****�r*******#it��r�*****#�**#**�*x**�*��er�r*�***��**�**��*��***+� 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 5 ------------ MAIN bUILDING ---------- --------- ACCESSORY HUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN . LEFT: FT IN RGHT: FT IN PAR'KING REQ: PROV: PARCEL: 41814108 ZNE: REF NO: PLANNING NOTES> > iE # iE if iE ## iE iE iE if !E if',E i� df jF �lf� if 3f-iE!E iE iF iF if # iE iF if 1E 1E fE il-i4 �E it iE ik?f iE it it M iF ik iF ik ## i4 ih ## if 3f iE jE iE iE iE i! iE iF iE iE 1E iE-1E�E if iE iE iE �7E iE if iE iE D E V E.I. O P M E N T S E R V I C E S R E Q U I R E M E N_T S ZONING APPROVED HY . DATE: " HUILDING APPROV.ED bY APPLICATION iF if iE aE if jf iE if iE if ik 3E LEGALIZATION:N BLDG PMT PLUMBING PERMIT 45.00 DATE: ,-r f �,-- � ' �,s�—. ..�'�'��r*�D*****��7�t`�* iE�E�fi4iEiElfifiEiElfM�iF�1E�3EjF r ififMitiEiEiFiEiEiF?EiEif�iE3EiEif3EjE3Eit;EiEi(�iEiE�Eif�lfifiElt F E E S U M M ra R Y STRUCTURAL SEGMENT:Y ELECTRZC 'MECHANIC FIRE SMIP/RES GRADING .S� • SMIP/NON—RES PLAN , ISSUE FEE BUILDING—DIV—> PEAMZT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 45.50 0.00 .:5 0.00 45.50 45.50 .00 REVENUE DIVISFON TOTALS--> COLLECTED: 45.50 OVER/SHORT: .00 BLDG PMT PLUMHING ELECTRIC MECHAN7aC FIRE SMIP/TOT GRADING PLAN—CHECK 45.00 , " .50 i• if iE if i! iE!E iE if if if iE if iE # iE'k �E if if i! if �E if * 9!� iE if it it if if i: iE it 3f # if �k 7E iE�i iE iE if if'lf ?f �lE±E 1E it iF iF iE ik it iE iF iE if iE i(�?F!t if ie it iE if ih il-iE iE iF u iE �IE 3E X� 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 Q;N UNIT COST TOTAL COST SFR 2000 REROOF HY VALUE RESZDENIAL N020NE ]..00 2,000.00 ,END OF�, FEES O1 00�65541-00065542 "f �J T �S.aO OqTE: 07/17l9D T'IttE: 1Z�55 � CONSTRUCTION AND PL'ANNING POOL 'PA , APPROVALS Permit #� Date Inspector qppROVALS Pem�it # Date Inspector 1. Temporary Elec[rical Service or Pole 52. Pool & Equipment Location ' . 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement �• . 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding .. ' ' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd. 10. Struttural Floor System 61. APPROVAL TO DECK 1 i. 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 - 75. Rough Electriwl-Conduit 66. Solar System-Final ' � i 6. Rough Electric Wiring 67. Fencing & Access ApProval - 77. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVAIS Permit # 27. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas OOiI 23. Gas Pipe�Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing � 74. Overhead Hydro 26. T�Bar Ceiling (Structuraq & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation /� 78. FIRE PREV. FINAL 30. Drywall Nailing '-' � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final �� 80. FOOD CERTIFICATE ISSUED 33. Final Eleciric �� ' Notes: 34. Final Heating & Air Conditioning . 35. Final Gas Pipe�Test : / -7� � C� � � 36. Hood or Canopy „ . i. 37. Final Factory Fireplace , ' � 38. Final Plumbing ./ 39. Water Service-Final 40. Gas Service-Final � 41. Solar pomesticFinal 42. 8ackflow Preventer 43. 8ackflow Irrigation 44. Landscape Irriqation System 45. Sound Attenuation 46. Handicap Regulations FINAL STRUCTURE & BUILDING ��..l�� jj[{i' 48. FINAL PLANNING 49. Elearic Release to Edison • 50. Gas Release to Southern Galifornia Gas Co �% � I 51. CERTIFICATE OF OCCUPANCY � No. Date � - � AVolicant ta fi11 in all spaces except Yhose within heavy ooraer Iines ana sign all avPropriate tleclarations. CITY OF COSTA MESA • CONSTRUCTION PERMIT . Project Address � 1 .3 `� 1� r � ` ,n S-i-'� - ' A'ppiicant's Mailing Address ��Owner'sName L�� J—�' � Phone�S`"I6_79yg Address �0. �^'�' ' Areh/Eng. � ' Licenu No. Address � Contractor's Nam -Phone S �2 3 3 Addresslm'�' � �pSU «'- �✓�'�FiNO Ciry License No. .S ` `�3 LICENSEp CONTRACTOR DECLARATION ' 1 hereby.aftirm th5t I am licensed untler provisions oi-Charter 9(commencing ' with section �000) of Division 3 ot the Business ana Protessions Cotle, antl my Iicense is in ce %a �tl eff t� ' license CI s � v'•�� U � Nq,� ��5 . Date I 1�� 3 t P yi��/e�la '�ORKERS' COMPENSATION DECLARATION � iereby affirm that I have a certifica[e of consen4 [o sel!-insure or a certificate ,l Workers' Compensation' Insurance,- or �a certitietl copy�thereot (Section + 3800, Lab. C. I ��T��'�t l.�f Policy No. �� +'� � Company ��-�-� 1. S �Certifietl copy is hereby fuTishetl. . � , Certifie cooY "s tiletl wiN the city �% Itli 9 I o Date ADPlicant �<- �2 Qn-� EXEMPT ON F OM WORKERS'�COMPENSATION DECLARATION (This section neetl not be completetl i! the permit is fo� one huntl�etl ($100) o� less) ` I ce�tify that in the perfo�mance of the work fo� which thl5 pe�m�t i5 izsuetl I' shall not employ any pe�son in any manner so as to become subject to t�e � Workers' Compensation laws of Califomia. � Oate Si9nature � NOTICE: If,-atter making this tleclaration, you shoultl become subject to the Wo�kers' Compensation prOvislons of'the l�bo� Cotle, you must forthwith comply wlth such provisions or this�permit'shall be aeemetl revoketl. CONSTRUCTION LENDING�AGENCV I hereby affirm that [here is a construction lentling aqency for the periorman<e of the work tor which this permit'is issuetl-($ection 309] Civ. CJ Lender's Namx Lentler's Atltlresz '� ' OWNER BUILDER DECLHRATION " ' ' ' I he�eby afti�m thdt I am exempt f�om the Contractor'S License'Law to� the followin9 reazon (Section, 7031.5 Busine5s antl Ptofessional Cotle: Any city or county which �equi�es a permit to construct, altei, improve, tlemolish or repalr : any structure, prior to its Issuance, also requires the applicant for such permit to tile a signetl 5tatement 4hat he/she is licensetl pu�suant to the provision5 of 'he Contractor's License Law (CM1aOter 9(commencing wi[h'Section �000) of ivision 3 of the Business antl Professions Code) or that he/she is exempt �erefrom antl the basis foLtbe allegetl exemption. Any,violation of Section � �/031.5 by any applicant for a Permit subjects"[M1e applicant to a civil I�enalty o( not more than five huntlretl tlollars ($500). � I, as� owner of the property or my employees with wages as thelr sole �� mmpensation, will tlo the work, antl the structure is not intentletl or ofieretl tor sale (Section 7044, Business and Professional Cotle: The Contractor's license Law does not apply to an owner of a p�oper[y who builtls Or improves thereon, antl �who tloes such work hlmself/he�self or [hrou9h liis or her own employees, prOvitletl that such improvemen[5 a�e not intentletl or otteretl for sale. If, howeveq the builtling or improvemanf is soltl within one year of com- pletion, the owner will �have the burtlen Ot p�oving he/5he tlitl not builtl or im- �rove fo� the pu�0ose of sale). I, as owner of the property, am exclusively contracting witn licensetl con- tractors to construct the oroject (Section 7044, Business antl Professions Cotle: The Contractor's License �aw tloas not appty to an owner of Oroperty who builtls or improves thereon, antl who mnVacts for Such pwject5 with a con- tractor(s) license pursuant to the Contractor's License taw). ❑ I am exempt untler Section e. & P. C. for this reason Date Owner certify that I have reatl this application antl state tnat the above m is correct. I agree to comply with all city antl county ortlinances laws „e�li�9 to b�iltl�ing c�on�5tt„et�abovetl hereby authorize reore- n n mentlonetl orooeriv to� Y'��/-O�d— �I ...„ TYPE OF CONSTRUCTION rvE ❑ CONVERSION �❑ DEMOLISH DESCRIPTION OF WORK J ADO LJ ALTERATION L1 REPAIR OTHER - TVPE OF P,ERMIT IJ GRADING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAI ❑ OTHE(3 PROJECT DESCRIPTION Sp: FT.� OCCUPANCV CONSTRUCTION TVPE � VAIUATION $ � ZONE C�FADINGCU.YDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation � Bathtubs Clarifiers Drinking Fountains Floor Drains Floor Sinks Gas Service O Interceptors Kitchen Sink ioof Drains - Reinspection Fea $25 Boiler Duct - Under Ground Duct - Structurel Duct - Ventilating � Exhaust System ❑ Multiple ❑ Firepl/Fact.Blt.IC80�# � Heating System & Ducting ❑aioo,00a eru �ioo,000eT� Signature - � W�� ate��' l..l�.�� I I Reinspectian Fee Drivers' LicenSe 55 � �� CMFOB65-46rw.7/83 Wbite-Builtling;Canary-Applicant;Pink-Accounting;Goldeniotl-Assessor $25 Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/S', Urinal Water Closet ' � Water Heater � Water Service Isue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ' �� ❑0-100,000 BTU ❑ 100,000 Bl System Repair/Alteretion Issue Fee A.P. # S Main Buiitling: E • T Front B Rear A C Right K Left S Ping. Ref. # Parking Req./Provided Use of Building: Planning �Notes: Automatic Washer', Cooking Unit' �' Dishwasher � • Dryers ❑Gas ❑Elecvic L�JE2 12/��/�'? Zone ' Accessory Building: . Park.Fees $� ELECTRICAL Transformer F.A.U. Fixtures Device Boxes • Outlets Switches Garbage Disposal Generetor � 0.5 K W � 5-15 K W $ 3 QG Reinspection Fee . $ FEES �PUBLIC SERVICES REQUIREMENTS: � Zoning APProved By � APPlication APProved By Aooliqtion Iuued.Bv $ 3 BUILDING PERMIT PLAN CHECK PLUMBWG PLAN CHECK ELECTRICAL PLAN CHECK MECHANICAL PLAN CHECK Meter'LJi Meter ❑� Sub Panel J 15-50 KW 7 50+KW r 100�amps' 100 amps Motors �41 HP 07'/: - 8 Inc.Solar �9-75 HP �16-15+ Microwave Pole Light ' Range � Standing Sections Trash Compactor Issue Fee SUMMARV OF FEES $ SMIP � $ $ PERMIT + $ S "— T ISSUANCE $ $ ENERGV P.C. $ $ ' GRADING $ $ � MICROFILM $ $ TOTALFEE .$ 500" Ti_ . Z O ' N I N G R E , Q U 1' R E . M E • ` N T S FEES $ 3 � CONSTRUCTION AND PLANNING - ' POC .SPA APPROVALS .Permit# Date Inspector pppROVALS Permit# Date Inspector ,,1. Temporary Electrical Service or Pole � - 52. Pool & Equipment Location. .2: SoiPPipe-Undrgrnd. , 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. ' � 54. Forms � - 4. Electrical Conduit-Undrgrnd. . �� 55. Electrical Bonding '`5. Steel Reinforcement � � � � 56. Rough Plumbing & Pressure Test 6. ElectricalUFER�Grnd. � � � 57..APPROVALTOCOVER-GUNITE 7. Footings i � .- 58. Electrical Conduit-Undrgrnd. S.. Foundation � � 59. Gas Pipe, O Undrgrnd., Test 9.; Water Pipe-Undrgrnd. , 60. Backwash Lines, P-Trap, O 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. RoughElectrical-Conduit � . � 66. SolarSystem-Final 16. Rough Electric Wiring -, , 67. Fencing�& Acces9 Approval - 17. Rough Wiring Sign . �, _� � 68. APPROVED FOR PLASTERING 18. Rough Electrical-T�Bar Ceiling 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning . � � FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace •, �, , APPROVALS Permit # _ y27. Ducts, in Structure � ; 70. Underground Hydro r ' 22: Ducts, Ventilaiing . ' , ' 77. Product Piping OGas ❑Oil � • 23. Gas Pipe-Rough & Test � � � ' 72. .Underground Flush � - 24. Roof Framing , . 73. Undergrnd. Storage Tank O Gas ❑ Oil ' 25. Root Sheathing � '. 74. Overhead Hydro � 26. T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical : 27. Frame and Flashing � 76. Dry Standpipe 28. Lathing & Siding , � . 77. FIXED SYSTEM FINAL 29. Insulation ' 78. FIRE PREV. FINAL � 30. Drywall Nailing '. HEALTH DEPT. REQUIREMENT . 31. Plaster Brown Coat � 79. FINAL INSPECTION ' 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric ' Notes: ' 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test _ 36. Hood or Canopy � , . 37. Final Facmry Fireplace � � i- ' 38. Final Plumbing '� �5-' � 39. Water Service-Final 40. Gas Service�Final ' � 41. Solar pomesticFinal , ! 42. Backflow Preventer . , . � 43. Backflow Irrigation ' � ` - 44. Landscape Irrigation System � 45. Sound"Attenuation � � ' 46. Handicap Regulations . _ 47. F.INAL STRUCTURE & BUILDING � 48. Special Requirements Completed . , 49. Electric Release to Edison . - - , � ' �- - . 50. Gas Fielease to Southern California Gas Co - � ' 51. CERTIFICATE OF OCCUPANCY _ . . ' �, � � � -� - No. Date - , . . . . • OWNER C0118gE MeS3 COmD3riy DATE �-18-56 JOBADDRESS 3139 Dublin��Street BUILDINGPERMITNO. 2779 GENERAL CONTRACTOR The Hale Co VALUE $ 11�Z8O.00 LOT Z� BLOCK TRACT 2�t32 Single Res. W�3tt. gar G �P I & J IN ECTI NS . � �„ �'� Fon ng Trench C _ Foundation Forms and Grade to Rough Framing Plumhing, Rough to Sla� Plumbing, Rough Complete Temporary Pole Wiring, Rough Lathing,ln �' � Plastering P! ing, Final, Fixtures Plw��oing, Fin.al GasTest Wiring, Final Occupancy FORM 210 3M 10-93 I PERMITSISSUED SUBCONTRACTOR DATE I NUM6� st. � ;z3-��u.��. '. ��-- ..�� ,_ --, _ A ti , '��'osta Mesa Bnilding Department —ti i 111 EAST 20th STREET ' • COSTA MESA, CALIFORNIA FOR APPLICANa TO FILL IN Building ndaresa 3139 Dublin Street Costa Mesa, California Nearest crosssc 1'�atson Avenue owner College Mesa Comn� Mail Addrou 8002 Central Avenue nrcnttector Engineer Davi Address 43 Ma1 CuatracMr The Address $�02 C Leaal I Lot Size of Lot 100 X 95 Use of Existing Bldg. Setback �ine from Center oi Street 52 � D�SCRIPTl� New I X I plte�a Repair I I �Movin� Building I Tract 2432 Now on Lot None No.of No.oT Families Rooma Rear Yard 3f1� Sida VaM k l Addition APPLICATION FOR PERMIT 2808 BUILDING '� FOR OFFICE USE ONLY I Recelpt No. I�er� N� � Costa Mesa, CORRECTYONS 1 .:1�/� � '.�- � z,\ I .. . , . .. ... _ ' _r.. ' _ . &ize 1310 Rooms 6 Stories 1 Exterior Wall I Rooi — Covering Stucco Covering Shake APgR,Q`7��` Use of New Building Single family dwelling tiPlth Foundation Location Inspecto Forms, Materials, attached �arage. under-ainning Frame: Ffre Stops, Bracing, Bolts I hereby aclmowledge that I have read this Applicatlon and s[ate that the above is rnrrect and agree to rnmply Lath. Int with all City Ordinances and State Laws regulating building Con5truction. Lath. Ext. Slgnatureot THE F3ALE COMPAN Permlttee Plaster, Int Authorized Agt. ` Plaste�, ExL RllNER Valuation Permit Fee $ ' Masonry Reintorced Plan Check $ � � � $ / /, `�G� Bond Beam �0 Total `/ Fee T v FINAL AM 2[14 S-RP 2M &SS O A � Z D r YLUl YLAlV Show Ixation and distancea irom property line and 6etween buildings f ^ ! J\�� cosr^ ,,•....n� ri °R 7 � r�PDtsESG l`J7� . '��V • 4 J owN�x BALMEOR'PH S. A. - — nATE 10-24-61 dOB ADDRESS 31i9 I}ublin Avenue� BUILDING PERMIT NO. j�Z]�(j __ GENERAL CONTRACTOR H,�','. Warmoth VALUE $ j�$00.00 add util,rm, AP No.11 -2� -1 LOT � TRACT RIRE ZONE D�SCRIPTION OP WORK QOn.gar.to der INSPCCTIONS � Signature� DA'CC GROUP I TYPE V 7,ONE R-1 \ r SUDCONTRACTOR OCCUPANCY 0 • - � 15'��_� COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. 80X 9f7 COfffA MEBA. CALIFORNIA For Applieanf fo Fill In Complefely TYPE OR PRINT BUILDING ADDRESB �/� (I'G C05TA MESA. CALIFORNIA � ARGHITECT TEL. NO. TEL. STATE /� �� 6 TEL. � LIC. NO. � Y/ NO.. SIZE I�� G S-30 � I NO. OF BLDG9. OF LOT � NOW ON LOT USE OR x ps • EXISTING BLOG BETBACI( LINB FROM CENTER OP BlHeei REAR YARD SIOE YARD ILEFY IRIGHT DESCRIPTION OF WORK BUILDING size EXTERIOR WALL COVERING USE OP BUILOIN OF FIRE L80AL FEE RECEIVED OCT 2 41981 FINANCE DEPT.. ��,r C1TY 4F COSSA MESA APPLICATION FOR PERMIT BUILDING For Office Use Only �RECE�PT NO. Pei{M�l � � 1 BY � DATE NECEIVHD I onSe II 0 MESA. NO. OF UBE OP NEW �LANB � BUIL�ING � G �3-� YAR�S EVES APPROVED (QNT6R LIN6 OTJ ��1�� [y r _ A / 2� ��• " �� IN. IN. IN. DATE ,D��_�� , I HHRBBY ACKNOW�008 TNAT I H�VE NHAD THIe APPLIGTION TMe �NOUM BHOWN UNDER V�LUATION IB IOR TM! AND 9TAT8 TX�T TNB ABOVH 18 GOPAC AND AGREE TO COM- pUPP08¢ OP EBTABL�BHING A PBNMIT FEH ONLY. PLY WITH ALL CITY O INANCE6 AND AT8 LAWB REOULATI Bu1Lo1No coNeTliU N. VALUATION 81GNATURE OF � PERMIT FEE $ /� � PERMITTE - / �$ ��OO� PLAN CHECK $ (/ � AUTNORIZBD AGENT TOTAL FEE -�