HomeMy WebLinkAbout1188 AUSTIN ST - Building Permits • • 411 III
CITY OF COSTA MESA
BUILDING DIVISION
Et
fy '), 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714)754-5626
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PERMIT NUMBER. BC08-00176
PERMIT TYPE: B_COMBO STATUS: ISSUED
Sub Type: RES ALT DATE ISSUED: 04/25/2008
ISSUED BY: RMD
JOB ADDRESS: 1188 AUGUSTA ST;CM Suite/Unit.
APN: 14160119 ,:a,� �Zoning.Rl,"., `
Vicinity: BATHROOM Prima y Occ' R3
Const Type: V-B S0;FT 0 Valuation: $9,500.00
SCOPE OF WORK: INTERIOR/BATHROOM;REMODEL FOR A SFD. CHANGE OUT 1'SHOWER, 1 WASH BASIN, 1 WATER
CLOSET, 2 LIGHT FIXTS, 1 OUTLET 2-SWITCHES AND DRYWALL WORK.
OWNER: MC CORMACK' PATRICK H .. - Address: ,.1188 AUGUSTA ST � ` ` Unit:
Phone: 714-751-7227,4 ; r City/State/Zip.,•COSTA MESA CA
APPLICANT: FERDINAND;JOHN "- Address: 21191 CUPAR LN "� " ; '^'s Unit :
Phone: 714-536-8400 s*"�` � . City/State/zZip: HUNTIGTON BEACH CA
IF`
CONTRACTOR: FERDINAND CONSTRUCTION INC - • License,No. - 884615
Phone: 714-536-8400 Address: 21191 CUPAR LNUnit: :-,
Cell: - City/State: HUNTIGTON BEACH CA -':ZipCode 92646
ARCHITECT: - License No. - - PHONEa,�
ENGINEER: License No. = :PHONE:-
,
COMBINTATION PERMIT FEE SUMMARY -
Building Plan Check:
Building Fees: $181.25
Electrical Fees: '�'' -• $29.00-->
Mechanical Fees: ' $0.00 : -
Plumbing Fees:
SMIP Residential: $0.95. - " •'.;.`
SMIP Commercial: $000 • ,
TOTAL FEES: $264 .10 •
"Refer to fee receipts for all fees paid for project t '
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: 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 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.
coDE s. INSPECTION TYPE DATE INTITALS CODEC INSPECTION TYPE DDTF INTITUIL§
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Dem 222 Final Site �/
O
204 Final Demolition 250 Final Building/Occupancy k g�a O
r •
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driv 66 t]Yes ❑No I •%
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: .
❑ I have and will maintain a certificate of consent to self-Insure for workers' •
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. .
❑ I 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 .DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure,scafidding,falsework,or demolition
rCarrier: I9/ E (ivN42
�, or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This sector need not be mmpleled a'the permA is valued at one hundred dollars($100)os less.)
�4ZO / �O2,Art 2,Sec.341,Title 8,California Administrative Code).
Policy Number:
❑ As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
Applicant's Signature Dale
the La.. ••:,I s� ora.-� th these provisions.
��W /i ZSa ? Division of Industrial Safety Permit Number:
ice/_ `7
Applicant's Signature _ Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑ No
($100,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in ff.ulllforce and effect. a registration form for acutely hazardous materials? ❑Yes ❑No
sic.#-- w (J_ e746"75 'Class.# i� (Section 25533 of the California Health and Safety Code, with some
ISA 1 _Z 5... op exceptions, requires registration with the Costa Mesa Fire Department by
d each business which at any one time has on hand a quantity of acutely
'''&iir•dors Signature Daae hazardous materials equal to or greater than a weight of 500 pounds. or a
L.
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa 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 Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes ❑ No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No
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 (Section 65850.2 of the California Government Code requires that the requested
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
information be fumished on applications for non-residential building permits).
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code). .
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety,Code Section 42303 been made? 0 Yes ❑ No
thereon,and who does such work himself or herself or through his or her own 8 (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer). . •
completion, the owner-builder will have the burden of proving that he or she , CERTIFICATE OF COMPLIANCE: I certify that under.penalty of perjury,the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply'with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
❑ I. as.owner of the property, 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 . Signature Date -
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
10am exempt under sec. • the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Sign Owner( Date
Signature Date 0 i/_2 to Q
3057-46(3107) `T' l v
nNorAuthorize Applicant Date
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APPROV
CITY OF COSTA MESA,
PLANNING DIVISION' 5-A-;.;; 27;Y' ;3 g r r Ifioa sr?, fi-:
SUBJECT TO BLDG. DEPT. REG.
0 • NOTE: ADDITIONS, DELETIONS,
.•'
OR CORRECTIONS SHALL BE
x .
• ' ,ROVED BY THE PLANNING DIV. ' 41.1 rlOCU\-- /A\E' .
61 21/0-
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BY: tei DATE: Z lif,
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No- -ernocle/ 04/7-/Pei Icilo +Off piq rit 5Act it yrf elf a-ier•
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All dimensions size designations gb ir ate i This is an original design and must nor be i Designed: 12./13007
subject to s ei i ficat ion on job site and 0 released 01 copied rinless:gull icable rre has i 1311111C(i: 12/12/2007
'
. •adjustment to lit job conditions. been paid or Job or del placed
1 p„. , • , . I .
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C i2009C7.kil lit I j rhau mg 4: I j Scide (1 I2"
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VI.111COAF.D OA. .1.11F 1.1-V>M11/111,11i.
tIOCF(.110/1" ."H / 'I 1st
1.1011: Mint/(11.1.4 I) 1 I U .V.••
'(. 111111:1..1. 11) UI • )1 1.1 RFC!'
ibl'IVI.,114(' Du
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L'IANDATORY MEASURES SUMMARY: RESIDENTIAL (Page2of2) MF-1R
Space Conditioning,Water Heating and Plumbing System Measures: (continued) Enforce-
- NAS Designer ment
5.Insulation must be protected from damage,including that due to sunlight,moisture,equipment maintenance,and wind. 0 0 0
6. Insulation for chilled water piping and refrigerant suction piping includes a vapor retardant or is enclosed entirely in ❑ ❑ ❑
—
conditioned space.
7.Solar water-heating systems/collectors are certified by the Solar Rating and Certification Corny inn 0 0 0
• §150(m): Ducts and Fans
—
I.All ducts and plenums installed.sealed and insulated to meet the requirement of the CMC Sections 601, 602.603.604,605
and Standard 6-5;supply-air and retum-air ducts and plenums are insulated to a minimum installed level of R-42 or enclosed
entirely in conditioned space.Openings shall be sealed with mastic,tape or other duct-closure system that meets the applicable 0 0 0
requirements of UL 181,UL 181 A.or UL 181 B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is
_ used to seal openings_greater than 1/4 inch.the combination of mastic and either mesh or tape shall be used,
2.Building cavities-support platforms for air handlers,and plenums defined or constructed with materials other than
sealed sheet metal,duct board or flexible duct shall not be used for conveying conditioned air.Building cavities and ❑ ❑ ❑
support platforms may contain ducts,Ducts installed in cavities and support platforms shall not be compressed to cause
reductions in the cross-sectional area of the ducts.
- 3.Joints and seams orchid systems and their components shall not be sealed with cloth back rubber adhesive duct tapes ❑ ❑ ❑
_ unless such tape is used in combination with mastic and draw bands.
4.Exhaust tan systems have back dram or automatic dampers. 0 0 0
—
5.Gravity ventilating systems serving conditioned space have either automatic or readily accessible.manually operated ❑ ❑ ❑
dampers.
—
6.Protection of Insulation.Insulation shall be protected from damage-including that due to sunlight,moisture-equipment
maintenance.and wind.Cellular foam insulation shall be protected as above or painted with a coating that is water 0 0 0
—
retardant and provides shieldine from solar radiation that can cause degradation of the material.
7.Flexible ducts cannot have porous inner cores. 0 ❑ 0
6114: Pool and Spa Heating Systems and Equipment.
- I.A thermal efficiency that complies with the Appliance Efficiency Regulations.on-otT switch mounted outside of the ❑ ❑ ❑
_ heater.weatherproof operating instructions,no electric resistance heating and nopilot light.
2.System is installed with-
a.at least 36"of pipe between filter and heater for future solar heating ❑ 0 0
- b.cover for outdoor pools or outdoor spas 0 0 0
- 3 Pool system has directional inlets and a circulation pump time switch. 0 0 0
- §115] Gas tired tan-type central furnaces,pool heaters.spa heaters or household cooking appliances have no continuously ❑ ❑ ❑
burning pilot light. (Exception:Non-electrical cooking appliances with_pilot c 150 Btu/hrl
6I 18(i): Cool Roof material meets specified criteria 0 0 0
0,),............
--
Residential Lighting Measures:
§150(k)I: HIGH EFFICACY LUMINAIRES OTHER THAN OUTDOOR HID contain only high efficacy lamps as
outlined in Table 150-C,and do not contain a medium screw base socket t E24/E26) Ballast for lamps 13 watts or greater la-- 0 air electronic and have an output frequency no less than 20 kHz
-
§ISOtk)I:HIGH EFFICACY LUMINAIRES-OUTDOOR HID contain only high efficacy lamps as outlined in Table Er--
❑ ❑
_ ISO-C. luminaire has factory installed HID ballast CI
*150(k12:Permanently installed luminaires in kitchens shall be high efficacy luminaires.Up to 50 percent of the wattage,as -
determined in§ 130lc).of permanently installed luminaires in kitchens may be in luminaires that are not high efficacy 2.-----
--.,/ ❑ ❑
luminaires.provided that these luminaires are controlled by switches separate from those controlling the high efficacy
LT
— luminaires _
§150(k)3:Permanently installed luminaires in bathrooms,garages.laundry rooms utility rooms shall be high efficacy -
luminaires.OR are controlled by an occupant sensors)certified to comply with Section 119(d)that does not turn on 0 Fd—" 0
— automatically or have an always on option.
§150(k)4:Permanently installed luminaires located other than in kitchens,bathrooms,garages.laundry rooms,and utility
rooms shall be high efficacy luminaires(except closets less than 70&Y1:OR are controlled by a dimmer switch OR are 23-- ❑ ❑
controlled by an occupant sensor that complies with Section 119(d)that does not turn on automatically or have an always
_ on option.
§I50(k)5: Luminaires that are recessed into insulated ceilings are approved for zero clearance insulation cover(IC)and are GA-- 0 0
- certified airtight to ASTM E283 and labeled as air tight(AT)to less than 2.0 CFM at 75 Pascals.
§Ii0(k)6: Luminaires providing outdoor lighting and permanently mounted to a residential building or to other buildings on
the same lot shall be high efficacy luminaires(not including lighting around swimming pools/water features or other Ilk--- 0 0
Article 680 locations)OR are controlled by occupant sensors with integral photo control certified to comply with Section
119(d).
— §1g1(107: Lighting for parking lots for 8 or more vehicles shall have lighting that complies with Sec. 130, 132.and 147. 12P-- ❑ 0
` Lighting for parking garages for 8 or more vehicles shall have lighting that complies with Sec. 130, 131.and 146.
*I 50(k)8. Permanently installed lighting in the enclosed.non-dwelling spaces of low-rise residential buildings with four or
more dwelling units shall be high efficacy luminaires OR are controlled by occupant sensors)certified to comply with ❑—" 0 0
Section 119(d).
Residential Compliance Forms April 2005
08-22-2008 Inspection Request Reporting Page 28
4'15 pm Costa Mesa, CA - City Of
•
Requested Inspect Date: Monday,August 25, 2008
Site Address: 1188 AUGUSTA ST CM
BATHROOM
A/P/D Information
Activity 8C08-00176 Type: B_COMBO Sub Type RES_ALT Status: ISSUED
Const Type V-B Occupancy: Use Insp Area:
Owner MC CORMACK, PATRICK H Phone 714-751-7227
Planner JG
Contractor FERDINAND CONSTRUCTION INC Phone: 714-536-8400
Applicant FERDINAND JOHN Phone: 714-536-8400
Description INTERIOR BATHROOM REMODEL FOR A SFD. CHANGE OUT 1 SHOWER, 1 WASH BASIN, 1 WATER
CLOSET, 2 LIGHT FIXTS, 1 OUTLET, 2 SWITCHES AND DRYWALL WORK.
Requested Inspection(s1
Item 250 FINAL BUILDING I OCCUPANCY Requested Time 08:00 AM
Phone
Assigned To Entered By ZWART_B K
Action Time Exp:
r Comment NEEDS SMOKE DETECTORS.
4
Inspection History
tern 56 SEWER LINE CONNECTION
tern 70 DUCTS VENTILATING
tern 3 JOB SITE CONSULT
tern 4 FOOTINGS/UFER GROUND
tern 6 SLAB
tern 8 STRUCTURAL FLOOR SYSTEM
tern 11 PRE-INSPECT ROOF
- tern 12 ROOF SHEATHING/BLDG HEIGHT
tem 16 SHEAR PANEL
tern 18 FRAME & FLASHING
tern 20 LATHING&SIDING **Approved"
06/06/08 Inspector: HM Action: AP APPROVED
Comment: -SHOWER LATH.
tern 22 INSULATION
tern 24 DRYWALL NAILING
tern 26 PLASTER BROWN COAT
tern 30 PRE-GROUT
tem 31 NPDES/BMP
tern 36 UFER GROUND
tern 38 ELEC CONDUIT- UNDERGROUND
tern 44 ROUGH ELECTRICAL-WIRING Approved **
06/05/08 Inspector: HM Action: CAN CANCELLED
Comment: CANCELLED IN AM BY M.J.
06/06/08 Inspector: HM Action: AP APPROVED
Comment:
Item 45 SUBPANELS
Item 50 ELEC. POWER FINALJMETER RELEAS
Item 51 TEMP POWER FINAL
Item 52 SOIL PIPE- UNDERGROUND
Item 53 SHOWER PAN "Approved "
05/30/08 Inspector: BN Action: AP APPROVED
Comment:
Item 54 WATER PIPE- UNDERGROUND
Item 55 UNDERGROUND GAS
Item 62 ROUGH PLUMBING 'Appproved"
05/30/08 Inspector: BN Action: AP APPROVED
Comment:
tern 63 PREWRAP
tem 64 ROUGH MECHANICAL
tern 66 ROUGH-FACTORY FIREPLACE
tern 68 SEWER SYSTEM
tem 72 GAS PIPE-ROUGH
tem 90 GAS PIPE TEST- FINAL \1\11/4111
tem 92 WATER SERVICE- FINAL
tern 150 MISCELLANEOUS INSPECTION
tern 206 FINAL MECHANICAL
tern 208 FINAL PLUMBING Approved**
07/16/08 Inspector: NM Action: AP APPROVED
Comment:
Item: 210 FINAL ELECTRICAL
REPT131 Run Id: 10235
J•
a
•
08-22-2008 Inspection Request Re orting Page 29
4 15 om Costa Masa, CA - CsOf
07/16/08 Inspector: HM Action: Correction(s) Required
Item 216 FINAL ENGINEERING GROUNDED.T PL
Item 220 FINAL PLANNING APPROVAL
Item 250 FINAL BUILDING/OCCUPANCY
07/16/08 Inspector: HM Action: CO Correction(s) Required
Comment: NEEDS SMOKE DETECTORS.
Item: 247 Pool Anti-entrapment Dev Final
REPT131 Run Id: 10235
FEE RECEIVED I
• 17492 ►i JUL 101 2
COSTA MESA BUILDING-SAFETY DEPARTMENT • FINANCE DEPT.
P. O. BOX 917 COSTA MESA. CALIFORNIA Cl iY OF COSTA MESA
For Applicant to Fill In Complete�r3/ APPLICATION FOR PERMIT ri
TYPE OR PRINT l_/
/ �QJ( /j' Cr, UILDING
ADDRESS / /5" iy C/6 v C//9 7
COy,TA MESA. CALIFORNIA For Office Use Only
.4-Seel/Q�' •
I RECEIPT NO. PERMIT�9�!�O.
OWNER Homes Inc. 7
MAIL RECEIVEDBY DATE RECEIVED DATE ISSUED
ADDRESS 1602 W Almond - - - /L� 7- / - Y
CITY Orange E NO. BUILDING
.
ADDRESS
ARCHITECT
OR ENGINEERWeber/ TELy COSTA MESA. CALIFORNIA
& Lowrey NO.p17-6131
2127 No. Main St. Santa Ana FIRE /� /� tL
ADDRESS c ZONE TYPE ✓ GROUPc�y V
CONTRACTOR S. V. Hansaker & Sons APPROVED
/
$
BY DATE /
ADDRESS
15855 Edna Place ZONING
CITY Irwindale ZDNE�- I NO.OF I USE OF NEW �✓ 4d.,Hey.�J
//{1 PLANS BUILDING /t .
LIG No. 164929 No: ED 8-7361 DLEGAL ESCRIPTION L.:/* 3 / 7 �/6 s 3
SIZE 00
� y' /{T^ NO. OF BLD09. ��.
OF LOT lln, 0/l (/C/L/ I NOW ON BLOT 0 A.P.NO.
USE OF YARDS EVES
EXISTING BLDG. -- APPROVED ALLOWED
SETBACK LINE PROM , (CENTER LINE ST.) /J
-CENTER OF STREET REAR YAR26-'6 FRONT 7.S- FT. IN.
/I
SIDE YARD I LEFT / /i? RIGHT .C /6 R.SIDE S-- FT. e IN.
DESCRIPTION OF WORK s _____
L.SIDE FT. -IN.
NEW I X IIALTERATION I 0I ADDITION REAR 30 FT. L
`� IN.
REPAIR I III MOVING I II DEMOLISH I APPROVED -O�hn DATE 7,/' T-
BUILDI / /1 / /)NO. OF 1 Wei TP .i'
SIZE snit ROOMS STORIES
EXTERIOR
ING WAL Sidling I COVE hingles•
COVER
COVERING S
USE OF BUILDING AND WORK TO BE PERFORMED
Single Family Dwelling with /` i1•
Attached Garaae poigsgnet 42'V.9 0
- Plan 4C)P.&
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 OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. , . . . VALUATION J/rte/
SIGNATURE OFs PERMIT FEE $ J
PERMFITEF S. V. Hunsaker & Sons // 7,
$/ y��� PLAN CHECK $ ,72
AUTHORIZED AGENT . rc
/�
TOTAL FEE $ D
u