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HomeMy WebLinkAbout1174 DORSET LN - Building Permits o MFSq CITY OF COSTA MESA w ►, BUILDING DIVISION F r � I ' DEVELOPMENT SERVICES DEPARTMENT PERMIT PERMIT NUMBER • • 41`A4" ie,.. M98-00546 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 . MECHANICAL PERMIT Job Address: 1174 DORSET LN Status: ISSUED 1 1 t Suite No Applied: 11/30/1998 ' Issued: 11/30/1998 Vicinity: Parcel Nunmber: 14114218 - Applicant EMPIRE PLUMBING & HEATING )E*HA-1AJr Jj All Address: 11568 trask av . Phone: 714 530-7320 garden Grove, ca Zip: 92843 . Owner: DYE,DAVID A ' . Address: DYE,SHERYL COSTA MESA,CA Phone: 1174 DORSET LN Zip: 92626 • - Contractor: f%N'lei E pLUr'l'f)(NE7" 6 Address: Phone: Zip: License: Arch/Eng: . Address: • , Phone: , Zip: License: . SCOPE OF PERMIT • REPLACE THE EXISTING FURNANCE AND CHANGE OUT 7 OUTLETS. •' FEE SUMMARY ../ .• . Quantity / Quantity • ISSUE FEE $22.00 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $13.25 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 Ventillation_System $0.00 0 Repair/Alt Cooling/Heat $12.25 1 Evaporative Cooler $0.00 0 ' • Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 ' 0 . Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping . $0.00 0 Up to 3 hp/100 k BTU - $0.00 0 Factory Fireplace • $0.00 0 3 To 15'hp/500 k BTU : - $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 '0 30 To 50 hp/1,750 k BTU '$0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/.Over 1,750 BTU '$0.00 0 Appliance $0.00 0 . Boilers - Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent - $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp' $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp , ' $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee- Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $47.50 COMMENTS/SPECIAL CONDITIONS • IEXPIRATION: 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 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. 1 FOR INSPECTIONS CALL: (714)754-5626 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'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 permit is issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed i/the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the p' ormanc= .f the work for which this permit is issued, I shall not employ any person in any manner as to become subject to the workers' compensation laws o alifornla, .nd agree that if I should become subject to the workers'compensation provisions of Sectio 3700 o the Labor Code, I shall forthwith comply with these prove '.ns. Applicant Signature: _� _ Dat) I 3?' WARNING:FAILURE TO SECURE WORKERS' PENSATION •VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P TIES AND CIV INES UP TO ONE HUNDRED THOUSAND DOLLARE(i100.003).1=AADDITION T THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I a . cense der provisions of C.•pter 9(commencing with Section 7000)of Division 3 of the Business and Pr tessiors Code,and my license is in full force and effect.Lic. Class» i ai L Contractor's Signature: CDate: l/ 5 y CONSTRUCTION LENDING AGENEY/ ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions 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 or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or 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 a civil penalty 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 is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or Improves thereon,and who does such work himself or 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 completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner o1 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 property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,1.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2.Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Cale requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire 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 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Callfomia Health and Safety Code provides that the 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. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes ❑No (Section 65850.2 of the California Government Code requires that the requested intonation be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: _ Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree.to-comply with all state laws and city ordinances relating to building construction,end authorize representatives of the City of Costa Mesa to enter upon the above-desd property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this per it until final inspection. re /I Signature OLIETgal ner(s) et .z:A And/Or Authorized Applicant CODE I--QL.SPFnTInN TIP'S PATE ISMALS SOU 4 INSPECTION TYPE In� PAIL It��T,IA,LS 1616 Fixed System Final Fire Prevention 206 Final Mechanical N-2/-9&" # ljy 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 Sign 222 Final Site _ 204 Final Demolition 250 Final Building/Occupancy -- 2446-46 - mr. a - 'ADDREsh3Fe1BLMNG: 1174 DORSET LN MT: CITY OF COSTA MESA - BUILDING PERMIT NERS NAME IF KNOW DYE, DAVID A PERM NO: B 07199E rfEn: DYE, SHERYL 1174 DORSET LN PERMIT NO: B 071996 PLAN CHECK NO: N GOVT : N SUPP : N If COSTA MESA, CA 92626568-8795 AP PL.MIUNGADDRESS: CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: ALT 1 ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION , T/OFF RESTH & REROOF W/COMP SHINGLES SQ FT: 6, 500 ARCH.OR ENG.'S ADDRESS: DMT: CLAIM VALUE: 6, 500 . 00 CALC-VALUE: 6, 500 . 00 GROUP OCC : R-3 / 0NmACTowsNAME: PERFECT COVER ROOFING ( 714 ) 434-1566 . ' caNTRACTOWSMMUNO 3303 HARBOR BL COMMENTS : SMOKE DETECTORS REQUIRED PER 91UBC, REROOF 24O0SF RESIDENCE ADDRESS: COSTA MESA CA ue.NO.: 622516 ****************+ **** -****+ *** -*******+A******* ;+F***... ,_-y1()KED pF'Ef F7T'©® 92626 utas: D-5 Z ONING REQUIREMEN L €VtVf� C V fl LICENSED CONTRACTORS DECLARATION:f hereby alfum under ofesaiy d perjury that I am licensed under provisions d Chapter o S E T B A C K S ��E D (commencing with Section 7000)d Division 3 d the Business and Professions Code,and my license is in lull force and effect. CITY UC.No.: O54055 uacuss: B uc.No.: 622516 EXP: 08/95 MAIN BUILDING ACCESSORY B 1 1 Data: Ct "Z �) corrector: FP,NT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT ; FT IN OWNER BUILDER DECLARATION:I hereby affirm under penalty d Perjury that I em exempt from the Contractors License Law for the lalowag reason(Section 7031.5 Business and Professions code:Any cin or county which regdres a perms to construct,arta,import PARKING REQ: P RO V: PARCEL: 14114218 Z NE; REF NO; Hemolah.d repair any Milldam.pion to as issuance,also requires the applicant les such permit to De a signed statement that he or she licensed pursuant to the provisions of the Contractors License LAW[Chapter 9(commenting with Section 7000)of Division 3 of the PLANNING NOTES> - ,usiness and Professions Code[or that he or she is exempt therefrom and the basis for the alleged exemption.Any vidmion of Sedan ' 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of nd more than five hundred doles.1$5001). ****s********.If.N.'**.*.*******.Y.*.*.*********.****.*****..**********y.*i(**-****u3*{E**3******** ❑ I.as owner o the property or my employees with wages as Utak sole compensation.will do the work,and the structure is not intended D E V E -L O P M E N T S E R V I C E S R E oroffered for sae(Section7044,Business and Professions Code:The Contractors License Law does not appy to an Owner of property Q U I R E M E N ,T S who builds or improves thereon.and who does such work himself or hersel or through his a her own employees,prodded that such improvements are not intended or offered for sale.if,however,the building or improvement is sold within one year d completion,the ZONING APPROVED BY owner-builder will have the burden a proving he or she did not build or improve for the purpose of sale). DATE : ❑ I.as owner of the property,am exduvvey contracting with licensed contractors to construct the project(Section 7044,Business and Professions Cede:The Contractors License Law does not appy to en owner d property who builds or improves thereon and was BUILDING APPROVED BY DATE: contracts for such projects with a contractode)licensed pursuant to the Contractors License Law). • ❑ Iamexemptunder Section: B.BP.C..tor this reason: APPLICATION ISSUED BY; *** DATE: 412.t( AI ************1E**************1f1E*******33*3** *************4*****9-*****M **3*** Ddee LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT;Y I do hereby certify that I am aware of end understand the requirements of Caliomia Heats and Safely Code Sections 25505,25533,and 25534.and that I or any future building occupant will/will not(Isle one)need to campy with said rote codes and the requirements for a permit for constructionormodgmion from the Ai DuaityManagwnnnt District.Residential ma,vqun applications are exempt from then BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 90 . 00 , 65 Date: Applicant:_ SMIP/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of era!o the following dedns: PLAN ' ❑ I have and wiN maintain a certificated consent to self-insure tor workers'compenntion.as provided for by Section 3700 d the LabLabor' ISSUE N G E Code.tor m theperfomnceoftheworkforwhichthispermiSissued. BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE o Iha.eand w,Nmaintain workers'opminsurance, d pensafonasrequiredbyRadian37Domperformance eLaborCode,fortheperfoofth. TOTALS 90 , 65 0 , 00 0 , 00 90 . 65 90 , 65 00 • work(or which this permit is issued.My workers'compensation insurance carrier and policy number are: Carrier: • STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 90 . 65 OVER/SHORT: , 00 Policy Number: 1263t13-94. 07/01 /95 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE - SNIP/TOT GRADING PLAN-CHECK cis section need not be completed trite permit is for one hundred dollars(slXDJ or lm) 90 , 00 . 65 -- . ❑ !wily that in the performance d the work for which the permit a issued.I shall not employ any person in any manner a as to become eubjed to the worked compensation laws of Caliloma,and agree that d l shouldbecome eubled to the workers' **************'******yF**if*****************4****3*************r4*-1****************af. w4 ¢��ee sation provisions of Section 3700 a the Labor Code.I shall forthwith comps with mese provisions. INDIVIDUAL F E E BR E A K D O 4I N ,.__1. Date: 1\ Ci S Apakanc-_ —. Warning;Failure to secure wodan'compensation coverage Is unlawful,and shall aWiect an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines up to one hundred thousand dollen($100,000),In addition to the coat of compensation,damages as provided for In Section 37gsoythe Labor Code,lntsnt aendatomeysyw. SFR 6500 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 6, 500 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES performance d the work for witch this permit is issued(Section 3087.Civ.C). LENDER'S NAME: - ' LENDER'S ADDRESS: , I certify that I have read this application end stele that the above information is coned.I agree to campy with all tit and county ordinances and state laws Siding to buildup consvuction and hereby aumorise representatives of this Oilyto enter upon the above-mentioned properly for inspection purposes .9 y p Ruins Print Name 17 -.wag Date: ' . r -9, S 01 coi043 11155 TIME: !O:12 `,0-65 spmalureaUwuedAgenuAppticant/Contract« t)%i_. 04:21/96 TINE: ti12 t (5151-46.WP) White-Building A Safety;Green-Re:Canary-Appicanl:Pink-Revenue:Oddenmd-Assess r - - F.- :I bJNSTRUCTIONTDPLANNING POQI .PA • AreROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector. 1 1t 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 I 5. Steel Reinforcement • 56. Rough Plumbing& Pressure Test '.t 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE i 7, Footings 58. Electrical Conduit-Undrgrnd. • 8. Foundation _ 59. Gas Pipe, 0 Undrgrnd.,Test • 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 l{ndrgrnd. i . 5 10. Structural Floor System61. APPROVAL TO DECK + 11. Property Sewer Line & House Connection 62: Backwash & Receptor-Final 12. Sewer Csp 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 • i 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace - APPROVALS Permit# 21. Ducts,in Structure - 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 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 / AL Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat al 27. Frame and Flashing . 76 . Dry Standpipe • 28. Lathing& Siding 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 ElectricNotes: sir//q 44 S> 'c.ccr j- "9 34. Final Heating & Air Conditioning - 1ft/ s C &ci'°r'N, 35. Final Gas Pipe-Test • /it/sinLf/1-C.29‘41-1-4-- �� 36. Hood or Canopy Ot itq I9 co Ge, II„ ✓ eiL4-- 37. Final Factory Fireplace • - o4512 . 3 n c c_ 5 R 5 38. Final Plumbing r 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final • 42. Backflow Preventer - • 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation - 46. Handicap Regulations Yti . 47. FINAL STRUCTURE & BUILDING /D_/(/_� 6'G,.;;/ 48. FINAL PLANNING • I'll t 49. Electric Release to Edison " 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - No. Date ' Lor 4o TRACT 4395 16315 FIE RECEIVED • JAN 31196 . . COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DET P. O. BOX 917 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING //7" brief .t�..n 7 ADDRESS COSTA MESA. CALIFORNIA For Office Use Only RECEIPT NO. I 1P)CANLTIl�G. OWNER K �. K DEVELOPMENT CO. , INC. _ UJ1�VKKI ��{F�VJ1l MAIL RECEIV D BYD TE RryECEIVED DATE ISSUED ADDRESS 1555 PLACENTIA AVENUE _ I ,"Lr iJAN 31 1962 CITY . NEWPORT BEACH TNO.MI 63227 BBEAUILDCH ARCHITECT TEL COSTA MESA. CALIFORNIA OR ENGINEER NONE NO. ,FIRE / /f Q ZONE TYPE Y GROUP'. 1 ADDRESS U CONTRACTOR K. W. KoLt. APBYPROVED DATE ADDRESS 1555 PLACENTIA AVENUE ZONING ZON4 INPO.NOSFZ IBUSIE OGNEW/S/n i � CITY NEWPORT BEACH —t W/ STALIC.NO . 61195 TEL "M I . 6-3227 LEGAL DESCRIPTION G r 90 7, 4 5f 3 9 DESCRIPTION • SIZE I NO. OF OLDGS. OF LOT GG .J In h J NOW ON LOT O A.P.NO. USE OF YARDS . EVES EXISTING BLDG. NONE APPROVED ALLOWED SETBACK LINB PROM r �-y�, (CENTER LINE ST.) CENTER OP STREET r�� �� �� REAR YARD 0....9.3"- FRONT -Si/ -FT. H IN. SIDE YARD I LEFT �o I I RIGHT 6 / R.SIDE 6 FT. — IN. DESCRIPTION OF WORKL.SIDE /o FT. __ N. NEW I XII ALTERATION I II ADDITION I REAR zr FT. J IN. REPAIR I II MOVING I IIDEMOLISH I BYAPPROVED�a�Q ion DATE //3"0/67- BUILDING A-177 S�r` NO. OF –/ SIZE 4.- 5/97S . tl ROOMS / STORIES 1 -----777-4115t- --�- g4' EXTERIOR WALL d ROOF G�ECIG/ d--/./ ' - COVERING STUCCO COVERING shk,ee, USE OF BUILDING AND WORK TO BE PERFORMED �a at SINGLE FAMILY RESIDENCE WITH ATTACHED GARAGE. PLAN # c_7N 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 SIGNATURE OF PERMIT FEE $ q /- N PERMITTER /i $ /7//W ti PLAN CHECK $ /" o AUTHORIZED AGENT J7 C TOTAL FEE $ 4 / ' LL