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HomeMy WebLinkAbout2908 CHESTNUT AVE - Building Permits�� \ _( �.�'" Applicant �o fill in all spaces except lhose within heavy bortler lines antl si9n all approDriate tleclarations. PERMIT N.U. _ TRACT NO. LOT NU. UNIT Nn ' fCITY•7F COSTA MESA CONSTRUCTION PERMIT , vcoi ct Address Z908 Chestnut Avenue �ApplicanYs Mailing Address ,� 26 Commerc i a_I Way, , CM 92627 ow�ers rvame Ber n i ta' E i l ertson • PnOfe 751-5235 Address 2903� Chestnut Ave. , C.M. 92627 Arch/Eng.. License No. Address ' ' Convactor's Name C�Bnk Bros.' Roof i ng C��e . 548-556 j address Ima�r�el 126' Commerc i a l Way, CM 92627 Ciry License No. 005993 " �/ IICENSED CONTRACTOR DECLARATION � �j 1 M1ereby atfirm ihat I am licensetl untler provi5ion5 of Charter 9(commencing with section �000) oi Division 3 of the Business and Protessions Cotle, aritl my license is in full forc(�` a ff2ct. Licens I "—� e No. 40867�7•1 Oale� Siqnature ORKEftS'COMPENSATION O LARAT .�ereby affirm that 1 have a certiticate of nsent to sei/-insure or a certificate o( Workers' Compensation Insurance r a certifietl copy'thereof (Section 3aoo, �ao. c.�285/224-89 State• Fund Poiicy No. Company ❑�Gertifietl copy is hereby fumishetl. S� C�<i 'ti o rilea witn tne citv g. D. . Date� Appticant � EXEMPTION FROM WORKERS' C NS DECLARATION (Thissection neetl not be completetl it the ' I5 for One huntlretl ($300) or less). I certity that in tM1e pe�formance of t rk for which this perm�t is issuetl, I sM1all not employ any perzon in any anner so as to become subject to the Workers' Compensation Wws of California. Date Signature NOTICE: If, atter makin9 this tlecla�ation, you Shoultl bewme subject to the , Workers' CompensatiOn Provisions of the Labor Cotle, you must fo�thwith comply with such ptovisions or this permit shall be tleemed rewketl. CONSTRUCTION LENOING AGENCV I hereCy aftirm tnat there is a construction lentling agency for the periormance ot the wark tor ivhicn jthis permit is issuetl (Section 3097 Civ. C.) Lentler's Name � Lentler'S Atltlre55 - � OWNER BUILOER C�ECLARATION I hereby affirm thaCl%am exempt from the GontractoNs License Law for the following reason (Section 7031.5 Business antl Professional Cotlei Any city or county which requires�a permit to canstruct, alt¢r; imp�ove, Gemolish or repair any structure, prior�to�its issuance; also requi�e5 the applicant for such permit :,�o file a signetl statement that he/she is'licensetl pursuant to [he p�ovisions af s;<he Contractor's Licen5e Law (Chapter 9(commencing with Section ]000) of �i+�ivision 3 of the Business antl Professions Cotle) or that he/she is exempt �2:.'Oerefrom antl tM1e basis for the allegetl�exemption. Any violation of Section � 7031.5 by any applicant for a permit subjects the applicant to a civil �enalty of not more than frve nuntlretl tlollars ($500). LI I, as owner of tne property or my empioYees with wages as their sole . compensation, wi11 tlo the work, antl the sVucture is not intentletl or offered }OI SdIC (52CIiOl1 �044� BI1510255 dOd Professional Cotle: The COlI[IdCIOY'S License Law tloes not appty to an owner of a property who builtls or improves thereon, antl wno does such work.himseli/herselt or tnrough his or ner own em0loyee5, p�ovitletl that such improvements are not inientletl or offeretl fo� Sale. If; howeve�, the builtlin9 or imp�ovement is soltl within one year of com- pletion, the owner will have tM1e burtlen of pravin9 he/she ditl not buiitl or im- prova for tM1e purpose of sale). ❑�I, as owner of the property, am exclusively contractin9 with licensetl con- trattOrs to const�uct the project (Section 7044, Busine55 antl Protessions Cotle: The Contractor'S License Law tloes not apply to an owner of property who builtls or imDroves thereon, antl who contracts for such projects witM1 a con- Vactor(5) I¢ense pursuani to the ConVactor's License Law). I'am aware that proof of their Worke�'s Compensation insurance shoultl be provitletl to me. i� I am exempt under Section B. & P. C. tor this reason Date _ I hereby informatio dOd 5[dI¢ 5¢Otdtiv¢5 �inspection Siqnature , DriverY Li 9F 0865-46, Owner • that I have reatl thi5 application antl state Ihat the above �rec I agree to comply with all city antl munty ortlinances a' to Itling construction, antl hereby authorize repre- it enter upon the above-mentionetl (�J�.r�Q/Q Qe�rt�y�. fo/r Oaie� � �� TVPE OFCONSTRUCTION �LJ NEW LJ ADD `iS' �iLTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH � OTHER DESCRIPTION OF WORK/USE OF BLDG. � n5'YB I�P CLASS N f i ber= glass shin les 30f{ felt. New metal ed e& flashin s TVPEOFPERMIT ❑ GRADING ❑ FOUNDATION STRUCTURAL � '0 TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL . �.y.0 OTHER • ' ; PROJECTDESCRIPTION Sq.FT.2�397 � OCCVPANCV�js.ip � CONSTRUCTION TVPE res i dent i a l 'vnwanoN s2.896.0i3 ZONE GRADINGCU.VDS. ACRES Bar Sink BackFlow Preventer Backflow Irrigation, Bathtubs Clarifiers _ . 7rinking Fountains Floor Dreins� � Floor Sinks 3asService •Outlets Interceprors � Kitchen Sink � Lavatories � P—Trap Roof Drains Reinspection Fee � $15 Boiler Duct - Under Ground Duct - Suuctural Duct - Ventilating Exhaust System ❑ Multiple FirepVFact. Blt. ICBO # Heating System & Ducting ❑0-100,000 BTU 0100 000 Reinspection Fee I $75 WM1ite - Builtling; Canary - Appllcanh Pink - Accounting; Goltlen�otl - Assesm� Showers Service Sink . Sewer Cap Sewer Connection Solar Collecmrs - Solar Piping Solar Tank Swimming Pool w/Spa Urinal� Water Closet Water Heater Water Service . A uto-W ash LaundrYTrays , Issue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,0006TU ❑100,000 System Repair/Alteration Fire Dampers Registers luue Fee F FEES $ 3 FEES $ 3 A.P. # S Main Building: — E T Front B Rear A — C Right _ g Left � — PIng.Ref.# - . Planning Notes: Automatic Washer : ConsVuction Pole Sub. Cooking Unit, Dishwasher : DrYers �Gas ❑Electric Fan Fixtures Device Boxes . Outlets Switches Garbage Disposal Generator �b5 KW 0 i_..., „ . . ". � : � ! I Zone Building: � � � 'Parking Req./Provided 1 ELECTRICAL Transformer'�� 15-50 KW ❑ 50+KW Meter, Dup to 100 amps � � Meter ❑over 100 amps � ' Sub Panel . Motors � 0-1 HP � 1 Y- 8 Inc.Solar 09-75 HP �16�15+ Microwave • Pole �ight . .' Fange � Standing Sections 15 KW� � Trash Compactor I Reinspection Fee I$15 I I Issue Fee DEVELOPMENTSERVICESREQUIREMENTS:� Zoning Approved By Building Approved By APolication luued By n z O N I N G � R E Q M T S FEES r- �- $ 3 SUMM,�AR�/VO�F�'�EES � BUILDING PERMIT $ � `f��Js.J-SMIP $ ,� ., PLAN CHECK $ PERMIT_ � � PLUMBING � $ ISSUANCE $ � PLAN CHECK 25% g ut VULt4J:7?SJ�CiENERGI' P.C. i$T `-� °„ i'��L• U'/L"vIS GRADING �+�'�$= ELECTRICAL . $ PLANCHECK 50% $ `MICROFILM $ ��� MECHANICAL $ � TOTAL FEE � $ S PLAN CHECK 25% $ - • ' CONSTRUCTION AND�PLANNING ' POOL' & SPA _ .� , __ . APPROVALS Permit�� Date � Inspector AppROVALS Permit# + i Date Inspector 1_.Temporary Electrical��Service or Pole 52. Pool &•Equipment Location , ' � 2.� �Soil Pipe-Undrgrnd. ' ' - � 53. Steel Reinforcement . 3. Electrical Conduit Utility-Undrgrnd. 54. Forms , . 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding � . 5. Steel ReinforcemenL'�:�. 56. RougR Plumbing & Pressure Test ' � 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE , . 7: Footings .., 58. Electcical ConduibUndrgmd. '. 8. Foundation � � 59. Gas Pipe, � Undrgrnd., Test � � 9. Water Pipe-Und'rgrnd. 60. Backwash Lines„P�Trap, O Undrgrnd. 10. Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final - 12. Sewer Cap 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. POOL/SPA SYSTEMS FINAL � 19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT _ 20. Rough Factory Fireplace APPROVALS Permit# � _ 21. DuCis,in Structure � 70. Underground Hydro • 22. Ducts, Ventilating . � 71. Product Piping � Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush - � 24. Roof Framing . � 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro ' 26. T-Bar Ceiling (Strucwral) & Monocoat , 75. Dry Chemical , - 27. Frame and Flashing ' - 76. Dry'Standpipe 28. Lathing & Siding � 77. FIXED 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 �� r 33. Final Electric � � Notes: � � � 34. Final Heating & Air Conditioning . � , � ' - ; , f� 35. Final Gas Pipe-Test � 5'��, � � 36. Hood or Canopy , , 37:•Final Factory Fireplace , . y � 38. Final Plumbing . . � 39. Water Service-Final - - - � ' 40. Gas Service-Final- , - - �41. Solar pomesticFinal . ' 42. Backflow Preventer - . _� ',43. Backflow Irrigation � ' � •. • • �44. Landscape Irriqation System , ' � . '45..Sound Attenuation ' � ' ' 46. Handicap Regulations � � � 47. FINAL STRUCTURE & BUILDING � s � . 48.;Special Requirements Completed . , - � � 49.. Electric Release-to Edison - . � , � � • . � - 50. Gas Release to Southern California Gas Co " 51..CERTIFICATE OF OCCUPANCY � . . ' / No. Date � � ; i: . . �1. �-,i .. .. .. . .... ♦�'�` �p M� q r o, � > f J , �`�+.o.,,w A" (714)754-5273 • Faz(714)754-4856 CITY OF COSTA MESA BIIILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT Job Address: 2909 CHESTNUT AV Suite: Vicinity: HOUSE AND GARAGE Parce�Number: 13928417 Applicant: JONO WIHONGI Address: 76702 MT BAXTER FOUNTAIN VALLEY, CA Owner: ALDRIDGE, MARY ELAINE Address 2909 CHESTNUT AVE � COSTA MESA,CA Contractor. CONSUMER SERVICES Address: 16702 MT BAXTER FOUNTAIN VALLEY, CA � Zip: 92708 Address: � ' . Phone: L BUILDING PERMIT Zoning: Phone: (714) 839-4549 Zip: 92708 Phone: Zip: 92626 Phone: (714)839-4549 License: 676090 — Eng: Address: n PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 02/07/2000 Issued: 02/07/2000 ISSUED BY: �/ // � Phone: � Zip: ' � " License: License: , � SCOPE OF PERMIT REROOF.- T/O, INSTALL 7/i6" OSB BOARD, 1 LAYER OF 30# FELT AND 20 YEAR COMPOSITION SHINGLES. Plan Check: $0.00 � Permit: $153.25 SMIP Res: $0.77 SMIP Com: $0.00 Other: . $0.00 Inspection: $0.00 Total: $154.02 SETBACKS MAIN STRUCTURE Frant 0- 0 ACCESSORY Front 0- 0 PARKING existinq: o NOTES: Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation Right 0-0 Right 0-0 s�,�oo.00 s�,�oo.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related I regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commanced within 180 days, or if work is suspended or abandoned I 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 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: (714) 7545626 I WOhKERS'COMPENSAnONDECLARATION: I hereby aHirm untler penalty of perjury one of the following declarations: ❑ I have antl will maintain a certificate of consen� to self-Insure tor workars' compensation, es provided lor by section 3700 of ihe Labor Cotle, for the pertormance of ihe work tor which Ihis permit is issued. � ❑ I have and will maintain workers' compansation insurance, as required by section 3700 of the Lebor Code, for ihe performance oi Na work �or which this permit is issued. My wo/rkwy,�compensation Insurance carriey and policy number ere: Carner. C L/-1—Q / N�C�—_.-jl / Policy Number. (lhis section need nof be campleted i! the permit is vel�eO at one huntlred dollars ($100) or less.) ❑ I certiry that in the pedormence oi the work, for whic pi permit is issued, I shall nol employ eny person in eny manner so as to become subject to Ihe workars' compensation laws of CaliFornia, and �at}�al iF ould ecome su6ject to the workers' compensation provisions of Secti n 3700 of the Labor Cotle, I shall forthwith comply with these pr visions. Applicant Signature: ` Date: � v�--O'°�9 WAFNING: FAIWRE S CURE WORKER$' COMPENSATIQ4 COV GE AI�� SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALT ES AND CIVII FINES UP TOONE HUNDRED THOUSANDDOLL4 (S ,OOO�,INAODITIIXJTOTHECOSTO� ENSATIIXJ,DA�6ESASPaOVIDEDFOiiINSECTION3lO60FTHELABORCODE,IMEREST,ANDATTORNEV'SFEES. LICENSED CONTRAC70RS DECLARATION: I hereby affirm that I am force and eHecL Lic. q_ Contractor's Signature: 9(commencing with Section 7000) of Division 3 of Ihe I � Class k � _ .__ _ Da�e: _ CONSTRUCTION LENDING AGENCY: V ❑ I hereby attirm ihat there is a consiruction lendinq a9ency tor ihe pedormance of the work tor which Ihis permit is issued. (Sec. 3097, Civil Cotle). Lentler s Name: Lentler's Atldress: Signature: OWNER-BUILDER DECLARATIONS: Date: and my license is in full I hereby aHirtn Ihat under penalty of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Professions Code: Any ci�y or counry which repuires a permit to constmc6 alter, improve, demolish, or repair any simcture, pnor to its issuance, also requires the applicant br such permi� to tile e signed statement ihat he or she is licensed pursuant to the provisions ot the Coniractors License Lew (Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and Professions Cotle) or ihat he or she is exempt tharetrom antl the basis tor the alleged exemption. Any violation ol5ection 7031.5 by any applicant for a permit subjects the applicant to a civil penalry ol not more than flve huntlretl tlollars ($500).): ❑ I, as owner of ihe pmperty, or my employees with wages as Iheir sole compensation, WILL DO THE WORK, and the stmcture is not intentletl or oNeretl tor sale (Sec. 7044, Business and Professions Code: The Coniractors License Law does not apply to an owner of propeny who builds or improves ihereon, and who does such work himself or herself or ihrough his or her own employees, provided thet such improvements are not inrendatl or ottered tor sale. It, however, ihe building or improvement is sold within one year of completion, the owner-builder will have ihe burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner oi the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct ihe project (Sec. 7044, Business and Pwfessions Code: The coniractors License Law tloes not apply to an owner ot property who builtls or improves ihereon, antl who comracis for such project with a coniractor(s) license pursuant to ihe Con�ractors License Laws.). ❑ I am exempl untler sec. Business and Pmfessions Coae tor this reason: Signeture: Date: Owner ID verified by tlriver's license. ❑ Ves ❑ No Driver's License No. Expiras: Venfication of Ownership by (rype of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFE7V PERMIT CERTIFICA710N: ❑ I hereby certily that no excavation five (5) or more feet in depth into which a person is required to descend, will be matle in connection with work authorizetl by this permit, and t�a� no building simcNre, scallolding, talsawork, or demolition or dismantling thereof, will be more than thitly-six (36) teet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title e, California Administrative Code). ❑ As ownerbuilder, I will not employ anyone to do work which woultl require a permit irom the Division of Indusinal Safety, as notetl ahove, unless such person has a permit to da such work from the division. Signature: Dale: Division of Industrial Safety Permit Number. CER7IFICATE OF COMPLIANCE AND AUTMORIZATION OF ENTAY: I certify under penalty of perjury ihat I have reatl this application and state Iha� the information given is correct I agree to comply with all state laws and city ordinances relating to builtling consiruction, antl authorize represematives of ihe Cify of Cosfa Mesa to enter upon ihe above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by Ihis permit until final inspection. Of Legal INSPECTIONTYPE V Fixed System Final Fire Prevention 1266 Pod Spa Final 200 Final Re-Roof 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition 244636 ��F, INTITIALS /`.�"-�.— WV v �a�e 7�2000 Date COOEf INSPECTIONTYGE 206 Final Mechanical 208 Final Plumbing 210 Final Elecincal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy P9T€ �NTRIALS GENERAL CONTRACTOR S AP. No. LOT INSPECTIONS OCCUPANCY DATE 3-28-60 TiiACT 2ti22 FIftE ZONE DESCRIPTIONOFWORK`�/COirtirl. i510i DwrE I GROUP J TYPE 111 ZONE H-1 — ---I SUBCONTRACTOR I _ __ PERMITSISSUED__ Form 210-5M-11-59 5-8 P . . • -- 116I.16 - - ; �� ��� COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. HOX 917 COBTA MEBA. CALIRORNIA For Applieant fo Fill In Completely � TYPE OR PRINT - BUILDING ADORES � COSTA MESA. CALIFORNIA � aTM � / _ �' T-� �i��, re�. Q/j/ NO. ARGHITECT TEL. �=�E R�C�il��� 3.�2k J�o �� FillNNCE DtPT. ri�'v nc r�grn MFeA APPLICATIOtJ FOR PERMIT euaDiNG For Office Use Only REGEIPT NO. �/pEKM,'IT6(NVO'�v ��. L1.a.n FECEIVED BY DATE flEC�gIVED DATE 1&BU !�"`�!/� �3—�d"60� 3—Yt��e BUILDING ADDRE56 COSTA MESA. CALIFORNIA FIRE ZONE APPROVED BY � : / //� LEGAL , SIZE I NO. OP BLDG9. OF LOT NOW ON LAT � BBTBACK LINE FROM DESCRIPTION OF WORK NO. OF PXTERIOR WA�I. COVERING USE OF BUILDING � �// ✓ / / "� 1 (O ' 1 HEHEBY ACKNOWLEP48 �HAT 1 XAVE READ TH19 •MPLIGTION ANO BTATE THAT TXg A90VE I8 GORRECT ANO AOREE TO COM- PLY.WITX ALL CIIY O��NANCEB ANO 9TATE LAW9 REGULATINO BUILDIN6 CONBT(tUCT� p � 81GNATURE OP . � / �;:�I"y[,rlA� PERMITTEF AUTNORIZED AGENT ZONIIdG NO. OF USE OF NEW PLANB �/ BUILDWG YARDS EVES APPROVED ALLO (CCNTER LINE BTJ �� , • ��� sIN. _ i.�'/ U TXE AMOUNT BHOWN UN�ER VqLUAT10N 18 FOR THE PYRPOBE OP, EBTA9L19HING N PERMIT FEE ONLY. VALUATION 1 � PERMIT FEE $ � �' �� /a O O PLAN CHECK $ TOTAL FEE $ � � �� . i �4�:3�5 ,,:. COSTA MESA BUILDING•SAFETY DEPARTMENT P.O, BOX 3f7 COSTA MESA. GALIFORNIA fOR APPL/CANT .TO f/LL /N COMPLETELY ' TYPE OR PRINT BUILDING 2gpg Chestnut Avenue ADDRESS COSTA MESA. CALIFORNIA � �u�9 . .:, i_- 0�1 t:. l; :: � � - ;,. � n��u 7 1959 FlNP,(�CE �EPT. �'.�1b nc �r,C'rn r.qFcµ APPLICATION FOR PERMIT BUILDING fOR Off/Cf USE ON[Y I RECEIPT NO. I PERMIT NO. -1 �fA,f'Af`� CEIYF.p�BT I DqTE RECEIVEO I l�� qT }95U [ �� / y y '� U 1 U 15 CO$t$ AYesa TEL.��11 � BUILDING CITY NO. S pDORESS ARCHITECT Carlson $[ ���� ' COSTA MESA, CALIFORNIA OR ENGINEER NO. aa e roo FIRE •� � i ADDRESS � ZONE TVPE �' � GROUP .— CONTRAGTLOR &' CO].0g1^OVe� Inc� c NTO. 167293 ByPROVED � DATE AooREss 419 E. 17th St., Costa hiesa^ ZONING LEGAL LOT [ � 2�q2 20NE NO.OF USE OP NEW DESCRIPTION NO. �V� IBLOCK ITRACT �/ I>�ANS IBUILOING A.P. NO. APPROVED L �S BV � DATE �. SIZE 6O X 11J� rvo.oFa�pcs. ypRDS EVES � OF LOT I how orv �oi none REQUIREO ALLOWED USE OF I�ENTER LINE 9T.1 EXISTING BLDG. SETBACK LINE FROM CC} CENTER OF 6TPEET ll REAR YAR[ SIDE YARD I LEFT � S, I RIGHT F DESCRIPTION OF WORK NEW I X IIALTERATION I II�+DDITIO REPAIR I II MOVING I II DEMOLI; BUILDING u,SQ NO.OF� �j SIZE ROOMS STOR EXTERIOR WALL ROOF COVERING Stl1CC0 COVERING rock USE OF BUILDING AND WORK TO BE PERFORMED SSnRle familv residence with 1 eJ �� .1 FT. � � � �. c� I HEREBT qCKNOWLEDGE TXAT 1 HAVE REAO THIS APPLICATION THE AMOUNT 9HOWN UNDER VALUNTION IS FON THE AND STATE THAT TXE ABOVE IS CORRECT AND AGREE TO COM- PLV WITH ALL CITV OROINANCES AND STATE LFWS REGULATING PUppO3E OF ESTR9LISHING A PERMIT FEE ONLY. aui�oirvc coNsirxuc orv. VALUATION SIGNATURE OF �` � PERMIT FEE S 3��CO PERMITTEE , $ �'�C�, PLAN CHECK $ 17�0Q Dike & Cole rove Inc � 1 nn AUTHORIZED AGENT g � . TOTAL FEE $ Sl�w V� r )