HomeMy WebLinkAbout2141 ASTER PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
JobAddress: 2141 ASTERPL
Suite:
Viciniry:
Parcel Number: 42615122
Zoning:
Applicant: CHRIS KING CONSTRUCTION INC
Address: . 29592 ANA MARIA LANE
Phone: 949-249-5512
LAGUNA NIGUEL, CA Zip: 92677
Owner: ACORD, MICHAEL PATRICK TR
Address 2141 ASTER PL
COSTA MESA, CA
Phone:
Zip: 92627
Contractor. CHRIS KING CONSTRUCTION INC
Address: 29592 ANA MARIA LANE
Arch :
Address:
Phone: 949-249-5512
IAGUNA NIGUEL, CA
Zip: 92677 License: 800201
Phone:
Eng:
Address:
Status: ISSUED
Applied: Ot/18l2005
Issued: Ot/18/2005
ISSUED BY:
Phone:
Zip: License: License:
SCOPE OF PERMIT
CHANGE OUT 5 WINDOWS THROUGHOUT S.F.D. TO MEET 7997 U.B.C. EGRESS REQUIREMENTS. REPLACE WITH DUAL PANE, VINYL AND
WOOD WINDOWS. HEADERS WILL REMAIN THE SAME. CHANGE OUT SIDING IN FRONT OF S.F.D.
Plan Check: $0.00
Permit: $293.25
SMIP Res: $1.80
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $295.05
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existin : 0
Rear 0- 0
Rear 0- 0
Re uired: 0
FEE SUMMARY
Calc Valuation: Sia,000.00
Claim Valuation: $�s,000.00
PLANNING & ZONING
Left 0- 0 Right
Left 0- 0 Right
Proposed: 0
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void iF work is not commenced within 1 BO 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
I reqWred Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of �his permit.
FOR INSPECTIONS CALL: (774) 7545626
24d6i6 (fiN0)
WORKEHS'COMPENSAnON DECLARAnON:
I hereby affirtn under penalry oi perjury one of Ihe following declarations:
❑ I have and wlll melntaln e certificate ot consent ta self-Insure tor workers' compensetlon, es provitleC for by section 3700 af the Lebor Code, for the pertormflnce ot the
wark for which �his permi� is issued.
I,have end will meinlain workere' compensation insurance, es requiretl by sectlon 3700 ot ihe Lebor Code, tor the perfortnance of the work for which this pertnit is issued.
(ay workers' compensatlon Insu/anca carrier and palicy numbar ere:
��arrier:_: �r�{-T�, FUN� aoncyNu'"oe5 �¢�In�i%
� section need not be completed ll the permit /s va/ued at one hundretl tlollers ($700) ar /ess.)
❑ I certiy that in the pedortnance of Ne work for which t�is pertnit is Issued, I shall not employ eny Derson in any menner so as to become subject to the warkers'
wmpensation lews of Celifomie, entl egree that If I shoul0 become subject to the workers' compensatlon provisions of Section 3700 ot the Labor Code, I shall forthwi[�
com ly with�these proWsions. t
lys,ucant sig u�e':> �,.�--�'�c���. o,lL_i� ,��p � e exi�'.�s�- /•/7 ' 0 7
WARMNG: FAILURE TO SECURE WORKERS' COMPENSATION COV MGE IS UE NLAWNL M!D SHALL SUBJECT AN EMPIDYER'fp CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNORED
TNOUSANP DOLL4RE ($100,000), IN ADDITION TO THE COST OF CAMPENSATION, DAMAC+ES AS PROVIDED F9R IN SEGTION 3]Ofi OF THE LABOR CAOE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirtn ihat I am license�untler provisions ot Chapter 9(commencing with Section 7000) of Division�iqe�Busiiress and Professions Code, end my license Is in full
CONSTRUCTION LENDING AGENCY: .
❑ I hereby aHirtn that there is e consiruction lending agency tor Ihe perfortnance of the work for which this pertnit is issuetl. (Sec. 3097, Civil Code).
Lentlels Name: Lendefs Address:
Signeture: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eHirtn ihet untler penalTy of perjury �hat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the tollowing reason (Sec. 7031.5, Business antl Professions
Code: Any ciry or county which requires e permit to constmct, elter, improve, demoiish, or repair any structure, prior to its issuance, elso requires ihe applicant for such pertnit
to file a signed stetement ihet he or she Is Ilcensed pursuent to the provisions oi ihe Contrectors Llcense Lew (Chepter 9(commendng with Section 7000) of Divislon 3 at ihe
Business end Profeulons Code) or thet he or she is exempt Iherefrom entl the 6esis for the alleged exemption. Any violetion of Section 7031.5 by eny applicent for a permit
subjecis ihe applicant to a civil penalry of not more t�en five �untlred dollers ($500).):
❑ I, as owner ot ihe propeny, or my employees with weges as iheir sole compensation, WILL DO 7HE WORK, end Ihe structure Is not intendetl or oftered tor sale (Sec.
7044, Business and Professions Code: The Contrectors License Law does not apply to an owner of property who builds or improves thereon, enG who does such work
himself or herself or ihrough his or her own employees, provided thet such improvemenis are not intended or oflered lor sale. It, however, Ihe building or improvement is
sold within one year ot completion, Ihe owner-builder will heve ihe burden of proving ihat he or she did not build or improve tor purpose of sala.). '
❑ I, as owner oi Ihe properry, em EXCWSNELY CON7RAC71NG WI7H LICENSED CONTRAC70RS to constmct the prqect (Sec. 7044, Business antl Professions
Cotle: The cantractors License Law tloes not apply to an owner ot propetly who builds or impmves thereon, and who contracts for such project with a cantracror(s)
. license pursuant to the Comractors License Laws.).
❑ I am esempt undar sec.
SigneNre:
Owner ID verifietl by tlnver's license. ❑ Yes ❑ No
Busine55 end Proiessions Code for �hi5 ree5on:
Venficatlon ot Ownerehip by (rype of daumenL i.e. - property tex bill or deed):
Driver's License No.
Date:
Expires:
DIVISION OF INOUSTRIAL SAFETV PERMIT CER7IFICATION:
❑ I hereby certity ihat no ezcavation five (5) or more feet in tlepth into which e person is required to descend, will be matle in connection with work euthonzed by ihls
permit, and that no building structure, scaftoldinq, talsework, or demolition or dismantling thereof, will be more Ihan thirry-siz (36) teet high. (Chap. 3.2, Gry 2, Art 2, Sec.
341, Ttle B, Califomla Atlministrativa Code).
❑ As awner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Satary, es notetl ebove, unless such persan has e
permit to do such work irom the division.
Signatura: Data:
Division of Intlustnal Safery Permit Number:
ICERTIFlCATE OF COMPLIANCE AND AUTHORVA710N OF ENfFiV: I certify under penalry ot peryury that I have read Ihis application and state that the information given is I
correct I egree b comply with all state laws end city ordinances relating to building construc�ion, and eu�horize representatives ot Ihe Ciry of Costa Mesa to enter upon Ihe
ebove-described Droperly far inspection puryoses. I egree not to occupy or allow occupency ot eny building euthorized by this permit until final inspection.
COOE t. INSFECPONTYPE
1616 Fized System Finel Fire Prevention
1266 Pool Spa Final
200 Final Re-Root
201 Final BIocWRetaining Well
202 Final Fectory Fire Place
203 Final Sign
204 Final Demoliiion
�I� �MRULS
CppE 1 INSPECTION TYPE
206 Final Mechanical
20B Finel Plumbing
210 Finel Electncal
212 Finel Flre Prevention
220 Flnal Planning Approval
222 Flnal Site
250 Final Building/Occupency
PiTE Ixmu�S
�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: R141 ASTER PL
Suite:
Vicinity:
Parcel Number: 42615122
Applicant: UNKNOWN
Address:
Zoning:
Phone:
2ip:
Owner: ACORD, MICHAEL PATRICK TR
Address 2141 ASTER PL
COSTA MESA, CA
Contracror. CHUCK WAITE CUSTOM
Address: 286 WALNUT
CA
COSTA MESA
Zip: 92627
Arch :
Address:
Phone:
Phone:
Zip: 92627 .
Phone: 949.722.1134
License: 667291
Eng:
Address:
Status: ISSUED
Applied: 01/04/2001
Issued: 01/15/2001
ISSUED BY: <�,_
Phone:
Zip: License: License:
SCOPE OF PERMIT
55 LINEAL FEET OF 6' HIGH BLOCK WALL ALONG THE SIDE OF THE PROPERTY.
Plen Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$27.17
$41.80
$0.50
$0.00
$0.00
$0.00
$69.47
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 42-6
PARKING Ezistinq. o
NOTES:
Rear 0- 0
Rear 0- 0
R uired. 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Pro osed'. 0
Calc Valuation:
Claim Valuation:
Right 0-0
Right 0-0
$�,ioo.00
so.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inapectiona end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOA fNSPECSIONS CALL: (714) 7545626
?oe�aslaoo�
WORKERS'COMPENSAnON DECLARATON: �
I hereby attirm under penalry of perjury one of the following declaretions:
❑ I have end will maintain a certificate of consent to self-Insure for workers' compensetion, as provided tor by section 3700 of the Le6or Code, for the peAormance of the
work for which IhiS permit is is5ued.
❑ I have entl will mainiain workers' compensation insurance, as required by section 3700 of the Labor Code, for Ihe pertortnance of the work Por which this pertnit is issued.
�My wocrke[�s comypens�a,tion Insurance carner antl poll number are: v�
Ca r `l -� `— � �`� N � Policy Numher: (70 Z � % �
(Th/s ecfion need not /eted il alued et one hunOretl tlollars (5100) o� /ess.) .
❑ I certih/ that i ihe pedorm c of ih w tor whi Ihis permit is issued, I shall not employ any person in eny manner so as to aecome sugj to the workers'
compe ' of Calif r ia, e agr s ultl�he ome sub�ect to ihe workers' compensatlon provislons of Section �700 ot U4 r Qotle, I shall torthwith
with
LICENSED CI
I haraby aflirtn
torce end eltef
SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND;
100,000�, IN ADDITIqJ TO THE COST OF CAMPENSNTION, �AMAGES AS
licen5ed
9 (commencing with
� � i
Date:
AN EMPLOYER RIMINAL PENALTIES/
INSECTIIXJ THELABORCOOE�M
ivision 351 Ihe Business and Plotessi
�
CIVIL FINES UP TOONE HUNDRED
EST, AND ATTORNEI^S FEES.
Code, antl my license is in tull
CONS�Bf�.Gi10R LENDING AGENCV:
❑ I hereby a%irm that there is a construction lending agancy for Ihe peAortnance of the work for which ihis Dermit is issued. (Sec. 3097, Civil Cotle).
Lender's Neme: Lentler's Adtlress:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eXirtn thet under penelry of perjury ihat I em E%EMPT FiiOM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Buslness and Protesslons
Gotle: Any ciry or counry which requires a pertnit to construct, alter, impmve, demolish, or repair any strucwre, pnor to its issuence, also requires Ihe applicant for such pertnit
�o file a signed statement Ihet he or she is licensed pursuaN to the provisions of Ihe Contractors License Law (Chepter 9(commencing with Section 7000) of Divislon 3 of ihe
Business antl Professions Code) or thet he or she is exempt theretrom and the 6asis lor the elleged exemption. Any violation of Section 7031.5 by any applicant for a pertnit
suDjects the applicant to a civil penalry of not mora than five hundred dollars (5500).):
❑ I, as owner of ihe property, or my employees with wages as iheir sole compensation, WILL DO THE WORK, antl the structure Is not intentletl or oNered for sele (Sec.
7044, Business end Professions Code: The Contractors License Law tloes not appiy to en owner of property who builds or improves ihereon, and who tloes such work
himsetl or herself or through his or her own employees, providetl ihat such improvements ara not intentletl or oHeretl for sele. It, however, the builtling or improvement is
sold within one year of completion, the owner-builder will have the burtlen ot proving ihat he or she did not huiltl or improve for purpase ol sale.).
❑ I, as owner of the pmperty, am EXCWSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consimct the project (SecJ044, Business and Professions
Cotla: The contradors License Lew does not apply to an owner of propeny who bulltls or Impmves thereon, end who contracts tor such pmject with a contrector(s)
license pursuem to the Coniractors License Laws.).
❑ I am exempt under sec. Business antl Professions Code tor ihis reason:
Siqnature: Date:
Owner ID verified by dnver5license. ❑ Ves ❑ No Oriver5 Licensa No. Expires:
Veritication of Ownership by (type ot tlocument, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICA710N:
❑ I hereby certify ihat no excavation five (5) or more teei in dep�h into which e person is required to descend, will be made in connection with work euthonzed by ihis
partnit, antl t�a� no builtling siructure, swflolding, talsework, or demolition or tlismantling ihereoi, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Ttle B, Calitomia Atlministrative Code).
❑ As owner-builtler, I will not employ anyone to do work which would require e permit irom the Division of Industrial Sefety, es noted ebove, unless such person hes e
permil lo da such work irom the division.
SignaNre: Date:
Division of Industrial Safery Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certity under penalty of perjury that I have read �his applica�ion and s�ete that �he informa�ion given is
correct gree omply with all laws end ciry ordinances rela�ing Io building consimction, and authonze represeniatives ot �he Ciry of Costa Mesa to enter upon the
ebo -descri6ed pro rty lo � sp tion p oses. I egree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
COUE L INSPECTIONTYPE �-�—�
1616 Fixed System Final Fire Prevention
1266 Pool Spe Flnal
200 Final Re-Roof
201 Final BIocWRet�'w�p¢Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
u_mu:��.y
COpEN INSPEGTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electncal
212 Finel Fire Pravantion
220 Final Planning Approval
222 FinalSite
250 Final Building/Occupancy
J
PAg U�IIELB
,
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PARTY WALL AGREEMEP.�T� � A�` ��
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�_� I� �\
t
THIS AGFiEEMENT, made and entered into this —� _>>_
, by and between � � ' �~ ✓� � _��
hereinafter referred to as "LANDOWNER;' and � 2� a� �%� �`
hereinafter referred to as "ADJACENT PROPERTY OWNER"
�. ,
4
�
�
_ day of
It is hereby agreed that a party wall wiil be consYructed on the property line
between
1,
— - --- -- — .. - � --
in the City of Costa Mesa, County of Orange, State of California, as per map recorded �'
in Book jH3 , Page � of Misceilaneous Maps, in the office of the Counly Racorder
of said County. The party wall shall be permitted to encroach �-
IN WITNESS WHEREOF, the parties have entered into this Agreement the day and
year first above written.
LANDOWNER
-1���c�-
" ignaturel
_�1Z i� (` f � (:�D (' � -----
Name (Taped Printed) '
.� �"-11 ��f ✓` f � ct L ��'1_ f 2(02'� 2��5'7-.z r V' �!x c-2 � M�.21P2>
(Nddress) � (Address) �
:`il,�:�inlL.l���'�I htl:iji�.�L1
15CE �d
• THLS SKEfQ-i LS FOR WFORMATIONAL PURACS6
ONLY. APPLCANT IS RESPONSIBLE FOR PROVIDPIG
AN ACCURATE RFPRFSENIATION OF 7}�Qt PROPER7Y
A1 CASE TI-IE SHAPE AND S7ZE DO N07 CORRF_SPOND
WITH 7'F� INFORMATION PROVIDID ON i}DS S}�F.7'.
�, � Y, y� .�,�. j-; �
= 7:�1 ._'��J .il
rI�Y v; .._-� P:1cSA
i'LF.:d�"':.�:.v DIV.
_i . ; � _.. � � (l --:iU. �GI� 1 . fYC.rl.
(', /
�'.1 i��aT� %t �r i c
• SOLID WALLS/FENQ�S BEIWFFlJ 2'�' k 6' IN}ff7G7iT SHALL
HE SbTBAIX A7 LEASIIO' FROM FRONI' PROPF�CfY 1.INE
• SOLID WALLS/FIIJ�55 SFULL NOL &X� 2' 6' PI i�]Gtit
WIf}IIN ld OF ]HE iROM PROPFR7Y IINE �107 CUBH I]Nt)•
• VFRIFY D6fAN� FROM CURH TO YROPFRIY LiNE
AND SHOW ON PLAN, YFitII�iGilON FROM THE QIYS
FNGINffitING DN6fON S REQUIRED. GIl. (714) 754,53�4 .
AOR INPORMATION.
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�_' _ - - , .. ,. s�"-i . .. - . . . S� . :>:= :. .,. _il tiP.E
� make any changes o; alteral�on on Lr,�r; wfliroN Ev!it:� er.vnis: �r���
_ . �.1- .d. f.. C.. �.�k _. .z�. _ � �
it is �n
sion of
me stamp:ng o( this plan and sp.�i icalioas SNP.LL �lOT ba i�s:d io pertr�it or lo be �
ur Ih v� _' � any provis:or.s ci as•r Citc uf !;os!a ;Ae;.�. Ub:�ance anNor
� ����
i'�e , ,: mtshaitez�inr6yn � �, r� iliP,e
work is not cemrr�c; csd;nd r�0131i1c� cFi:� per ��� �3f3 i;� wfhin ;;� �Sr!s o
BLOCK WALL LAYOUT FOR BUILDING PERMIT
PLANNING DIVISION
lew.
:
T Y PI C AL 6�� CONCRETE BLOCK FENCE
Cement Coping Op�ional —
ChannelBbck Wi[h 1�3/8�
Hori:ontal Top ol all
f ences
For Fences 5' or less
Vef�. Bars 3/8"4 at 4' �0" O.C.
For Fencef Higher Than 5'
Vert. Ban 3/8"� at 32" O.C. �
Fill Cells $olid With Grout
Where Steel Occurs
Rrinlnrcing Sleel $hall
Conlorm to Sec.A�15�39
A.S.T.M,
All Steel to 6e Lapped
24" or to Code
NATURALGHADE
TWO 7/8"O BARS
CONTINUOUSTOV I
B BOTTOM �_�
HORIZSTEEL MUST BE TIED �N
VLACE AT TIME OF THENCH
INSPECTION.
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� SEE CMe
I = BELOw
D
WIOTH
THVCKNESS
DEPTM OF �ARTHTOOTM
SPACING OF EARTHTOOTH
14��
10�
2 4"
12'
FOOTING RE�UIREMENTS CHART
I4.
10"
20"
14�
BUILDING DIVISION
12-
B"
16„
16'
GENERAL- NOTES
MORTAR: pne Pa�t Plaslic Cement, and
Three Parts Sand
GFOUT; One Purl Cemenf Three ana
Onfl Nulf Paris S�and
COPING: One Part Cement, Three
Parts Sand
CONCfiETE: Weil M��ed 1:2-V2:3-i/2
Ma■ ol 7-I/2 Gal�cns of
Waler Per Sack of Ceme�t
GROUT MAV 9E POURED FROM TME TOP
OF iNE FENCE IN CELLS WHERE STEEL
OCCURS.
CEltS ANO AREASOF N�Rt20NTAL REIN
FORCEMENT SHALL BE CLEAq, CLEAN 6
FREE OF AlL MORTAH DEBRIS. ETC.
ll L1 LARTHICDIH
V! friE NE�GTN 0� FENCE
�LOw BOT7pM 0� GOG7iNG
SCALE: I/2�� = 1
12"
8"
12"
�6�
^_r � .. .� —
. ����`Z 1 �. � � ! � Sl �-, a u .-. ^�
� 1PR 2 S i£fiV
COSTA MESA BUILDING-SAFETY DEPARTMENT fINAh�CE DEPT.
P. o. aoX s�� COBTA M�A. CAL�FORNIA CITY Of COSTA MESA
For Applieanf fio Fill In Complefely APPLICATION FOR PERMIT
TYPE OR PRINT
BUILDING BUILDING
ADDRESS 21 Aster Place
COSTA.MESA. CAUFORNIA FOr Offiee Use DO��/
OWNER Irying C.. _ JOPC18r1 ' nece�rT NO. I �PERM�T NO�
S
' MAIL R¢CE� Y I DATE RECEIVED I DAT6 IBSUCD�
wooeess 00 Ne ort Blvd. � � a��
C�Ty Newport Beach ND�R�SUll BUILDING
ADDRESS
OR ENGENEER D• Southworth NEoLz85�61 COSTA MESA. CALIFORNIA
ADDRE55 COS�iQ M88A PIRE � P �
ZONE TYPE GROUF�+�'
CONTRACTOR �8-Ii _ APPROVED I
BY DATE
ADORESS SBmG ZONING .
- ZONE I NO. OP I U8E OF NEW S1R •
C17Y R�1 PLAN9 /z BUILDIN6 w •dt-t 8T•
LICTNO. B�.—VZJr' / N�o: OR3 8811 ��� �t #21 Tr. #3856
DEBGqIPTiON
SIZE �" / 1 NO. OF BLDG9. O
OF LOT . I I Now oN Loi p, p, NO.
USE OF YARDB EVES
EXISTING BLDG. APPROVED ALLOWED
BETBACK LINE PPOM IGCNTCR UN8 BTJ �
CENT¢R OP BTReET REAR YARD FRONT FT. IN.
�7 II
SIDE YARD I LEFT � O�� RIGHT 1� � R. SIDE FT. IN.
DESCRIPTION OF WORK
L.SIDE FT. IN.
NEW I X IIALTERATIONI IIA�DITION I REAR � FT. IN.
REPAIR I IIMOVING I IIDEMOLISH I BYPROVED W. L. D. DATE 4-14-61
BUILDING NO. OP 11
BIZE ROOMS STORIES 2 7
EXTERIOR WALL ROOF
COVERING StiUCO COVERING �t�n �-eS
USE OF BUILDING AND WORK TO 6E PERFORMED
i HEREBY ACNNOWLE066 TMAT 1 HAVE REAO TH19 APPLIGTION TH¢ AMOUNT BXOWN UNOER VALUAT�ON IB FOR TXE
ANU BTAT! THAT THE ABOVE IB CORRECI' ANU AGFI!! TO GON- p{�ppO6B OP CBTABLI9HINO A PERMIT FEe ONLY.
PLY WITH ALL CITY OqDINANCE6 ANP 81'ATE LpWB R6pULATNG
BUILDIN6 CONOTqUCf10N. VALUATION �/
SIGNATUR6 OF � � PERMIT FEE $�!� OO
PERMITTE p r �
)%%—/J�� f%�/�' - $ � qC PLAN CXECK $ ZU�7O o
AUTHORIZED AGEM'I�����/ ��r(/�^-"�. �' f t72 TOTAL FEE 55 �7O 0