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Home My WebLink About1914 FEDERAL AVE - Building PermitsCITY OF COSTA MESA BUILDING DIVISION } DEVELOPMENT SERVICES DEPARTMENT �• PERMIT PERMIT NUMBER E98-00858 (714) 754-5273 Fax (714) 754-4856 •77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Owner: BASSETT, VERONICA Address 1914FEDERALAVE - Phone: 949-645-3487 - COSTA MESA,CA Zip: 92627 Contractor: ' GILBERTSON ELECTRIC Address: 24661 rhea dr Phone 949-830-6590 mission viejo,ca 1 - Zip: 92691 License: 562188 i SCOPE OF PERMIT 100AMP SERVICE UPGRADE. Job Address: 1914 FEDERAL AV Status: ISSUED Suite No Applied: 08/1311998 Vicinity: Issued: 08/1311998 Parcel Nunmber: 42251116 Applicant: JAMES GILBERTSON Address: $22.00 Phone: $0.00 Zip: Owner: BASSETT, VERONICA Address 1914FEDERALAVE - Phone: 949-645-3487 - COSTA MESA,CA Zip: 92627 Contractor: ' GILBERTSON ELECTRIC Address: 24661 rhea dr Phone 949-830-6590 mission viejo,ca 1 - Zip: 92691 License: 562188 i SCOPE OF PERMIT 100AMP SERVICE UPGRADE. COMMENTS / SPECIAL CONDITIONS EXPIRATION: This permit shell automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 FEE SUMMARY Quantity Quantity ISSUE FEE $22.00 Temp Dist System / Lighting $0.00 0 Temp service test $0.00 Busway /100 It $0.00 0 Res. a/c package $0.00 Standing Section $0.00 0 New Res (1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res (3+units) $0.00 0 Transformers up to 1 kvalkw $0.00 0 Pool / Spa $0.00 0 ................up to 10 kvalkw $0.00 0 Lighting Fixts $0.00 0 .................up to 50 kvalkw $0.00 0 Recept Outlets $0.00 0 .................up to 100 kva/kw $0.00 0 Switches $0.00 0 ..................over 100 kvalkw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System / Ckt $0.00 0 Service to 200a $27.25 1 Misc. Conduit $0.00 0 Service to 1000a $0.00 0 Misc. Conductor $0.00 0 Service over 1000a $0.00 0 Circus ( gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus (mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits '$0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $49.25 Intermed Pole $0.00 0 COMMENTS / SPECIAL CONDITIONS EXPIRATION: This permit shell automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this penmit is issued. My workers' compensation Insurance carrier and policy number are: Carder. 1 Policy Number. (This section need not be completed If the permit is valued atone hundred dollars ($100) or less.) I codify that In N rformenca of the work whiU this permit is Issued. I shall not employ any person In any manner SO as to become subject to the workers' pensellon la s i elifomla, antl egr ii uld bJect to the workers' compensatlon provisions of Section 3700 of thhhoa�.{66..ape/Code, I shall fol wilh- comply with lhes 's'o /J _ 7// Applicant Signature: Dale: 5 lxJ WARNING: FAILURE TO SECURE WORKERS' ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL FINES UP TO ONE HUNDRED TFKKISAND pOLLARE (5100,000), IN ADDITION TO E COSI OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under pro gns ofT t (commencing with Sec�ion 7000) of Division 3 of the Businessf)nd Pro�sions Code, and my license isn full force and effect. Llc. k Class q Contractor's Signature: / Dater / CONSTRUCTION LENDING AGENCY: "TT" ❑ 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby aOlrm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty o1 not more than five hundred dollars (5500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Lew does not apply to an owner of property who builds or improves thereon, and who does such work himself or nerselt or through his or her own employees, provided that such Improvements are not intended or offered for sale. Ii, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the properly, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ NO Drivers License No. Expires: Verification of Ownership by (type of document, Le. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation live (5) or more feet in depth Into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, Scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec, 341, Title B. California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressed gas at Standard temperature and pressure). .................................................................................................................................................................................................................................................................................... 2 Does or will the applicant or present or lulure building ocwpant need to Ille a registration form for acutely hezerlous materiels? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .................................................................................................................................................................................................................................................................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutey hazardous materials)? ❑ Yes ❑ NO (Section 25534 of the California Health and Safety Code provides that the Costa Mese Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the F re Department. .......................................................................................................................................................................................................... 4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied wfth? ❑ Yes ❑ No .................................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building Occupant require for the work which is the subject of this a plicatlon aPemit for such construction or modification from the South Coast Air Quality Management District or from any other Sir pollution control district or agency? Yes LJ No (Section 650502 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ................................................................................................................................................................................................................................................................................... 6 WII any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ................................................................................................................................................................................................................................................ 7 If a pereit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, nave all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ......................................................................................................................................................................................................._.......................................................................... B (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I cartly that under penalty of perjury the information given above Is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE Of COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above -d cribed properly for Inspection purposes. I agree not to occupy or allow Occupancy of any building authorized by this pernit until final inspection. SI tl/Or Authorized Applicant Date CODED. ESPEGIalc PE DATE INIT[IIALS CODE! INSPECTION TYPE gA¢ gMMAt$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re'Rool 210 Final Electrical ' �81 201 Final BIdciuRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Anal Demolition 250 Final Bullding/Occupancy 244648 CITY OF COSTA MESA CALIFORNIA 92626 F.O. SOx 1200 FROM THE OFFICE OF THE DIRECTOR OF BUILDING SAFETY Project Address / l l- y../ti' d&4 A .� J Project Name Owners Name Owners Address "J Owners Telephone ":9 Perini t Type z ' City Use Only �� as Owner, Contractor, Agent (strike out all except re) do hereby Wttest that employment of any person, or persons, is not anti4iJ ated at the time of seeking the above -referenced permit. In the.event that any person, or persons, are employed under the provisions of this permit, I shall immediately cause a valid Certificate of Workmen Compensation to be filed with the Costa Mesa Building Division. I agree to defend at my own cost, and to indemnify and hold harmless, the City, its officers, agents and/or employees, from arra against, any and all liability, damage, costs, losses, claims and expenses, howsoever caused, resulting directly or indirectly from, or connected with the improvement under this permit. I further state that I have read and fully understand sponsibilities of the above statements, and will cmply Contractors State License Law found under the Business Division 3, Chapter 9, of the State of California. 1lRy RL229o/ Print Name ature the implications and re - with all provisions of the and Professions Code, 61114,11- �? 6 Date V1L . WL ZaV 1'. BUILDING PERMIT NO. GENERAL CONTRACTOR Owner-Blclr. DESCRIPTION OF WORK L)et.J AT vn 119-481-16 LOT TRACT FIRE 7nMW VA1.11F It L XTIONS Signature Date GROUP J TYPE V ZONE Rl Soil SUBCONTRACTOR PERMITS ISSUED Gas I Date Number Signature Water Plumbing Hough Plumbing Prop. Swr. Line D House Con. ❑ Sprinkling System Miscellaneous Rough Heating and Air Conditioning Temporary Service or Pole Underground ❑ Power a Rou h Winn V;11 _-Heating and Vent. Trenches Forms,& Steel Reinf, ❑ - Floor System _ Bond Beam ❑ Steel Reinforce 0 Sheathing Frame and Flashing Lathing — In ❑ Out {] Plaster, Brown Coat S ural, Final Elec 'c R, -.mg, Vent., Refrig. and A.C., Final Plumbing, Final and Gas Test ❑ Electric, Final Building, Finai - �C Special Requirements I I_ EOSTA �dESA BUILDILv-SAFETY DEPARTMENT BOX 317 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINT BUILDING cci2r41/ e— ADDRESS O COSTA MESA, CALIFORNIA 0 ARCHITECT t - TEL 4i TY OF L]S'tA MESA MAR 10 1965 For Office Use Only RECEIPT NO. I yly O SETBACK LINE FROM �T .. I S1 1 DESCRIPTION OF WORK ■ ■ EXTERIOR VIHEREBY ACK ANO STATE TH PLY WITH ALL Bm1.DING CON 0 AUTHORIZED AGENT ROOF 1 HAVE READ THIS APPLICATION CORRECT AND AGREE TO COM. 9 ANVXrK "Wo ^eG TING !\ DISTANCE BET. BET. MAIN 9 MAIN BLDGS. ACCESS. BLI VAR.# DATE C.U.P.# APPROVED APPROVED I I I JO�— THE AMOUNT SHOWN UNDER VALUATIONIS FOR THE Z PU RPOEE OF ESTABLISHING A PERMIT FEE ONLY. D VALUATION �. I PERMIT FEE $ N yam, PLAN CHECK SZ 4 TOTAL FEE $ /3 PLAN. �- I -I OF NEW BUILDING q vr �1 LEGAL DESCRIPTION A. P. NO. NOTE: NO EAV E OVERHANG SHALL BE LESS THAN 30' TO SIDE @ REAR P. L. EAVES ALLOWED (U. B. C. REQUIREMENT) F GLOSS. GN LOT YARDS APPROVED MAIN BUILDING YARDS APPROVED ACCESSORY BUILDING O SETBACK LINE FROM �T .. I S1 1 DESCRIPTION OF WORK ■ ■ EXTERIOR VIHEREBY ACK ANO STATE TH PLY WITH ALL Bm1.DING CON 0 AUTHORIZED AGENT ROOF 1 HAVE READ THIS APPLICATION CORRECT AND AGREE TO COM. 9 ANVXrK "Wo ^eG TING !\ DISTANCE BET. BET. MAIN 9 MAIN BLDGS. ACCESS. BLI VAR.# DATE C.U.P.# APPROVED APPROVED I I I JO�— THE AMOUNT SHOWN UNDER VALUATIONIS FOR THE Z PU RPOEE OF ESTABLISHING A PERMIT FEE ONLY. D VALUATION �. I PERMIT FEE $ N yam, PLAN CHECK SZ 4 TOTAL FEE $ /3 UWNti< M1 VipoluhUY UA I C —' -- JOB ADDRESS 1914 Federal Avenue BUILDING PERMIT N0. 49491 D. 115-4R1-16 FIRE ZONE VALUE S II XTIONS Signature Date ITYPE y GROUP I ZONE Rl SOIL SUBCONTRACTOR p HITS ISS ED GAS Date Number Si nature WATER PI umbin _ ROUGH PLUMBING PROP. SWR. LINE 0 HOUSE CON. O SPRINKLING SYSTEM MISCELLANCOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER ROUGH WIRS -/ Heatingand Vent. TRENCHES FORMS STEEL REINF. FLOOR SYSTEM it BOND BEAM STEEL REINFORCE , r t SHEATHING ir omp e e ns ectlon FRAME AND FLASHING Ca cel LATHING — IN Lj OUT PLASTER,BROWN COAT S_' -TUBAL, FINAL M. W. VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST ' ELECTRIC, FINAL BUILDING, FINSL CPFf ILI RFnIIIRFMKNTS se r� C. ...._—COSTA MESA BUILDING-' METYDEPARTMENT APPLICATIO. JRI:STRU��TURAPLPERMIT 54.50 P.O_ BOX 1200 COSTA ME A_ CALIFORNIA 92626 For Applicant to Fill in Co pletely — Use Ink Only BUILDING ADDRESS RECEIVE By PERMIT A.P. N BUI ADDRESSLDING '9/4/ F6D6- OWNER ORRa. TENANT UNIT OR SPACE NO. MAILIN� S / ADDRESS TR.NO. LOT BLK. �� /��) CIT OIDTQ07 NEW ADD ALTER IREPAIR IMOVINGIDEMOLISH CONSTRUCTION LENDER BRANCH OWNER ADDRESS USE OO VALUE$ // ARCHITECT TEL. OR ENGINEER N ZONE PE GROUP ADDRESS CONTRACTOR t APPROVED Q BY GATE IQ ADDRESS TEL. CITY NO. STATE CITY LIC. NO. LIC. NO. APPROVED SETBACKS SIZE OF LOT NO. OF BLDCS. NOW ON LOT (FROM C/L STRFET) NTFT. USE OF EXISTING BLDG. R. SIDE Separate permits are required for electric, plumbing and heating work. L. SIDE FT_ REAR USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION DATE APPROVED APPROVE X1/7 CACI I hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I am exempt from the provisions of the State of California Business end Professions Code, Division 3, Chepte B. Signature 1/� Permittee �� ,�J(///�/� SD. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESi LISHI G A PER T FEE NLY: VALUATION S /� /1 ()C) 11 IJ d� PLAN CHECK y V TAX $ or �•7 H Authorized Agent ate C C� TOTAL PAID TL ORANGE COUNTY BUILDING DEPARTMENT f North Broadway SAN'. .NA, CALIFORNIA APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN RECEIPT NO: Gjf s (� .: PERMIT NO. 4t? 3 a BUILDINGl1914 Federa Ava 1 SCHOOL DIST. RED BY -" DATE OF APPL. DATE ISSUED OR TOWN NEAREST CROSS ST. 19th St OWNER ALEUT HOMES, INC. All RESS MAIL ADDRESS 9363 WILSHI RE BLVD., SCHOOL DIST. OR TOWN p �% //��.W J 07 �/ PrC CITY BEVERLY HILLS Np' CR.54361 NEAREST^ CROSS ST. ARCHITE T g p Wo� -6Y.64891 ZOI TYPE ANS ENGINEER & MCKERRAC HE I PN I i nDl.A1N ADDRESS 2110 E. WALNUT ST. PASADENA SETBACK LINE REAR YARD S�� OM EN ER OF ST. CyS••Jy'1—.1y- 1 �11 IDE YARD t -4— T TEL. , CONTRACTOR NEWPORT VISTA CO NO.CR. 54361 APPROVED BY DATE ADDRESS 9363 WILSHIRE BLVD. BEV. HILLS CORRECTIONS 1 I LEGAL I DESCRIPTION LOT NO. 4 BLOCK 712 (ATTACH METES 8 BOUNDS( _ 1 TRACT /� NO. OF 66 �0 I ' SIZE OF LOT x NOW ON LOTS 0 USE OF NO. OF NO. OF I EXISTING BLDG. F. M.ILIES ROOMS DESCRIPTION OF WORK D NEW I x I ALTERATION I I ADDITION I _A O REPAIR I I MOVING I I DEMOLISH I Z BUILDING NO. OF r SIZE 351 x 381 ROOMS_5 STORIES WALL IROOF COMPO STUCCO COVERING COVERING SMI N(:1 FS USE OF NEW BUILDING RESIDENCE . g. APPROVALS FOUNDATION: LOCATION INSPECTOR DATE I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS FORMS. MATERIALS, APPLICATION -AND STATE THAT THE ABOVE IS CORRECT UNDERPINNING FRAME: FIRE STOPS. A AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. BRACING, BOLTS LATH. IrJ7. SIGNATURE OF NEWPORT VIST CO. LATH. EXT. PERMITTEE. PLASTER. INT. S AGT PLASTER, EXT. nn s 4830.00 P C. $ Z MASONRY REINFORCED FEE )-4, S BOND BEAM J / 3 VALUATION — FEE FINAL i j:1 Z W Z J � J a PLOT PLAN ' O i . O W N - - STREET I I v a i� 133 1/I8/60 36.31 TL COSTA MESA BUILDING40,1,,' iTY DEPARTMENT APPLICATIO1 R STRUCTURAL PERMIT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only RECEI Y PERMIT BUILDING / / ADDRESS A.P. NO. BUILDING ADDRESS OWNER OR �,/t D TENANT UNIT SPACE NO. MAILING cA _ ADDRESS TR.NO. LOT BLK. TEL. CITY NO. NEW ADD ALTER IREPAIR IMOVING JOEMOLISH CONSTRUCTION LENDER BRANCH OWNER ADDRESS USE � . VALUE E ARCHITECT TEL. OR ENGINEER ZONE TYPE GROUP ADDRESS CONTRACTOR APPROVED Y DATE ADDRESS TEL. CITY NO. STATE CITY LIC. NO. LIC. NO. APPROVED SETBACKS SIZE NO. OF BLDG3. OF LOT NOW ON LOT (FROM C/L STREET) FRONT FT. USE OF EXISTING BLDG. Separate permits are required for electric, plumbing and heating work. L. SIDE FT. REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION / [ DATE APPROVED APPROVED DATE I hereby acknowledge that 1 have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and affect, or I em exempt from the provisions of the State of California Business end Professions Code, Division 3, Chapter 9. Signature of, / ��.. (,� • Permittee �(yY� SO. FT. •_ THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION ^ ' S // y '��/////J PERMIT FEE E PLAN CHECK E TAX E or p Authorl.. Agent r.Xate 11440 TOTALPAID E 3