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Home My WebLink About2992 ANDROS ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT R Job nddress: 2992 ANDROS ST Suite: Vicinity: RESIDENCE AND ATTACHED GARAGE Parcel Number: 13919304 Applicant: WELLS, SAR,4H Address: 2550 E MIRALOMA WY , �� Zoning: R1 R1 STE 100 � � Phone: 714-632-6929� ANAHEIM, CA " .. Zip: 92806 Owner: ROBINSON, LAWRENCE W TR Address 2992 ANDROS 3T�� _ - _ _ �� , ._ _Phone: � � � '� COSTA MESA, CA �-, Zip: 92626-4805 Contracror: � MESA' ROOFING CORPORATION ,-Address: 2550 E'MIRALOMA WY �- " ' STE 100 �, ' Phone: 714-632-6929 � ; - ANAHEIM,CA � � Zip: � 92806 ' License: 564151 Arch .: '. � � Eng: Address � � � /' Address: . � , , . Phone: � Zip: License: Status: ISSUED Applied: 06/29/2004 Issued: O6/29/2004 ISSUED BY: � � - � `�� .\ � �, �, . � , \, ;�� °, . . . , - . Phone: . License: � SCOPE OF PERMIT REROOF RESIDENCE AND ATTACHED GARAGE: T%O EXISTING ROCK ROOF, REPAIR/REPL,4CE SHTG AS NEEDED, 2 LAYERS 15# FELT, �. REROOF WITH "20-YEAR MALARKY SHINGLES:'NEW�PIPE, FLASHING AND EDGE METAL:-25 SQUARES - ' - , ; . FEE SUMMARY Plan Check: $0.00 _._. ___ _ _ _ _ . . "Permit: $125.25 � � �� ;SMIP Res: $0.59 �.� SMIP Com:. ,', $0.00 Other. $0.00 `Inspection: $0.00 � ' � . .?%r� �. " .. � Total: $125.84 . � = .Calc Valuation: . Claim Valuation: ' • - , ,, _; , ,, i � : , . :. � . � ,� , � ��- PLANNING�& ZONING � �-� � �- SETBACKS. � - ' , � , '.;�; MAINSTRUCTURE'Front �0-0 - . , Rear 0-0 -� ��LeR 0=0-- -" Right� ,0-0,- ; / . - - .. . ._ � , ACCESSORY Front � 0-0 - ,Rear 0-0 Left , 0-0 ` Rlght' �0-0-'�'/ . � ' � . . , . . , _ . PARKING Existinq: o. ' Reauired: o ^Pr000sed: �, o' � .. , . $5,910.00 $5,910.00 ti NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements 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 for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all required inspeetlons 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 zaasrs (r�oo� WORKERS' COMPENSATION DECLARATION: . I heraby affirm untler penalty of perjury one of ihe following declaretions: ❑ I have antl will meinlain a certificale of consent to selbinsure for workers' compensation, es provided for by seclion 3700 of ihe Labor Code, for tha pertortnance of the work for w�ic� th;s permit is issued. , {�- � I heve and will maintain workers' compensation insurance, es requiretl by section 3700 of the Lebor Gotle, for Ihe performance of ihe work for which thi permit is issuad. My worker ' co per�"sation I1n—su�re ce carrier entl policy number are: N+r-�f ,, /� Cartier: ��'C- Fl/� 1" K/1 Policy Num6er. lMi W�-1 � � (This section need nof be cromple(ed i! fhe permit Is valued at one hunareU tlallers ($100) or less.) ❑ I cetlity that in the performance ot the work for which ihis permit is issued, I shall not employ eny person in eny manner so as to become subject to ihe workers' compensation lews of California, entl egree that ii I should become subject to ihe workers' compensetion provisions of Saction 3700 ot ihe Labor Co e, I shall forihwith comply with ihese pro isi s. 1. '�nn��J �7/� �l Applicent Signature: �(i�� W�-CX��J' Date: �P �� L-- I' G�� WARNINO: FAILURE TO SECURE KERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMMOYER TO CRIMINAL PEN TAL IES AND CIVIL FINES UP TOONE HUNDREO THOUSAND DOLLARE ($t00,OW), IN ADDITION TO THE COST OF fAMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR CADE, IMEREST, ANO ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn that I am force entl eHecL Lic. A Contrector's SlgnaNre: of Chapter 9(commencing with Section 7000) ot 0ivision 3 of ihe Bi Class'a C � Dete: Code, arA my license is in full CONSTRUC710N IENDING AGENCV: ❑ I hereby aHirm that there is a construction lentling agency for Ihe performance of ihe work for which this pertni� is issued. (Sec. 3097, Civil Cotle). Lentler's Neme: Lender's Address: Signelure: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirm thet under penalty of perlury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Buslness end Protessions Code: Any ciry or county which requires a permit to construct, alter, improve, demolish, or repair eny stmcture, prior �o its issuence, also requires the epplicaN tor such permit to file a signed statement Ihat he or she is licensed pursuam to the provisions of Ihe Contradors License Law (Chapter 9(commencing with Saction 7000) of Division 3 of ihe Busineu and Pmfesslons Cotle) or Ihat he or she is exempt iherefrom and ihe basis for Ihe elleged exemption. Any violation of Section 7031.5 by any epplicant for e permit subjecis the applicent to e civil penalry of not more ihen five hundretl tlollars ($500).): ❑ I, as owner of Ihe property, or my employees with wages es �heir sole compensation, WILL DO THE WORK, antl ihe stmcture Is not intentletl or oHeretl tor sale (Sec. 7044, Business and Professions Code: The Contractors License Law tloes not apply to en owner of property who builtls or improves Ihereon, and who does such work himself or herself or ihrough his or her own employees, provitled that such improvemenis are not intended or oNeretl for sale. tl, however, ihe builtling or improvement is sold within one year of completion, �he owner-builder will heve �he burden of proving ihat he or she did not 6uild or improve tor purposa of sala.). � � I, as owner oi the property, em E%CLUSIVELY CONTRACTNG WI7H LICENSED CON7RACTORS m construa the project (Sec. 7044, Business and Professions Code: The coniradors License Law tloes not apply to an owner of pmperty who builds or Improves ihereon, antl who contracts for such project with a contractor(s) license pursuent to ihe Contractors License Lews.). ❑ I am exempt under sec. SignaWre: Owner ID venfietl Dy tlnvers licensa. ❑ Ves ❑ No Business and Professions Code for ihis reason: Veritication ot Ownership by (type of tlocument, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Dnvefs License No. Date: Expires: ❑ I hereby certity that no excavation five (5) or mora feei in tlepih into which a person is requiretl �o tlescend, will be made in connection with work authorized by this permit, and that no building siructure, scattolding, falsework, or demolition or dismamling thereot, will be more Ihan ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, California Adminis�re�ive Code). ❑ As owner-builtler, I will not employ enyone to do work which would require e permit from the Division of Industriel Setety, as notetl above, unless such person hes e permit ta do such work trom Ihe tlivision. Signature: Date: Divisian of Indusirial Safety Permit Number: CERTIFlCATE OF COMPLIANCE AND AUiHORIZATON OF ENTAY: I certity under penalry of perjury ihat I have read Ihis applicetion and state ihat �he informa�ion given is correct. I egree to comply with all stete laws and city ordinances releting to bullding conslmcllon, entl authodze representetives of the City ot Costa Mesa to enter upon Ihe above-descnbed property for insDection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ignalure � egaiOw e,� �(:� � � � J ��iiU�� And/Or Authorized Applicant CODE t. INSiECTIONTYPE 1616 Fixed System Final Fire Prevention 1266 200 201 202 203 204 Pool Spa Final Final Re-Root Finel BIocWRetaining Well Final Factory Fire Place Final Sign Final Demolition Q� �MIfIALS �� e: J� LOOE I INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 270 Final Elecirical 212 Final Fira Pravention 220 Final Planning Approval 222 Final Site 250 Final Builtling�Occupancy D�TE IH�fIALS '� Applicant ta till in all spaces except t�ose within heavY �ortler Iinez antl si9n all appropriate Eeclarations. -- CITY OF COSTA �MESA COnNST%(�' UCTION PJERMIT ' PEFMIT NO C ' TRACT NO. LOT NU. ' UNIT NO. ,� . ' Project Address 199� /.� nG1�20"-f - ,��'• � ' � � J � 2 Applicant'S Mailing AddreSS q m��-� �1 /� i �� TYPE OF CONSTRUCTION. NEW ADD ALTERATION REPAI R /� ❑ CONVERSION ❑ DEMOLISH �� OTHER�, � Owner'sName' �2. '/�./iJilc�q. PhoneS�- 9��5' - ' � ' ' ' ' , � , DESCRIPTION OF WORK/USE OF BLDGi . . ABdress . Sti'+'� � � ' _ - . . _ _ . . Arch/Eng._ � � � License No.' ' � TVPE OF PERMIT GRAOING- �FOUNDATION ❑ STRUCTURArL : i IAdd�¢55 '' ,,� /�p ' ' � ' y�,.� � �.��-� � ❑ TENANT �� ELECTRICAL � PLUMBING ❑'MECHANICAL � Contractor'S Name/L '�p� �� '�" �� Phone `StZ-�71�L5 . �..❑'OTHER � � , ) : ' ' ' , '. . � . " � Address Imaihng) �n'�I•�� -�LL! T� � f� 7jf/ . PROJECT DESCRIPTION� s�, Fr. - • oCCucarvCv 3O %3 S CONSTf3UCTION TVPE VALUATION $ I Ciry LicenSe NO. � � I ZONE � � GRA�ING CU. VDS. � , ACRES - �, LICENSED'CONTRACTOR DECLARATION ; ; � ' I.nereby�af(i�m tnat I am lic¢nsetl undev provisions of Charte� 9(commencing Remarks: , - � , iwith section ]000) of Division 3 0� the BuSiness antl Prof¢ssions Cotle, antl � , . my license.is in full force a}' tl efiect. � ! � IJcense Class � � � � e � Lice��a N� Yay�,� � � � Date �`% �/� -�`� Signature �LQ • �a � . . PLUMBING f •_ . , FEES 'RKERS'COMPENSATION DECLARATION; � � 'eby affirm that I have a certificate oi mn5en[ to Self-in5ure or a CertifiGate � Norkers' Compensation Insurance,' or_a certifietl. copy_thereof_(Section _ .a00, Lab. CJ F � / / PoycY N4 G"CS. :t i 9/ O/ � ComPanY l/./. h C I. /� �yT';ertifietl copy is hereby furnishetl. � L'J'Certifietl copy is f1letl with the city wl ing Oivi i n. / Date 9�/O.-a'Y Applicant ��+ � -� �"— � E%EMPTION FROM WORKERS'.COMP.ENSATION DEGLARATION (This section neetl no[ be completetl if the permit is fo� ane huntl�etl (5100) or lezsl: ., , ' . 1 certify;tha[,in Ihe Performance of th¢ work fo� which this pe�m�t is'issuetl, 1 sM1alf not employ any person in any manner so�as to become subject to,the , Workers' Compensation Laws of California.' �ate � Signature NOTICE: If, after making tnis tlecla�ation, you shoultl become subject ta the -Wo�ker5' Compensatiom provisions of-the -�abor Cotle,-you must forihwith compty �witn such provisions or�this. pe�mit� shall be aeemetl reyok¢tl. CONSTRUCTION LENDING�AGENCV'�'i:' "! '' ' � ` '� I lte�eby atflrm thal there is a const�uction lentling agency to� the per(ormdnce ' oi the work ,for which this permit is issuetl,(Section 309] Civ. C.) �entler's Name _ _ Lentler'sACtlress - - � ` � �� ' OWNERBUILDERUECLARATION�� - - ' � - I hereby affirm'lhat 1 am exempt twm the Contractor's L•icehse Law for the followin9 reason (Section']031.5 Business antl Protessional Cotle: Any city or - county which requires a permit to construct, alter,.improve, tlemolish or.repair. any structure, prio� to its�issuance, also �equires [he applicant for such permit _tn filP. d SiOlICtl SIdI2T¢flI Ihdl hC/ShQ IS IIC¢052d DU(SUdfIL �O IhC pIOVI510f15 O( � � I '-,Wvision: 3. of the, Buslness antl Protessions CODe) or that h¢/She is exemp[ ',^{;,<)erefrom antl the basis fon the allegetl exemption. Any violation of Section , y:'i9L•5'by any applicant for a pe�mit subject5 the applicant to-a Civil '� enalty ot not more than five M1undretl tlollars ($500). `� I, as owner ot the property'oi my employees witn wages as their sole 'compensation, will tlo the wo�k, antl the 5[ructwe is not intentletl o� offeretl ' for sale (Section 7044, Busine55 and Protessional Cotle: The Contractor's License Law tloes no[ apply [o an owner o( a pro0e�ty who builtls or improves thereon; antl who tloes such work himself/M1erself or throu9b his or M1er own employees, 0/ovitletl tM1at such improvements are not intentletl'o� ofteretl for sale. If, however, the builtling or improvemen[ is soltl within one year of com- � pletion, the owner will have the bu�tlen of proving he/she Citl not buiitl or im- �rove �or the purpose of sale). I, as owner of the property, am ex<lusively coniracting with licensetl con- • tractors to mnstruct the project (Section ]044, Business antl Professions Code: The Contractor's License Law tloe5 mt apply.to an owner of property who builtls or improves thereon, antl who wntracts for such projects witM1 a mn- tractor(s} license pursuant'to the Contractor's License Law�. I am aware that p�oof ot tnei� Wo�ke�'s Compensation insurance Should be provitletl to me. ❑;I am exemD� untlet Section B. & P. C. tor this �eason Date � Owner � I hereby certify that I have reatl this application antl state that the above information is correcL I agree to mmply with all city antl county ortlinances • antl s[ate laws rela[ing to builtling mnstruction, antl�hereby authorize repre- sentatives of. this, city to enter upon tne above-mentionetl pro ert for inspectian pur s y Signature Date � y : Sink <flow Preventer - - - - - <flow Irrigation ' rtubs ifiers iwasher � � ' ' ikin9 Fountains i . � Floor Sinks -- Gas Service � Interceptors� Kitchen Sink � Lavamries P-Trap •. . MOOi UI31l15 - Reirispection'Fee' BOiler Duct-UnderGround Duct - Strucmral Duct � Ventilating. Exhaust System ❑ Multiple FirepUFact. Blt. ICBO # Heating System & Ducting � ❑ ai oo,oao sTu O i oo,000 -ServiceSink^ -" ' Sewer Cap Sewer Connection Solar Cbllecfors Solar Piping� Solar Tank � Swimming Pool w/Spa Urinal ' -- � �W3t2fC105Et � Water Hea[e� ., „ Drivers' License or 55 � I I Reinspectian Fee CMF 0865-46, rev. 4/B4 Wryite - Builtling; Canary - Applicant; Pink -Accounting; GOIGenrotl - Assessor $15 A.P. # S Main Buildi — E T Front . e Rear A — C Right — K Left — S — Ping. Ref. # Planning Notes: 8395 9/I,B/84 .- . , . . . i . . � ' . . � � r. , � . i � Zon iq:� . - � . . Accessory Building:' _ �-. � . . . i . i Nachur r - '- Consbuctior Pole; Cooking Unit i' Dishwasher �� Dryers L'JGas LJEI � Fam � � � F.A.U. ' �-- - � � Fixtures - � � - Device Boxes � � ' Outlets � � Switches� ' - Garbage Dispoul ' . . Generator �0-5 KW � � � � 4 Isue Fee'� � ' Hood or Typel. ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,OOOBTU ❑1� System Repair/Alterati 0 lisue Fee 0 Parking;Req.; � � 1 � ' . ied ' � ICAL , . , � Trarisformer-��15-50KW� -i � � ❑ 50+KW Meten�up to 100 amps Meter ❑overi100amps' ; � Sub,Panel � � , 5,00' TL' �,. Z �'p i N I � N _ G R _ '_ EQ . ' M , T S. ; FEES , , � � ,Morors�0.1 HP�1Yz-'8 - ' Ina Solar �9-15 HP �16-75+ - � -Microwave�- ' ' --' ' ' ; Pole Light � � , ; � I I' Standing Sections ' I; 15 KW I. I Trash Compactor ; � f � �$� 3 � i . � . � Reinspection Fee $15 Issue Fee ' � $ 3 FEES , ,. DEVECOPMENTSERVICESREQUIREMENTS: - � Zoning Approved By Date � Building Approved By � � Date . Applitatian Issued By Dat� $ 3 ' SUMMARV OF FEES � BUILDING PERMIT $ SMIP $ � � PLAN CHECK , $ ,PERMIT PLUMBING ' $ � ..5� "� ISSUANCE $ , � PLAN CHECK 25% $ ENERGV P.C.� $� ELECTRICAL $ . ,GRADING � $ PLAN CHECK 50°6 $ � MICFOFILM $ MECHANICAL $ 's` �� •TOTALFEE $ PLAN CHECK � 25% $ � , . � c . . � POLh`"'°�PA CONSTRUCT�ION AND PLANNING ' � � • - � � . . . - . ' APPflOVALS Permit # - Date ' Inspector � pppROVALS ,�Pe mit # Date �Inspector . 1. Temporary Electrical Service'or Pole . � 52. Pool & Equipment Location , �� 2. Soil Pipe'Undrgrnd. � � . 53..Steel Reinforcement � "� •.. � 3. Electrical Conduif'Utility;Undrgrnd. ' � 54. Forms '� � . �. . � 4.�Electrical Condui{-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. � �'3"� h.f3 '8. Foundation . " � � . 59. Gas Pipe, O Undrgrnd., Test . � } • �� 9. Water Pipe-Undrg�nd. • ;. 60. Backwash Lines, P-Trap, 0 Undrgrnd. '� i 10. �Stcuctural Floor System 61. APPROVAL TO DECK , 11. Property Sewer �ine & House Connection .. ; • 62.� Backwash & Recepmr-Final _ - � 't•' . 12. Sewer.Cap � � � , i � 63. Heater & Vent-Final �; � � 13. Roof Drains , . • 64. Plumbing System , Final . ' � ! � ' 14. Rough;Plumbing..� ' � ' 65. Electrical-Final � 15. Rough Electrical•Conduit - 66. Solar System-Final -. �16. -Rough Electric Wiring - ' ' . - 67. Fencing & Access Approval . - - 17. Rough Wiring Sign� .� � � � � 68. APPROVED FOR PLASTERING ' �' �18. Rough Electrical-T Bar Ceiling . . , 69.• POOUSPA SYSTEM&FINAL � ' 19. ,Rough Heating & Air Conditioning � � ; • ' FIRE DEPT. REQUIREMENT � ' . 20. Rough�Factory Fireplece � ' APPROVALS Permit # � ' 21. Ducts, in Structure ' � ` . ' � 70. Underground Hydro- 22. Ducts, Ventilating . , , � . 71. Product Piping O Gas ' � Oil " � , 23. Gas Pipe-Rough $i Test , � 72..�Underground Flush �� ' 24. Roof Framing� ,�; ' , � 73. Undergrnd.StorageTank �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. F,.IXED 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 '� Noter.' � , 34. Final Heating & Air Conditioning � . , ' - . 35. Final Gas Pipe-Test ' � . � - , , . 36. Hood or Canopy . ; � � � ' 37. Final Factory Fireplace ' � � . � . _ �� . 38. Final Plumbing � � $ �7� � (�� ' � � � 39. Water,Service-Final , � � - . � , 40. Gas Service-Final � . � . � . 41. Solar pomestic-Final � ' � 42. Backflow Preventer - � ' � . 43..Backflow.Jrrigation.�_ ,: :�-�.--,; , ' . , � 44. ,Landscape Irrigation System ' ,. . 45. Sound Attenuation � ' - ' 46. Handicap Regulations � - � • � - 47. FINA'LSTRUC7URE&BUILDING �' , " 48. Special Requirements Completed + , ' . . . ' - 49. Electric Release to Edison- . - � � � - ' - ' � � . .� 50. Gas Release�to Southern California GasCo ' ' ' � '- 51. CERTIFICATE�OF OCCUPANCY � � ' - ' ' �. No. ' Date ; �_CD9�� "C057A MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 317 COSTA MESA. CALIFORNIA � FOR APPL/CANT TO f/[C /N COMP[ETELY � TYPE OR PRINT BUILOING 2y92 Andros St� ADDRESS � COSTA MESA. CALIFORNIA OWNER Glenverde Homes, Inc. cirr �lboa ARCHITECT OR ENGINEER ADORE55 CONTRACTOR a.�CCO COS'p� ADDRESS &%%� VJ, �lboa LEGAL I LOT I OESCRIPTION NO. � BLf A.P.NO. 1' / /l`- SIZE '��O ncinr � SETBACK LINE FROM v�w�nu in�s� � SIDE YARD IIEFT ZO IRIGHT DESCRIPTION OF WORK NEW I X II ALTERATION I II ADDITI BUILDING,r NO.OF SIZE 170��3� ROOMS � STORIES � EXTERIOR WALIStuCCO ROOF COVERING COVERING rock FIRE ZONE FEE RECEiVED � �� r-z�-ry fINANCE DEPT. A P PLI C�T}'j,S IQ F�Tfp�AIT BUILDING foR officF vsF aN�y RECEIPT NO. PERMIT NO. /�' %�'I �VEO BY DAT RE EIVED DwTE I6511EC -r .:�ofatJ �/_ � -?_ COSTA MESA. CALIFORNIA • I `" ZONE�� INO.OF / pLqNS APPROVED / BY V VARDS REqU1RED (CENTEN LINE STJ SIDE c DATE �/ � S ING I USE OF NEW / �.�.•� ' � BUILDING /� l..v�� LJ nerc 1 l� `�'�/ � ) `�.-�� ,�OU 1 HERE9Y ACKNOWLEUGE THAT I HPVE FEAO THIS APPLICATION TME PMOUNT BHOWN UNDER VALIIATION I6 FON THE AND STATE THAT THE ABOVE IS CORFECT AND RGREE TO COM� PLY WITH /LL CITY OROINANCES AND STATE LAW9 REGULqTING PUFPOSE OF ESTABLI9HING A PENMIT FEE ONLY. eultDlrvc CONSTRUCTION. � VALUATION �{d P RMnITTEE OF G�� "�� PERMIT FEE $�� PLAN CHECK S � �� //� $,c� ,�li/�— ;� AUTHORIZED AG �\ / TOTAL FEE $ �J � �a --