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Home My WebLink About108 CLEARBROOK LN - Building PermitsApplicant to4ill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Prpjpct Address �p� Geax1 hrool� Applicant's Mailing Address 1`,420 ��'c5--V1��-1��'1,,,...--- \23q _S-0-S! K��1�1�51�1\^Q� Owner's Name -f ) - - m� �� Phone `-V Address Arch/Eng: - 1 License No. Address I _ Contractor's Nam Phone Address (mailing) City License'Nc LICENSED CONTRACTOR DECL RATION ' I hereby'affirm that I am licensed under provisions of Charter 9 (commencing with section 70001 of Division 3 of the Business and Professions Code, and ; my license'is in full force and effect. License Class i�LLicense No.— Date— o.Date Signature WORKERS' COMPENSATION DEC ARATION 1 I hereby'affirm that I have a certificate of consent to self -insure or a certificate of Workers! Compensation Insurance, or a certified copy thereof_ (Section 3800, Lab. C.) Policy No. Company eCertified copy is hereby furnished. ' ' Certified copy is filed with the city Building Division. . Date I Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' (This section need not be completed if the -permit is for one hundred'($100) or ess): I certify that in the performance of the work for which this permit is,issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Dateg Signature ' NOTICE: If, after making this declaration, you should become subject to the .Workers' Compensationprovisionsof the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION, LENDING AGENCY I hereby affirm that there is a Construction lending agency for the performance of the work for which. this permit is, issued. (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am -exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a Slimed statement that he/she is licensed pursuant to the provisions of Division3 of the Business and Professions Code) or tbdt ne/sne Is exempt therefrom and the basis for the alleged exemption. Any violation.of Section .7031v5 by any. applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500).' I,. as owner of the property or my employees with wages as their sole '-compensation, will do the work, and the structure isnot intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law�does not apply -to an owner of a property who builds or improves thereon, and'who does such work himself/herself-or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building .or improvement is Sold within one year of com- pletion, the owner will, have the burden of proving he/she did not build or im- 5 ove for the purpose of sale). I, as owner of'the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner ofproperty who ' builds or improves thereon, and who contracts for such projects with a con- tractor(s1 license pursuant to the Contractor's License Law). 1 am aware that proof off their Worker.'s Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Owner, uL have readd-this application and staa that the above agree t000mply with all city andcountyordinances I to building construction; and hereby authorize repre- tqf enter, upon the above-mentioned proparty/for Signature Drivers' License or SS CMF 0865.46, rev. 4/84 White - Building; Canary -Applicant; Pink -Accounting; TYPE OF CONSTRUCTION LJ NEW U ADD LJ ALTERATION U REPAIR • - ❑ ❑ ❑'OTHER 3ar Sink - Showers I CONVERSION DEMOLISH Service Sink - A.R. # DESCRIPTION OF WORK/USE OF BLDG. Bathtubs I Sewer Connection Clarifiers Solar Collectors i S Main Building: Solar Tank ' Floor Drains Swimming Pool w/Spa Floor Sinks TYPE OF PERMIT GRADING - 'FOUNDATIOry STRUCTURAL' T Front ❑ ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B TENANT _ Rear ❑ OTHER TOTAL FEE A - C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K -CON STRUCTION TYPE VALUATION$ $ Left I ZONE ' GRADING CU. YDS. .ACRES Ping. Ref. # Remarks: - 1 ' - Planning Notes: _ I i • - PLUMBING 3ar Sink - Showers I 3ackflow Preventer - -- Service Sink - 3ackflow Irrigation Sewer Cap Bathtubs I Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping: Drinking Fountains Solar Tank ' Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Water Closet -- f Interceptors! " Water Heatei Kitchen Sink . - Water Service Lavatories P -Trap Roof Drains FEES ' Reinspection .Fee $15 I I Issue Fee I $ 3 • - MECHANICAL I FEES Boiler Hood or Type I ❑ - Canopy Typell El Duct - Under Ground Duct - Structural Refrigeration System - ❑0-100,000 BTU ❑ 100,000 B Duct - Ventilating _ I Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # ' Heating System & Ducting ❑ 0.100,000 BTU ❑ 100,000 BT F.A.U. - - Fixtures: - . Microwave.- - Reinspection Fee $15 I Issue Fee enrol - Assessor $ 3 9379 10/03/84 Accessory Building: Parking Req./Provided t 7,00 TLi Zone' Z O N I N G . R E M T S. ELECTRICAL I FEES -'Automatic Washer - -- - ConstructionPoleSub. - - Transformer ❑ 15.50•KW - - - ❑50+KIN 'Cooking Unit Meter ❑up to 100 amps Dishwasher Meter Dover 100 amps; ' Dryers ❑Gas ❑Electric Sub Panel Fan Motors ❑0-7 HP ❑ 1'/: - S F.A.U. Inc.Solar 09-15 HP ❑16-15+ Fixtures: - . Microwave.- - Device Boxes Pole Light Outlets ' Range Switches Sign Garbage Disposal Standing Sections ' Generator 00-5 KW 1:15-15 KW Trash Compactor I i ReinspeMion Fee 1 $15 ' 1 DEVELOPMENT SERVICES REQUIREME Zoning Approved By Building Approved By _ Fee $ 3 PLAN CHECK 25% $ SUMMARY OF FEES ' BUI LDING, PERMIT. $ SMIP $ PLAN.CHECK $ PER MIT PLUMBING $ ❑•00 ISSUANCE $ PLAN CHECK . 25% $ ,ENERGY P.C. $ ELECTRICAL $ 1 GRADING $ PLAN CHECK 50%' $ MICROFILM $ MECHANICAL ( $ TOTAL FEE $ PLAN CHECK 25% $ - CQNSTRUCTION•AND .PLANNING ' 'UPROVALS `Permit#' Date Inspector POOL &SPA APPROVALS Permit # 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-Undrgrhd, 55. Electrical Bonding - - 5. Steel Reinforcement - 56. -Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. - 57. APPROVAL TO COVER-GUNITE 7. Footings - - 58. Electrical Conduit-Undrgrnd: ' 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test " .9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P -Trap, O Undrgrnd. 110. Structural Floor System 61. APPROVAL TO DECK - - 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 112. 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 APPROVALS Permit # _ 20. -Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro ' 22. •Ducts, Ventilating -71. Product Piping O Gas 0 Oil , 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro •- 26. T -Bar Ceiling (Structural) 8e Mon ocoat '75. Dry Chemical - 27.,Frame and Flashing 76. D•ry 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 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 48 ,Jy LFA 36. Hood or Canopy 37. Final Factory Fireplace •. 38. Final Plumbing �t7�� y'�( GF/D 39. Water Service -Final , 40. Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer I ' 43. Backflow Irrigation.-_,,..,- -. - 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING " 48. Special Requirements Completed 49. Electric Release to Edison - • - - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA C NSTRUCTI/O/N PEFIMIT Project Address -��1e E62 ��=4 ,• �--7— _ Applicant's Mailingyess— _a7i 70 Owner's Name /i-�->A�d'drK: Phone Address Arch/Eng. License No. Address Contractor's Nam g , !'Phone Address (mailing) a<, �S°f��G-rJ' �'tl-or- "�� •i�.rm�fti City License No LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section -7000) of Division 3 of the Business and Professions Code, and my license is in full force aV e/fact. License _5 ,9, t LicenselNNt lapr�'+ uruT Date% -ice/ -9, O k Signature _e WORKER COMPENSATION DECL RATION 1 hereby affim' m that I have a certif is a of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy.thereof (Section 3800, Lab- C, �. [ Policy No. ��I/a.�._, ff % Company lye lif ted copy is here y furnished. -� LY Cert9fie)c pwith the city Bud! ing Divisip Date Applicant -EXEMPTIONROM ORKERS'CO EN SATION DECLARATION (Thissection need not be completed i he permit, is for one hundred ($100) or less): I certify that in the performance of the work for which this permit is issued I shall not employany person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which Ih's permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for Such permit to file a signed statement that he/She is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to is civil ee nalty of not more than five hundred dollars (8500). L� 1, as owner of the property or my employees with wages as their sole Corn will do the work, and the structure is not intended or -offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law tloes not apply to an owner of a property who builds or improves thereon, and who does Such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for Sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tract or9lo conStr uct the Project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property Who builds or improves thereon. and who contracts for such croiects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof -n, their Worker's Compensation insurance should be provided to me. ❑ I am txempt under Section B. & P. C. for this reason Date Owner — I hereby certify that I have read this information is correct. I agree to comp and state laws relating to building don Sentatives of this city to enter inspection purpos(;,5. Signature . Drivers' Licens4 r SS 7P i above pro TYPE OF CONSTRUCTION NEW LJ ADD ALTERATI ❑ CONVERSION ❑ DEMOLISH ❑ OT/Uy/ER DESCRIPTION OF WOBXLOSE 06 BLDG TYn OF PERMITGRA?i NG LIFOUNDATION U STRUCTU, TENANT 1:1 LEC ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. St OCCUPANCY CONSTRUCTION TYPE 4 VALUATION$ ZONE GRAOINGCU.YDS. ACRES_ Remarks: REPAIR Bar Sink Showers Backflow Preventer Service Sink SUMMARY O FEES Backflow Irrigation Sewer Cap BUILDING PERMIT Bathtubs Sewer Connection $ Clarifiers Solar Collectors $ Dishwasher Solar Piping Drinking Fountains Solar Tank PERMIT Floor Drains Swimming Pool w/Spa PLUMBING Floor Sinks Urinal $ Gas Service Outlets Water Closet $ Interceptors Water Heater 25% Kitchen Sink Water Service ENERGY P.C. Lavatories Auto -Wash ELECTRICAL P -Trap Laundry Trays $ Roof Drains $ I I Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System 0 Multiple 0 Firepl/Fact. Bit. ICBG # Heating System & Ducting 00-100,000 BTU ❑l 00,000 BT Reinspection Fee 1 $15 Canary - Applicant; Pink - Accounting: Goldenrod - Assessor Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System 110-100,000BTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES $ 3 A.P. �A S Main Building: E T Front ARear C Right K S Left Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer 0 15-50 KW ❑ 50+KW Meter, ❑up to 100 amps Meter ❑over 100 amps Sub Panel - Motors 00-1 HP 111 ''A -8 Inc. Solar 09-15 HP,❑16-15+ Microwave Pole Light Sign Standing Sections 15 KW Trash Compactor Reinspection Fee I $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved Application Issued By FEES $ 3 O N 1 N G R E Q M T S. 01 00021469-00021470 TC1T 63.510 DATE: 12/07/88 TIME: 15:30 SUMMARY O FEES M BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ - GRADING $ PLAN CHECK 50°.6 $ MICROFILM $ /ry �] MECHANICAL $ TOTALFEE $ ,Z� PLAN CHECK 25% $ 01 00021469-00021470 TC1T 63.510 DATE: 12/07/88 TIME: 15:30 CONSTRUCTION AND PLANNING APPROVALS Permit # 1POOL Date Inspector & SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole: - 52. Pool & Equipment Location - 2. Soil Pipe-Undrgrnd. 1v 53. Steel Reinforcement 3. Electrical ConduitiUtility-Undrgrnd. 54. Forms 4. ,Elect lConduitaUndrgrnd. .i 55. Electrical Bonding 5. •Steel ljeiiiforcemeht+:Ll "' 56. Rough Plumbing & Pressure Test �� j• 6. Electrical, LIFER Grnd7", - 57. APPROVAL TO COVER-GUNITE ; 7.-FootirJgs 58. Electrical Conduit-Undrgrnd.; ' 8.'Found'ation �. I 59. Gas Pipe, 0 Undrgrnd., Test �•.; 9.' Water Pipe-Undrgrdd'I / ? 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11"Property Sewer Line & House Connection ; _ 62. Backwash & Receptor-Final 12. Sewer,Cap �I 63. Heater & Vent-Final 13. Roof Drains y 64. Plumbing System -Final 14. Rough Plumbing 65. Electrical-Final ; 15. Rough Electrical-Conduit 66. Solar System-Final 16r Rough Electric Wiring 67. Fencing & Access Approval 171 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 APPROVALS Permit # 20(i Rough Factory Fireplace 21. Ducts, In.$tructure 70. Underground Hydro 22. Ducts, Ventjlating 71. Product Piping 0Gas 0Oil 23. Gas Pipe=Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑Gas 0Oil 25. Roof Sheathing 4� �• 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame annd Flashing 76. Dry Standpipe 28. Lathing &"Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall•. Nailing HEALTH DEPT. REQUIREMENT 31. Plaste%Brown Coat, ,i 79. FINAL INSPECTION 32. Electrical power Meter:Final , 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final YHeating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy . 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation .[,I � n 44. ,Landscape Irrigation System % 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING Q !( 48. Special Requirements Completed - 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date V n �^� City of Costa Mesa - Building Safety Department CERTIFICATE OF OCCUPANCY N? 2192 C P. O. Box 317 Costa Mesa, California The Building located at 108 Clearbrook Lane, 11nita A.P C has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group Occupancy. Use of Building Triplex with ettaehe d garagia Legal Description .141»313-03 _-- (See reverse side for Metes and Bounds) Building Permit No. 22817-, Electrical Permit No. 23 250 _ plumbing Permit No. 44103 Floor Load Signs have been installed as Room Capacity Signs have been instated as required under Sec. 2308 U. B. C. required under Sec. 3301 (1) U. B. C. 17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied until the owner or operator has been issued a valid certificate of occupancy by the enforcement agency. ;� (b) A new certificate of occupancy shall be obtained whenever there is a change in: 1) Occupancy classification of a building or portion thereof 2) The number of apartments or guest rooms 3) Ownership If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California Administrative Code, Title 8, Chapter 9, Article 8. Number of apartments3 and/or guest rooms ISSUED TO: Building Official CLMMI= LAMB CORPORATION bZ�� Date starch 25, 1065 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Form P .., 22817 FE, Au R ,Q4VED Cow MESA BUILDING -SAFETY DEPARTMENT FINANCE DEPT. P.O. BOX 917 COSTA MESA, CALIFORNIA For Applicant to Fill In Completely APPLICATION FOR PERMIT LbR PRINT" TrA BUILDING For Office Use Only BUILDING i O I ADDRESS f ' RECEIPT NO. COSTA MESA, CALIFORNIA 'LLQ G�epRBRo�/� />fy8 RECEI Y pA /ECEI� DATE ISSUED 11 OWNER CD O 'O MAIL BUILDING L ADDRESS/O i7 ADDRES9 FIRE TEL. ZONE TYPE GROUP` CITY B C NO APPROVED ARCHITECT TEL .�R OR ENGINEER' NO.O/O BY DATE ee J 3l/3z ZONING • ADDRESS 144 6 POR70 NZ " e C ZONA NO. OF , USE OF NEW '!� - v PUNS BUILDING CONTRACTOR % - - /Y� v I ADDRESS DEGAL I e A. NO. CITY Q L' P. NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE TEL 17IQ SO" TO SIDE @ REAR P. L. LIC. NO. NO. 112 EAVES •I� SIZE > I No. OP BLDOS. ALLOWED (U.B: C. REQUIREMENT) - OFLOT NOW ON T 17 - YARDS APPROVED YARDS APPROVED USE OF _ MAIN BUILDING' ACCESSORY BUILDING NG BLDG.' EXISTIAt (FROM C/LSTREET) SETBACK LINE FROM ^ , FRONT { 1 /FT. FT. CENTER OF STREET V REAR YA O F, - / / I R. SIDE FT. FT. W SIDE YARDI LEFT RIGHT O O DESCRIPTION OF WORK L. SIDE / FT. FT. V' EAR FT. FT. ADDITION ,NEW V ALTI—I - , CO DISTANCE BET. BET.MAIN Q Uj REPAIR MOVING DEMOLISH MAIN SLOGS. ACCESS. BLDGS. BUILDING % >", ',%0161F OP <_ VAR•`# DATE SIZE I •� OOMS J STORIES I G. U. P. APPROVED Q EXTERIOR WL I ROOF �' /1 COVERING T I COVERING go C APPROVE II(�A. BY I AWWYI / f�/. DATE u USE OF BUILDING AND WOR PERF RM_&P rex b o we, ki N. e rrq c i 44 q 7 s.. FT. 7 i 9' 1 I HEREBY ACKN LEOOE THAT 1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE ' IFE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITHALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDINGCONSTRUCTION. VALUATION TD m Q R PERMIT FEE IS 63 SIGNATURE OF PERMITTE 'J LA EC ¢ AUTHORIZED AGENT 2 �E - -TOTAL FEE 5