HomeMy WebLinkAbout1163 EL CAMINO DR - Building Permits! -i,
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- PROJEfj ADDRESS: - UNIT: „
OWNER'S NAME: 1163 EL CAMINO DR CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 058538
ADDRESS: CRONACHER BERNICE M J
• 1163 EL CAMINO DR PERMIT NO: B 058538 PLAN CHECK NO: N GOVT: N SUPP: N
• COSTA MESA,CA 92626
CONSTRUCTION TYPE: V-N PERMIT TYPE; STR PURPOSE; ALT
ARCH/ENGINEER: 645-5618 REG.NO.: JOB DESCRIPTION : T/OFF RESHT. REROOF W/PID�ryppry on 1 SQ FT; 10, 000
ADDRESS: UNIT: VI IE i•lig aNyx
PERMITTEE: - CLAIM VALUE: 10,000. 00 CALC-VALUE; 10, 000. 00 GROUP OCC; R-3 /
ADDRESS: PETRONELLA ROOFING ( 714 ) 548-1645 03 � �5// / # 3g1 10 NO CR�
[ ((2T66r'2T''66p MNAAEFWPORT COMMENTS; ICBO PIONEER LIGHT WEIGHT 'x,"•c
if DEC[AAATI ff:-Th *******1ElEiEif****kifiEiEiFiFiE#iE1EiEiEiEiElEiFiEiEiEif4EiE#ltiFiEiEiE****ifiFitiEik#3E iE*if itif#iFiEikiFjE1E#1E****iFi ***
SA CA 92627
LICENSED CONTRALTO O ereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 ot the Business and Professions Code.and my license is in lull rce and effect. SETBACKS
CITY LIC.: 0$32605 STATE LIC.:0046070n CLASS: 3Q
--ma $
le: -10-9T-- Signature: MAIN BUILDING ACCESSORY BUILDING
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WORKERS'COMPENSATION DECLARATION: I hereby affirm that I ve a certificate of consent to self-insure ora certificate of Workers' FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN
Compensation Insurance, or a certified copy thereof(Section 3B0D, Lab.C), LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
POLICY NO.: 1T WC 1 1 5 7 0 6 EXP.DATE: 12/01/9
CertifiederNrd GOLDEN EAGLE _ PARKING REQ; PROV; , PARCEL: 14156118 ZNE: REF NO:
❑ copy is hereby furnished. y3c( Certified copy is hl with the city Building vision. PLANNING NOTES?.
Ate: �lV' r Z. Applicant- '//�//Wi ********************************************************************!*********
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This sectiot need not be completed if the permit is for one hundred(1100)or lessl. D E V E'L OPMENT SERVICES R E Q U I R E M E N.I T S
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 a-.k
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE;
Date: Signature:
NOTICE:If,after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BIC-4_, f DATE:/ y�V!..
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. Y /�// / / o 4( e ,-I Z--
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY; / /i i . DATE;
which this permit is issued(Section 3097,Civ.C). ******.***.*.**************** *** *** -. *** ************************************* '
LENDER: **************tt*********************** *'. ***********************Bk************
ADDRESS: LEGALIZATION;N F E E S U A R Y . STRUCTURAL SEGMENT;Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC ( MECHANIC FIRE $MIP/RES GRADING
, (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 117. 00 (1 '" 1 . 00
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed �4
I pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business J k-^ $MIP/NON-RES
I. and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN t} ,r
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE -
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PIAN=CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 118 . 00 0. 00 ri S .0'. 00 - 118 . 00 118 . 00 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through f
his or her own employees, provided that such improvements are not intended or offered for sale.If,however the building or !d l r. 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COL'LECTED• 118 . 00 OVER/SHORT:
for the purpose of sale)_ BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
._ 'l,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
117. 00 ( 1 . 00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon �;
and who contracts for such protects with a contractor(s)license pursuant to the Contractors'State License Law). lam aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. IND I V I D U A 1 '/T F 4E E BR EAK DOWN
❑ I am exempt under Section: B.8 P.C.
(,.', _
for this reason TYPE QTY D E S C R I P T I/O N 1 UNIT COST TOTAL COST
t
Date: Owner SFR 10000 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 10,000. 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END;OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from '•�/
these provisions. r
./
Date: Applicant: r�
I hereby certify that I have read this application and state that the above information is correct.I /tree t0 comply with all city and county I 4.
ordinances and state laws relating to building construction and h¢re�,/+uthorize representativesof is city to enter upon the above-mentioned i.^
property for inspection purposes. / ;xi
4)11f1 01
Signature: .:/_ .th._ • \`-•i /V\3 n 1?v_a _ r":‘1,1...t.: r ..
Driver's License or Social Security e: DATI! [!,r„ 1!;r f 75„
1641-46 White—Building;Green—Code Enforcement;Canary—Applicant;Pink—Revenue:Goldenrod—Assessor
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CONSTRUCTION AND PLANNING - POOL A
•.-..`•- APPROVALS Permit.# Date Inspector APPROVALS Permit# Date Inspector
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- 1. Temporary Electrical Servi&pr Pole .. - - -- 52. Pool & Equipment Location
2. Soil Pipe`-Undrgrnd. _' rt 53. Steel Reinforcement
• _ 3z Electrical Conduit vinity-Unqrgri-id."_',II. 54. Forms
4El •
ectrical Conduit-Undrgrnd. - �, a. • 55. Electrical Bonding -
.5 -Steel R•einforcerrieritl. ^!c;,, •
- - 56. Rough Plumbing & Pressure Test
•-6.-Electrical UFER'Grnd . `•• ,r. • 57. APPROVAL TO COVER•GUNITE
''7:'Fbotings - - 58. Electrical Conduit-Undrgrnd. -
-, o
L:8--._,Foundation - 59. Gas Pipe, O Undrgrnd., Test .
Lg?Water Pipe-Undrgrnd. 60. Backwash Lines, ID-Trap, 0 Undrgrnd.
,r •
111:Structural Floor System is 61. APPROVAL TO DECK
11. Property Sewer Line,-8/ House Connection • 62. Backwash & Receptor-Final ,
12. Sewer Cap P., cu. ., _ 63. Heater & Vent-Final '
13. Roof Drains r V' - 64. Plumbing System - Final
14. Rough Plumbing", - 65. Electrical-Final • -
15. Rough Electricil Conduit - 66. Solar System:Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign _ 68. APPROVED FOR PLASTERING
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18. Rough Electrical'•T Bar Ceiling 69, POOL/SPA SYSTEMS FINAL
-19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT "
20. .-Rough Factory Fireplace I tr :-:l ui J t
'- 3 0 " :r APPRO•VALSU P.erm'it # ' `i =
: •-
'r "- le:'4 1 *•:.IT c.:t •r.. :r -' tr't i r t"C Cts0.-rr-- tr. tr.
21. 'Ducts, inStructure:,:: r ,• „ -,5 -r r3 •.,*. r j0. Undergrpurid ycco
22. Ducts, Ventilating- !,.7 '., _ .r t ,-_•r' i1 y 1. Product i:t ng 0G85 Coil
23. Gas'Pi e=Rou & T st 1 'p 'k r.r x r-1
^ : r ..^o•- .x "s o
P Yh e 'r7S it C.," ., i_72. Underground Flush��`., ., ii p
24. Boogframing, -- 1-r;
'1' 7 C' Jt = ,3.oSJndergrnd?'Storaq Tank T. Gas 00(P
. 25. Roof Sheathing C.;',1' -; t7�E3-0=i 6cZ .•=74,- erhead Hydro I X
26.:T-BanCeiling (Str,ycturall & Monocoat V I _• - hrr J t�]:r s 75.cDry Chemical = 3` '-+ i M
27. Frame and Flashiri x =• V x - trJ ^ ' " tr ' ` %:c. f' `' h'. ";
_ 9.
Dig LL"; w. r ,x-. , 76. It y Star141# t r, k ."
,28. Lathing & Siding. ' 'w,, tt: s r i � e
9 - -ar:p - 77.�FIXEDSY$�'EMFNAL- t
'29. Insulation rii.', c- '"' r" 1 I .;;_ ;_ 78.SFIRE PREV. FINAL ` t= u: s-,
30. Drywall Nailing •-
1 } ! i r+ HEALTH DEPT:+REQUIREMENT
31. Plaster Brown,Coat •r ' n•r.- I .rs rr?9.'FINAL INSPECTION y
;32. Electrical Power Mei r;Final cJ 1 / .. 180.;§OOD CERTIFICATE ISSUED
33. Final Electric ti Ir c ', t' � ' ` trNote"s: ({?/. qt.,,__
:1, .,_ i1 K�V
34._Final Heating& AirxCdnditioni g, n ' I ; Ko [l .t r�*�� S 4 4it
ti 4 .• = p
35. Final Gas Pi a Tesf' ,Th + " I ' 0 t !� '/. � '
36. Hood or Canopy ': '` 1 tr..- a ( ti . i' noR " r.
. I '� r0 :tit,'
,•n •ti•r.
;37.-FinallFacIory Fireplace ' SC •- t ill " , I I'` ' • ..• . _n
(38. Final-Plumbing n' 7.0 I ., „ I.° I I I. -1- "' k• •, v C -
! t , .. - . .tea= .
:39. Water Service-Final* i i -' H :, -� "-'t•i LC G
a G: t -, •, '� ,
0. Gas Servicerinal } v: Y ' "'
'
741. Solar Domestic-Final 5 •• 4• l j ' ; ^.4e - r
+ 1 - :it rc ,
f42. Backflow'Preventer; ''•1 i' 1 1; -!-• - t
_ 43. Backflow•Irrigation* iz.i::� t - ' x - u ;�:� -r O . -'
e+ .t lP r .., l4 / 7.
•44'. Landscape Irrigation System j ., t,_ - - (7, a I1• ty .-r ttIr i; p ,
:A5'.'.Sound Attenuation. r�•r;.• V• 3. Z : F. 4 r. 1 r` - • C = atmJ '.
. .. to IT: .2-1*i + i.., t: _t _
46.•Handicap Regulations --' ;; "-rte
47. SINAL STRUCTURE 81 BUILDING "j t9'3 I -.ir_+--.:
48.,F.INAL PLANNING: ; t;f-, ' ,. � ' C -i. !0 ¢ t - c
_49.'Electric•Releaseto Edison ' - I r : r ;it .. I r -3 c
I i > AS rz - .a
-50. Gas Release to Southern California.Gas Co ' tr 1 " tj `3'" .
j (, c.;rt �,
51. CERTIFICATE OF OCCUPANCY' -r r
No. Date
CITY OF COSTA MESA �� • "iv_ is FEE RECEIVED _ —
Building Safety Department IyJ'� / 387 / FEB 8 1962
` ��h FINANCE DEPT.
Application for permit for the fabrication and erection
of awnings, advertising signs or devices. CITY OF COSTA MESA
FOR OFFICE USE ONLY
LOCATION 9 f -2 r/
�� 6 F� 4/ O D�Pw� Date Issued T•'EB 1 X962 Permit No. / d
Building Site Address 3 � ry
Fire Zone (7� pe Group
p�
Name of Leasee A44-CCO CORAPR ATI U/V Phone NF 6046/
�. Approved by Date
Contractor �QI�T�� eL State License No.
`/y� .?ZONING
address ZL W S 7/ S"T City 6-/M/71;/ 4/YS A--/ /\
Phone 77G/7 Zone rte/ Use of Bldgs." " '
Architect or A. P. No. , Gt-z__ t P-'1 Tal Y
'gineer State License No. /
Bldg. Site Address //!a -5 tJ0
e42-ni."�-1--/'
address City Phone E2-.11
DESCRIPTION Legal Owner_ __
Description of awning, advertising sign, or device:
•
Address
Awnings canvas lj metal 111 Width: 1 ft. "~ in. Length: C ft. , in.
City Phone
Ground Sign 3 Projection Sign 0 Roof Sign El Wall Sign 0 Metal Letter Sign n
Yards Approved.
Banner 0 Canvas Sign n Gas Tube Electric Sign (Sub-section 1.44, Ordinance 313) n Large Sign in excess of 8 sq. ft. Setback from center line
Combination Sign ❑ Special Device (other) LI Explain: of street to front property line _Oft. in
From property line to edge of sign eft. in l
Two copies of plans and specifications shall be submitted with application for permit for each sign. Plot on ' t "1.
plan sheets proposed location of sign and locations of all other signs at site. Minimum size sheets must be 18" Side Yard Setbacks: p 1.1'by 24" and non-erasable. Left Side ft. I i . ,
If within the 10-foot area of front property line, owner is to sign written agreement with the City. Right Side Z h 9ft. in. L
Lia
1.
S' of Sign - Thickness ft. in. Height LengthBuildingLine Setback from
6 ft. in. 7 ft. f
eig-
/' center line of street _ // ft. in.
cd
hT" lbs. Height above grade L9 _ft. in. Projection ft. in. Area of Sign '[ r ft. in. p•
The undersigned hereby agrees to fabricate and erect awning or advertising structure within the intent and W
meaning and in strict accordance with the provisions of Ordinance 95, Ordinance 313 (Electrical Ordinance of Height above Grade _ 'ft. in. 0.'
the City of Costa Mesa), and all amendments thereto. ° iQ
Projection _ - ft. n. ,V
ALL APPLICATIONS MUST BE FILLED OUT BY THE APPLICANT. ALL FOOTING, FRAMING AND ELECTRICAL IN- Awning Size-Width _ ft. in. Et!
IN-
SPECTIONS SHALL BE CALLED. in
Length ft. in. p,.
Signature of The amount shown under Valuation is for the purpose of Awning Height above Grade ft. — in.
Yom.
Permitee p p
establishingC
apermit fee only.
—�--rj -yC0.@TIz@ IVM �Projection ft. pin.
Authorized Agent SCO $
- VALUATION Permit Fee �C �� r 0-r e, O °
Location and size d7� ��
$ Plan Check $ approved by ��`,/ /1�
I0i --e--- � dri ' I- 3 /– ( )—
Recd. by Date— Total Fee $ Date
Form 214—IM-11-60.-5-B P
//� � ���
MACCO REALTY COMPANY
3800 EAST COAST HIGHWAY, CORONA DEL MAR, CALIF.
MAdison 5-1356 • ORiole 3-4220
May 28, 1963
Ed Horrocks, Deputy Building Inspector
City of Costa Mesa
Building Department
695 East 19th Street
Costa Mesa, California
Dear Ed:
This letter is in support of our recent telephone conversation
in which Macco Realty Company guarantees to replace, remodel,
and/or bring up to code any discrepancies in the Sales Office,
located at 1163 El Camino, in the City of Costa Mesa.
This is especially designed to guarantee you that we will close
off the door between the garage and what will be the bedroom
in the final home. We will also replace the glass doors on the
garage with proper wooden doors before we sell, lease, or give
up control of said building.
Very truly yours,
MACCO REALTY COMPANY
R. C. H•seley ., Authorized Agent
RCH:rl
cc: J. Parker
J. Munselle
H. Cregan
• 24244 CITY OF CLISIA MESA
COSTA MESA BUILDING-SAFETY DEPARTMENT JUN 2 1965
• P.O.BOX 317 COSTA MESA.CALIFORNIA
For Applicant to Fill In Completely r5PLIf�AT�Q OR P IT
dlp
TYPE OR PRINT , AI G
BUILDING ) _ /q/�N] + I`, b —For 1C
ADDRESS ///03 F�. ` ///' i/00 �"
I RECEIPT NO. PERMIT NO.
COSTA MESA, CALIFORNIA
RECEIV Y DA RE IVED .-DAT IBB ED
OWNER /L�,gppCCO R 4k-n� . .��/('o , y //A -3 6C
AD RE/S/�Hq COX 01.4
E GaAs / • . wtj Ng-FRERESS ////) -3 EL CkAA/pin
brz
OX O/L/a &� MAR NO.OR3f.Ga1 ZONE APPROV ` i TYPE GROUP
CITY ,,,,�����DDDDD /- /
ARCHITECT TEL. BY DATE 64 4(03.
OR ENGINEER NO. J -.e‘ -
JL ONING
A. S5
Aln ZON NO.OF USE OF NEVIS l0 1 O.A.2.,L.0
CONTRACTOR /F! ryCC l'1 / I PLANS I"MOM J, CernL•1
/�J{�L�,Y.� LEGAL /Ait a ca-n_ .96.-t,-
96.-t py 6
ADDRESS �/ a yv B .`��C a/Is IIIA .�I Hui DESCRIPTION ///�`J �'a "7--BMJ/ 7
CITY eOROA/ A ^..�S1- ., -1 A ✓Z A.P.NO. /]/ -. Sej-1/ /
�jpp r� q y� y�/ NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
LIC..NO.1FF0S- 5B-I NO.. 612 JTZ2 C) 30"TO SIDE ft REAR P.L.
EAVES
SIZE I NO.OF BUDGE. l ALLOWED (U.B.C.REQUIREMENT)
OF LOT NOW ON LOT /
YARDS APPROVED YARDS APPROVED
USE OF C�A��` G7MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. a �T (irri C
(FROM C/L REET1///I) A
SETBACK LINE FROM - FRONT FTC-12- f FT.
CENTER OF STREET REAR YARD I
SIDE YARD LEFT - - RIGHT R.SIDE FT.
DESCRIPTION OF WORK L.SIDE . FT.
N' _ ALTERATION ADDITION REAR FT. FT.
DISTANCE BET. BET.MAIN Et
RE. -et MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS.
VAR.# DATE
BUILDING - NO.OF.
SIZE ROOMS C STORIESI / C.U�.fPP.# 7�J APPROVED / �.�•
EXTERIOR WALL S I UCLet COVOERING SN 1N GL-L A" i D// ( 0 • DATE L -?----c, c7
/CUV OF OVERING pI En
y- �] --�
l A&F it
I AREn ! of PKE /-os1=4 /
4Mb CDNVC,rrEl 7-0- L CAft- C RP-L- 11.6( t9I't,I C.
CREBY 46-E /Ate/ S �� iv,24/ =
�` m
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VA ATION IS R THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FE ONLY. G
PLY WITH ALL CITY ORDINANCES ND STATE LAWS REGULATING VALUATION i.. p
BUILDING CONSTRUUcc//S�ON. ),� � �®�� - m0
PERMIT FEE 5 3
PERMITTEE OF
/I� •
f/y� LATI/✓V�)'W��•,(y B
PLAN CHECK $ s
AUTHORIZED AGENT . . •l a YJ 4
.TOTAL FEE $ ✓✓✓
. A
300
tz. 187n4 •
-^n t S- c7 PjlcoW 7•052 a***$53$
CQSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA. CALIFORNIA
•
For Applicant to Fill In Completely APPLICATION FOR PERMIT
n TYPE OR PRINT BUILDING
BUILDING it‘ . T \��'���
ADDRESS J C6-�y1.t/n..v Hyl (.
COSTA MESA. CALIFORNIA For Office Use Only
Mesa Del Mar Development Co.
OWNER I RECEIPT NO. / Y /p7
. MAIL RECEI '0 BY I D.TERECEIVE DATE ISSUED
ADDRESS 3800 E. Coast Hi•hwa i —/, - 6-
13 BUILDING ft.., 4,
•
CITY • Mar Calif. TOLADDRESS
• Realty Co. COSTA MESA. CALIFORNIA
AIRF �// lej
ZONE TYPE ! GROU
• • -• O. APPROVEDCONTRACTOR �/.�/
BY 7V DA
• iii
NING
ADDRESS
• ZONE NO.OF 'f USE OF NEW L 'qv. Ma,
CITY R—( I PLANS /��I BUILDING W//'B/? c,
STATE .207343-SB-ILIC.
NO. LEGAL ,r�-4 ha •(,o Rt.F�t ( r II
DESCRIPTION O(, Il•'
SIZE
LOT 10,416 5, F. I NO. OF BLOC@.,one v
NOW ON LOTI V A.P.NO. u ✓I (/1/W
USE OF None YARDS EVES 111
EXISTING BLDG. APPROVED ALLOWED
SETBACK LINE PROM L2I - 491 (CENTER LINE ST.)
CENTER OP STREET VL REAR YARD FRONT ). O 1- FT. IN.
101 51511 6
SIDE YARD LEFT RIGHT . R.SIDE .�. FT. IN.
DESCRIPTION OF WORK - .—
L.SIDE /� FT. IN.
NEW I X II ALTERATION II ADDITION I. - REAR . r[� 9 T FT. IN.
REP.. I II MOVING I II DEMOLISH I APPROVED . ✓p�� DATE 7-4-11C3
SIZEDING601X501 ppppp��f��RNO. OF OOMS 5 STORIES I °��fY
EXTERIOR WALL Wood ROOF Wood Shake
COVERINGµSStu Stucco pRI ICOVpERRING�Rpp ,/,
tfn°9ge ramlly Ker. V AtEr.P�7arRMED L///.ud AREA g, TSF
�CA.cl 300 -(9 6,4844E NS/a jic
• I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM-
. PURPOSE OP, ESTABLISHING A PERMIT FEE ONLY.
PLY WITHALL ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION SIGN �7 •
SE MATURE OF Mesa Del Mar Develo ment Co. PERMIT FEE $ /�f—r N
y �/ $ 17,060.00 PLAN CHECK $ Cf J/✓C
AUTHORIZED AGENT eO�J ,C d��T`' ��/rt Q
TOTAL FEE ,l E