HomeMy WebLinkAbout2043 CAPELLA CT - Building PermitsPflC�F,CTR00flESS: zO43 S CAPELLA CT
O�i'NEIi'SNAME: CLARK TERENCE B
nooxess: z043 � CAPELLA CT
COSTA MESA,CA 92626
AflLMIENGINEEfl: 5 4 6— 4 5 5 9
RUOflE55:
flEG.NO.:
uxir:
UNIT:
PE"mmEE'ALUMINUM ROOF SPECIALISTS (714)558-0678
AODNESS: S �Sj '2�`Jn MnCUFADDEN AV �
LILENSED CONTflFCTUIf DECLiPA710N:1h�eie0y auirm tnat � am �icensea un0er pr�ovisfo9ns o�7C� 7er 9 ommencing wilh Seciion
7000) ol Orvisim 3 o11he Busines5 an0 Pmleuions CoOe. anG my license is in full torce antl etlect.
CITY LIC.: STRTE LIC.: CLASS:
03372 �23043 C-39
oate�, �� Sipnamre: �
WOBNE OM ENSATIONOECIANRTION: Iherebyatlirmt�ailhaveacenilicateofcansenttasell-insureoracertilicateolWorkers'
Comp¢n5alion Insurance, ot a cenili¢C caDY thereol (Section 3800. Lab. C�.
raucvxo.: 046-91UNIT3117 EXP.ORTE: OS O1/93
cornraxr: STATE FUNL}z
O Ceriilied topy is here�y �umi5he0. i j� CenilieA coDY is IileO w the y BuilOin ' j'
Ja�e: �� V�n'� ` unVliwnt:
E%EMPTION FBOM WONNEBS' COMPENSATION UELLNHATION: Qhis sec � n n not Ue completeE il �he Dermii is lor one �untlred (S1W) ar less�.
I cerlily Iha� in ihe pedormance o� �he work lor whic� Ihis permil is i 5ue0, I shall not employ any Oerson in any manner so as to become
subiect to Ine wo�kers' Campensalion Laws of Calilomia.
Da�e: Signalure:
NOTICE: II, aller making �his tleclaralion, you shoultl Decome su�lect to �Ae Workers' Compen5aiian Orovisions ol Ihe La�or
Cotle, you musl �onhwilh comply wilh suc� provisions or this permit shall �e tleemed revoked.
CONSTPUCTION LEN�ING RGENLY: I �ereby aifirm t�at there is a consimction IenOing agency lor the pedormance ol Ne work tor
which t�is permi� is issu¢a (Seaion 3097. Civ. C�.
LENOEfl:
FOUPE55:
OWNEB BUILOEB oECIAPATION: I �ere0y aflirm tAat I am e�empt Iram t�e Contractars' State License Law lor Ne lollovrinp reason
ISetlion 7031.5 Business an0 Protessional Code: Any ciry ai caunty wnich requir¢5 a permit to conStNCL altet, impmve, aemolis�, or
repair any slmcture. orior to its issuance. also rtquires Ihe apolicant for such permit to file a signea statement that he/she is Iicense0
pursuanllo�he pmvisi0n5 OII�e ConlratlorS'$ta�e license Law�C�apler9�commencing vnlh S¢ction 7000)a�Division 3 olthe Business
an0 Pmlessions Coae) or I�ai he/she is ¢xempi I�ereimm anG I�e basis for the allegetl exempiion. My Nolation of Section 703L5 Ey
any appliWnt for a Dermit su0j¢Cts t�e aODlitant Io a tivil penalry ol not more tlun (rve hunAreA Jollars (5500�.
I, as owner of Ihe propeny or my employees wilh wages as tneir sole comDensation, vrill Oo ihe wark, anA Ihe
❑ slmcWre i5 nol inlen0ea or ollerea lor sale (Seclion 70ad, Business antl Pwfessional Cotle: The CanVatlors' State License Law
tices not apply lo an owner o� a pmpeny who builtls or impmves �hereon. antl who does such woM1 himsel//�ersell ar l�mugh
his Or �er own ¢mDloyees, prmdEeG l�ai Suc� im0�ov¢m¢n�5 are n0�in�ende0 Or afl¢reE �or sale.li. howev¢r I�e OuilOing of
impmvement i5 5oltl vn�hin one year ol com0letion, I�e awner vnll have Ihe burtlen o� pmving he/5he aid noi Ouiltl or improve
�or Ihe DutpOse OI 5ale�.
I, as owner af Ine o�openy, am eeclusively Wnlracting wilh Iicense0 coniractors to consimct ihe pmiect (5ection 704a, Business
❑ anU Pmfessims CoOe: The Comracmrs Slate License Law does no� apD�' Io an owner al DmDertY w�o GuilCs or improves lhereon
anG w�o conlratis Iof Suth projeClS wilh a fAnVactor�s) litense pufsuan� l0 the Contratiors' Sia�e Lit¢nse Law). I am awar¢
I�al proo� ol t�eir WOrker'S Campensafion insuranc¢ sMUIG Oe D�oh0e0 �o me.
� 1 am exempl under Seclion: 0. 8 P. C.
br Ihis reason:
oate: 6r�+iec
I Do �ereby certity Ihat I am aware ol an0 wGers�and ��e reQuirements of Califomia Health an0 Salery Cotle Sections 25505, 25533, antl
25534 ana ��ai I or any IWure builtling occupant willlwill no� (circle one) neetl �o comply wi�h saitl s�a�e codes and �he requiremenis �or a
permii lor cons�mc�ion or modificalion Imm �he Air Ouahry Management �isVict. Pesitlential consVuction apDlicaiions are exem0� �mm
��ese pmvisions.
Date: Applicanl:
I nereby cetlify Ihal I �ave read Ihis applica�ion and s�ale �ha� Ihe bove - brma�i is cor cL I agree to comply wilh all ciry and county
ortlinan�esands�atelawsrelabnglobuilaingcons)mt�ionanAhere aut�orzereD�e mativ It�is t eru ntheabove�men�io
prDOetlY �orinspetl��On p py� oses. _ /
i4n/ /
Dale: v � � Signamre:
Driver's ' nse or Social Security M: ,� � � �
i5at�a6 Wnpe—Bwltlinq: Green—Cotle
Pink—Revenue: Galtlenrod—Assessor
CITY OF COSTA MESA — HUILDING PERMIT PERM NO: B 05772
PERMIT NO: B 057720 PLAN CHECK NO; N GOVT; N SUPP: N
CONSTRUCTION TYPE; V—N PERMIT TYPE: STR PURPOSE: ALT
JOH DESCRIPTION ; RESHT, REROOF W/ALCOA ALUM ICHO#3197 SQ FT: 6,500
CLAIM VALUE: 6,500,00 CALC—VALUE: 6,500.00 GROUP OCC: R-3 /
COMMENTS• SMORE DETECTOR RE�UIRED IN THE HOME
�r�r�r�r�t��t�t��r�r�t�r�t�r*�r�r*�t�*�t�t�t�r�r �r�r�t�t�r**�r*�t�t�r�r*��r�r�r**�t�***+r+t�r*x+��r*�r�r��**�t�r�r�r�t�t*�r��r+t
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
LEFT: FT IN RGAT; FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ• PROV: PARCEL; 13940221 ZNE; REF NO;
PLANNING NO'I'ES>
i
*�r��r�e*�r*��**�r**�r�r�r�r�e+r�e*�r*�r**�r+�**�r�r�r�*+r+��r�r x*�r**�r*�r******�r*�r�r�e�r��r*�r*�r+e.�r�r�r�r*�r*+��r**
D E V E,.L O P M E N T S E R V I C E S R E Q U Z R E M E N�.T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY ; DATE:
APPLICATION ISSUED BY: � DATE; ,�oL �
�EiF1f�F�k*MikiFk�FiFifiFiEiFlEifkiFifiF'i�F�iFR"iFiFiE'iF3F'{f7FiFiFiFiF7F�R�'�ifiF'iEiF3£iFaE�fihifiEitiFififiF �l�k
klFififklEiFiEkltiE�F�F�fklfiFiEkiFiF�EiE3f�FiFiFiFifMkkifikkiFiFiFMififiEkiFlfkkifiFiEikif�fititiflf�f�EififlkifklEaf�tfEkkk�fklkifkiFlEik
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT;Y
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 90.00 65
PL� , SMIP/NON—RES
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 90,65 0,00 •' 0,00 90,65 90,65 ,00
REVENUBLDGVPMT�PLUMHING ELECTRIC MECHANI� FIRE��SMIP�TOT/SGRADING PLAN—CHECK
90.00 " ' .65
k 3f iF M iF iF iljk if iFif if iF if 1! i! 1! it iF IE �k It 1E ft k if iF iF ikiF iF iF iF if k if it1F iF M k if k ih it M k if if �lf M if if iE iF iE 1E If 1k if iF iF 3f 1E iF iF fE iE k�f if k iF k if iF k iFiF
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N. UNIT COST TOTAL COST
SFR 6500 REROOF HY VALUE RESIDENTIAL N020NE 1,00 6,500.00
END OF FEES
.-
CONSTRUCTION AND PLANNING POOL , �PA
� APPROVALS Permit � Date Inspector pppROVALS Permit # Date Inspector
�
� ,
7. Temporary Electrical Service or Pole.. 52. Pool & Equipment Location '
2. Scil Pipe�Undrgrnd. � 53. Steel Reinforcement •
.3, ElBctrical Conduii Utility-Undrgmd.� ' S4. Forms
4: Electripl Conduit-Urtdrgrnd. 55. Electrical Bonding
5. Steel Rfinforcers}ent� 56. Rough Plumbing & Pressure Test
��- �EI�Qirical UFEitrGt,nd, � 57. APPROVAL TO COVER�GUNITE
= 7. Footings � 58. Electrical Conduit•Undrgrnd.
B. �Foundati0n ' ' 59. Gas Pipe, O Undrgmd., Test
9. Water Pipe-Untlr9�^d� 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor.$ystem �� � 61. APPROVAL TO OECK ��
11. Property Sewer Line & HoUse Connection � 62. Backwash & Receptor�Final
12. Se�*ier Cap . � . 63. Heater & Vent-Final
13. Fioof Drains 64. Plumbing System � Final ,
14. Rough Plumbing" � " 65. Electrical-Fina�
15. Aough Eiaarical-Condult 66. Solar System�Final
16. Rough Electric Wiring 67. Fencing & Accese Approval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18_ Rough Electrical-T Bar Cei�ing 69. POOL/SPA SYSTEMS FINAL
19. Rough Hsating & Air Conditioning FIRE DEPT. REQUIREMENT
- %.
20. Rough Factory Fir.eplace '- - _:- � J�PPROVAL�T'-� Perrttit# �
�
27. Ducts, in Struccure �. � �> 70. Underground•Hydco
22. Ducts, Ventileting �� _ � � x� Zi, product Piping C}G�us ❑ Qil
23. GasPipe•Rough & Test ' _. � - � 7Z, Underground Flush, x "
24. Roo€Framing �. � ' - ' 93.'lJndergrnd;Storogel'ank �Gas ❑Oi�
25. Roof Sheathing � ' 'D` -`
� 23�1�� 9$ ^ �4• averhead Hydro
26. �T�Bar Ceiling (Structural) & Monocoat � �*'-' 75. .�D� Chemical � ' - ,�
27. Fran�eand Fldshing_ . .; � 76.'Dry Standgip'� . �- '`r, �'
28. `Latfu_'ng $c Siding • « > � 77, _FIXED SVSTEM�F�NAL ` .
29. Insulation ' �t ` . �
� .. 78.�IRE PREV. FINAI �x i
30. Drywall Nailing �. � � j HEALTH DEPT.4iEQUIRENhENT
31. PlasterBrpwr�Coai,, ti .� I �`, 79.'FINALINSPECTION ;,'� J'
.r, - ----r- .
'32. Electrical.PowEr MeterF�nal .._ �- •�80. FOOD CERTIFICATE ISSUED
33. Fina(Elettric ' Notes. ti, _ ry` `. _lLYfi�
7--�. - a 1���9 . _ _ d'i'v
• i.. �
34. Final Heating & Air Conditionii+g �� i; e�� _
i� . . r �
35. FinalGas�Pipe•Test -- + ~ .
f - 9 ` " '
36. Hood or Canopy . - �. . - •
37. �FinaFPa�tory Fireplace ' - .
38. FinaL�Plumbing _ � � t t � , - • � -
39. Water Service-Final � � ` ' 1
f
40. Gas Servi�e-FYnal � , '. . ., _. x � '
'41. Solar pomestfcFinal � ' � - 't�'-
� -
42. BacY.flow Preventer ' . . � . �
43. Backflow Irrigation • > ' � � '
�
44. Landscape IrrlpatioqSYstem -� . - � i .. • � _ �
45. Sound Attenuation• - �� � - = " �
� _ �_
a6. Handicap,Aegulations ' /// � � � " ' _ � . �
47. FINALSTRUCTURE&BUILDING (Q�/Cty��--' � _ T
!
48. fINAL PLANNING. ' � � . - r J _
_49. Electric Reiease to Edison , • 3 "
� .
50. Gas Release to Southem Califomia Gas Co � � � ; -
51. CERTIFICATE OF OCCUPANCY . . - . _
No. Date
�JL1'ayjyl�yyY L'Y11\llltl LM1G )�'f VV
JOB ADDRESS 2 3 S. Capella Court BUILDING PERMIT NO. 25 2
GENERAL CONTRACTOR plVeri P. P0d0TSOri DESCRi:PTION OF WORK Pg'tl0 Cover
VALUE
Date GROUP TYPE
SUBCONTRACTOR
-+ 25682
'. . COSTA MESA BUILDINCrSf�FETY DEPARTMENT
I P.O. BOX 1200 GOSTA MFSA� CALIFORNIA BZE20
For AppllcaM ro F(11 In ComplNely
TYPE OR PRINT
�ui�.o�Na 'r� L' Fi-
ADDR6DD
COSTA MESA. CALIF RNIA
OWIilR /✓
:"�;,: 2,� �/ � S a A P_ I I l9 '
...
STATC /�S
LIC. NO.
SIZE '7 �f
LIN6 PPOM
�
CITY QF �;S �A MES.
MAY 6 1966
A►PLICATION FOR PERMR
_� � ►uru�� � suaoino
,-3—�/75�� Nare: Noewve
HO• TO SID64 P
ewvea
NO.OIGLDOt. ALLOWEO
DESCRIPTION OF WORK
WALL
�1 M[R6GY ACKI
AND 9TA� TN
VLY WITX ALL
eu�to�na coni
� AUTMOI��ZSDAO[N7
�
M�V6 RfAD TII� A��YGTON
CORR[CT ANO AOR[[ TO CAY.
A1/0 RAit {AN� IItOYlATNO
VARDD MPROVED
MAIN BUILDINO
IRONTC/LYT R�
.il.j
p I
II.�YID� C�d rT.
/
� a,o4 5 .�.
i
p�,a _ a �.
o�arwNce esr.
MAIN BLDaD.
VAR• #
— vn �. — a +
WO SHALL EH Ll88 THAN
(U. B. C. REqU1RBMeM'.
YARDBAPPROV6D
AGCH880RYBUILDINO
DATB
APPR
�C
a
m
�
4 3 2- ao. �,. �
TN[ /�YOYNT {XOWN lINO6P VALIIATION 10 POR TNQ �
►YRP06� O� meeuenmo A P6pMK !El ONLY.
VALUATION � 7
PCRMIT ReH �
E
� go � w,
.�
VWfVtK c�.tucn, 't.n,
JOB ADDRESS aPe
AP N�(� NSPECTIONS
` SOIL
� GAS
`� WqTER
ROt1GH PLUM0ING
PROP. $WR. LiNE
SPRINKLING SVST
MISCELLANEOUS
ROUGM HEGTING A
TEMPORARY SERV
UNOERGROUNO �
ROUGH WIRING
AIR CONpITIONING
OR POLE
POWER �
UA I t 4-ZZ "(j
• DESCRIPTION of
SUBCONTRACTOR
LATHING — IN � I OUT �(_O�•v•L�i
PLASTER,BROWN COAT � .(j. '��3-7
STRUCTURAL, FiHnL
HEATING. VENT., REFRIG. ANO A.C.. FINAL _` �J /1i.r..nw . i -'%T 'ZQ> 70
, � � i-r-7��":=CC e��; �.._�2:.63
• COSTA MESA BUILDING-SAFETY DEPARTMENT
' P.0.90X1200 COSTAMESA,CALIFORNIA92626
AP I ATION FOR BUILDING PERMIT
for Applicant to Fill in Comp/erety q c i e V DATE RECEIVED
AOORESS O� J �, �%rV r�/ ` ' D ISSUED
OWNER ,�. iJ�•I�\ A.P.NO.IJ 1�iOZZ P T
BUILDING ��{�� � �
MAIL S � /y�G ADDflESS ��� �"�+ ` *-'�"" � �fy`a
Z ADDRE55 r"•+•�f' p /
a U CIY�' (N� /--� �� NOL TRACT�J LOT Y� BLOCK
ZZ
Q Cp(57RUCTION W ADD A �
O N LENDEfl Y .
2 p]
J � BRANCH �"
JN OWNER 1'�.G��
m J qDDRESS /A1 VA E
m qRCHITECT 1�`p���-s TEL. S �I 7�D $ ��d ��
J N OR ENGINEER aWl I�l _ N
V � � M/ FIRE �'�/'
w 2 qDDRESS �-v��F� �ONE YPE V GROUP
a w ��(� APPROVED
W Z CONTFlACTOR �%W�F-� � BV DATE \
J O
m ^ry�G �
J� ADORE55 .S�I,r
w W TEL. Z�N NO.OF USE OF NE /N \
Z� ��Y,, N� � PL4NSZ BUILDING a /�
w � STATE CITV VARDS APPROVED VARDS APPROVED J�(I
y 2 UC. NO. LIG. NO. MAIN BUII�ING ACCESSORY HV�lO1NG �jY
_� S�ZE O� DO� NO.OFBlDGS. (FROMGLST EET) ?�
OF �OT � �C ( NOW ON LOT � FRONT FT. PT. !'�
�s� oF �o��G �1' C�.cRI�� �(- ; v'
EXISTING BLDG. FT. FT �
Z NIEWBLOG. IOO� ROOMS � STORIES �
1.51DE FT. FT.
EMERIOR WAL POOF G 1A (
V COVEFING COVERING P• �Y'�� REAR �"� FT. � FT. �
J USE OF BUIL�DIN�G,�A,,yN�D WORK TO� By�E PERFORMED OISTANCE BET. BET, MAIN &
a nG�Ci/• / /'<i' � I L MAIN BLDCS. ACCESS BLOGS.
a NL
O bP GV� �S II/�/ ��}+-�:�EYY•E C.U.P,�'+ APPROVED
NAPPROVE ��S
z �TATE
O
VI hereby acknowlatlBe thet I heve rantl this epplication antl smte ,
� that the ebove informntion is corract entl apreo to comply with
� all laws ragulating builtlinp constructlon, ontl I shall not employ
F any aerwn In violetion of the workmnn's compansatian laws of
y the State of Calitornia. �
zI hereby cartify Mat I am properly Iicensatl as a conttattor untler SQ. FT. o
the State of Californle Business antl Professions Cotle, Divisicn 3, HE AMOUNT SMOWN UNDER VAIUATION IS FOfl
Chapter 9, antl thai suc� licenses are In full force antl etfact, or I THE PURPOSE OF ESTABLISHING A PERMR FEE ONLV: m
am ezempt trOm t�a ptovisiOns ot tha State of CalifOrnia Business � ¢
antl Professions Cotla, Divislon 3, Chepter 9. VALUATION m
PERMIT FEE S �
J
Sipnetura ot ,( _ m
Perrt�itt¢e 5 /)hD , PL4N CHECK E �
�/(/ LL
A�tnorized Apant , TOTAL FEE S _v
� G �
.�:..
CpSTA MESA BUILDING-SAFETY DEPARTMENT
� P. O. BOX 917 C06fA MQBA. GLIFORNIA
Fo� Appllcanf to Fill In Complefely
TYPE OR PRINT
BUILDING �� � �T
ADDRESS
COSTA MESA. CALIFORNIA
OWNER /%Q�%I N �} `-.S�Pf l�n'i9aV
MAIL S, l.1/ FL�-�'i (�,�
ADDRE68�
cirv ''�A tSR iao:,S''is._7.�
ARCNITEGT__ t-�� TEL. `�
■ SIZE
FEE RECEIVEf�
JAN 2 4 1963 �'
FINANGE GEPI.
cirr oF coSTa mEsa
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
REEEIPT NO. PHf
RECEIVEO BY
�
BUILDING
COSTA MESA.
FIRE
�07 E'• ('°` �• ZONING �
�p�O �J �/ ZO NO.OP UBE OP NEW
�// NT// /J�VN' / I PLANS v I BUILDINO
2 �� � / J NEo. � ]J '/ / 7 � teaw� -%
oescairriorv �
4 O I NO. OP BLD69. / �•
Now ON LOT p, p, NO. � C
� ��� �K( � YAROS EVES
EXISTING BLDG APPROVED
68TBACK LINL RPOM � ��y Y (ClNTlR LINH 9T.)
cexien O� eixeeY � REAR YARD�� FRONT
/) %� tI
SIDE YARD ILEFT ✓ RIGHT R.SIDE
DE5CRIPTION OF WORK
L.SIDE
� � �� � �� �
� NO. OF
ROOMS STORIE:
WALL /l `� I ROOF
`�• COVEftING
IILDIN� P.N� WORK TO 9E PERFORMED
!i � V �i I t% . ti
1 H6IiEBY ACKNOW�3GOC iXAT 1 HAVH NBAp TXIB APPLIGTION
AND BTATE THAY THE A90VE IS GOflRCGT AND AGREE TO COM-
PLY WITH �LL CITY OPOINANC¢8 ANp BTATE ��w�Wif
BUILCINO CONeTr1UGT10N. %.�/fa�RN �� �O
SIGNATURE OP '�f �•l� �(n.4r�/
PERMITTE
AUTHORIZED AGENT �� �C.(S'« �
APPROVED
TXH �MOUM BHOWN UNDEft VALUATION IB FOR THE
PUPP088 OF E6TqBL�BNING A PEPMIT F8E ONLY.
VALUATION � �
S 7j/`'� PERMIT FEE $ 'P•
(y�J' � PLAN CHECK $ '�
.�
�
C��STA MESA BUILDING•SAFETY DEPARTMENT
P. O. BOX 917 COBTA MEBA. CALIFORNIA
For Applieanf fo Fill In Completely
TYPE OR PRINT
BUILDING LOI- [^,�I Tie/S�l�T ;�49 _
COS7A MESA. CALIFORNIA
1 MAiI
� STATE
cc
■ 6QTBACK LINB FROM
iF.
TEL.
NO. OF
DESCRIPTIOM OF WORK
BUILDING / G p ROOMS
81ZE V
EXTERIOR WALL lJoGO ROOF
COVERING STUC�rya COVERII
U3E OF BUILOING AND WORK TO BE
S/NbLG FAH7iL✓
G�
APPROVED
LEOAL
��� ��������
��tAR 2 1962
��+��cE D�Pr.
CITY OF COSY� MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
FECEIPT NO. ' PEPMIT NO.
BY I DA'�'EC�EIVEO� J D ��'
q /5 y �� G
c�c I
COSTA MESA. CALIFORNIA
ZONING
PLPN9 � I BOIL�INGEW %'~� 9+M/
w a �! 4•
Lot 6 9 7iP N3v9
��ne sr.� 6
S
s
9
yv
fEZI�
L
1 HEREBY AGKNOWL6DOE TXAT 1 HAVE REPD TXIB APPLIWTION TME RMOUNT BHOWN UNOEH VALUAiION IB FOR TXE
AND BTATE THAT THB ABOVE IB LORReCT AND AGREE TO COM- pUPPOBE OF ¢BTABLIBHING A PEPMIT FEE ONLY.
PLV WIiM ALL CIT' OROINANCES AND 4TATE LAW9 R¢6ULATING
eU1tnlNo CONBrnuCT1oN. VALUATION (//�
SIGNATURE OF . PERMIT FEE $ TC/ �
PER /�
� $�/ �j�` PLAN CHECK $ `�C /`
AUT O IZED AGENT /
TOTAL FEE l