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Home My WebLink About2855 CORVO PL - Building Permits(714) 754-5273 • F2X (714) 754-4856 • www.ci.costa-mesa�DING PERMIT 77 FAIH UHIVt, GU51 A MtSA, (:A 82ti2ti JobAddress: 2855 CORVO PL Suite: Viciniry: Primary Occ: R-3 Dwellings/ Cong Res <70 Type of Conslruction: V-N ParcelNumber: 13933402 Zoning: R1 npp�icant: STEVEN SHEPHERD Address: 1602 BABCOCK ST COSTA MESA, CA Owner: O'NEIL, RICHARD M TR Address 2855 CORVO PL COSTA MESA, CA Contractor. , - Address: Zip: Arcn : SHEPHERD, STEVEN C Address: , � Phone: 714-968-1640 Zip: License: C23684 Phone: 949-764-9495 Zip: 92627 Status: ISSUED Applied: 12/09/2005 Issued: 12/272005 Phone: 714-434-6230 � Zip: 92626-4876 � Ph ' � Eng: Address: Phone: License: SCOPE OF PERMIT ADD 291 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: EXPAND EXISTING BEDROOMS AND MASTER BEDROOM AND REMODEL EXISTING MASTER BATH. � EXISTING 3 BEDROOM, 2 BATH S.F.D. WILL REMAIN THE SAME. PLANNING: LOT SIZE = 7,500 SQ. FT. RESIDENCE = 2,048 SQ. FT. GARAGE = 465 SQ. FT. DRIVEWAY = 1,041 SQ. FT. - , - LOT COVERAGE = 3,554 SQ. FT. (47%) - � OPEN SPACE = 3,946 SQ. FT. (53%) FEESUMMARY Plan Check: $418.76 Permit: $644.25 SMIP Res: $5.00 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,068.01 SETBACKS MAINSTRUCTURE Front 33-0 ACCESSORY PARKING Front 13- 0 Existino: 4 Rear 25-0 Rear 65-0 Reauired: 4 PLANNING & ZONING Left 5- 0 Left 40- 0 Pr000sed: 4 Calc Valuation: Sso,000.00 Claim Valuation: Sso,000.00 Right 5- 0 Ri9ht 7- 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: This permit shall automatically expire and become void ii work is not commenced within 180 days, or if work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes„an� requlred Inspectiona end final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of thfs-permit. FOR INSPECTIONS CALL: (714) 7545626 � 2a46d816100) WORKERS'COMPENSAnON DEGLARAnON: . � I her9by atfirm untler penalry ot perjury one ol the lollowing tleclarations: ❑ 1 have and witl malntain a certillcate ot consent �o sell-Insura tor workers' compansatlon, as provitled for by section 3700 0l Ihe LaDor Cotle, for �he peAortnance of the work lor which this pertnii is issued. ❑ 1 have flnd will maintain workers' compensation insurance, as requiretl by section 3700 ot ihe Labor Code, for ihe peAormance ot ihe work for which this pertnit is iuuetl. My workers' compensation Insurence carner entl policy number ere: CarnBr: Policy Number: (-lh/is secfion need nof be cnmp/efed il the permif /s valued ef one huntlred dollars ($700) or /essJ �y I certify that in the pertormance oi the work lor whic� this permit is issueQ I shall not employ any person in any manner so as to become suDject to tha workers' compensation laws ot Califomia, and agree that if I s�oulC become sublect to t�e workers' compensation provisions ol Saction 3700 ot the Lebor Code, I shell lotl�wlth comply with t�e5e p m5. /'� ^p % AppliCem SignaWre: �� . � l J F-'7�-a � Date: � a" �'} / O� WARNING: FAILUFE TO SECURE WORKERS' CAMPENSATION COVEMGE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES DAN GViI FlNES UP TOONE HUNDRED THOU9�'D Dq.tARE (5100.000), IN ADORION TO THE COST OF COMPENSqTION, DAMAGES AS PROVIDED FOR IN SECTION 3]p60F THE 1A80R CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRAC70RS DEClARA710N: I here6y aflirm that I am Ilcensetl untler provisions of Chapter 9(commencing wiN Sec�ion 7000) of Division 3 ot the Business antl Pmfessions Code, and my license is in full force and aHect. Lic. q Class # Contractor's Signeture: Date: CON5TRUCTION LENDING AGENCY: ❑ I hereby aHirm thet there is a constmction lending agency tor the peAormence of �he work for which this permit is issuetl. (Sec. 3097, Civil Code). Lenders Neme: Lentlers Address: Signe�ure: Dete: OWNER-BUILDER DECLARATIONS: 1 herePY aHirm Met under penelty ot perjury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sea 703L5, eusiness antl Protessloas Code: P.ny city or cou�ty which requires e permit to construcL elter, impmve, tlemolish, or repair any slmcture, prior to its issuance, also requlres tha epplicam tor such permit to file e signetl statement that he or she is Ilcensed pursuani to iha provisions of the Contractors License Law (Chapter 9(commencing with Seclion 7000) ol Division 3 of the Business and Pmfessions Code) or that he or she is exempt Iherefrom antl t�e basis for the alleged exemption. Any violation of Section 7031.5 by eny eppliwnt lor a permit subjaG�s the epplicent to e civil penalty of not more then five huntlred dollars ($500).): ❑ I, as owner of Ihe property, or my employaes with wages as t�eli sola compensation, WILL DO THE WORK, and �he structure is not intended or ottered for sale (Sac. 7044, Business and Pmfessions Code: The Contrectors License Lew does not apply to an owner of properry who builas or improves thereon, antl who does such work pimseli or herselt or �hrough his or �er own employees, pmvidetl �ha� such improvemenis ere noi intended or oNered for sale. It, however, t�e building or Improvement is ,,_, �sold within ona year of completion, the owneo-builder will have Ihe burden of proving that he or she did not builtl or improve tor purpose of sale.). ' � i, as owner ol the property, am E%CLUSIVE�V CONTRACTING WITH LICENSED CONTRACTORS to consiruct tha project (Sec. 7044, Busineu antl Professions Gode: The crontractors License Law does not apply to an owner ot propeny who builds or impmves thereon, and who contraas for suc� prolea wtlh a comractoqs) Iicen58 pursuan� to the Conlrectors License Laws.). ❑ I am e pt i sec. SignaWre: Ownel ID venfietl 6y drivef5license. � Yes ❑ No Busineu and Professions Code tor thi5 reason: Expires: �.1 O Verilication ot Ownership by (type oi document, i.e. - praperty tax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby ceniy that no excavation five (5) or more teet in depih into which a person is required to tlescend, will be matle in connection with work euthorized by this permiL and that no Duiltling siructure, scatfolding, falsework, or demolition or dismantling t�ereot, will be more Ihen ihirry-sia (36) feet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Tule 8, Califomia Atlminlsiretive Cotle). ❑ As owner-builder. 1 will not employ anyone ta tlo work which woultl require e pertnit from the Division ol Indusirial Safery, es noted above, unless such person hes e pertnit to do sucfi work trom ihe tlivsion. Signature: Data: Division ot Intlusirial Safety Permit Number: CERT{F�GA7E OF COMPWWCE PNU AURiORIZA710N OF ENTRV: I certify under penalry of perjury ihat I have read this epplication end state ihat the intormation gi�en is wrtect I agree to comply with all state lews end ciry ordinances relating to building construction, and authonze representatives ot Iha Ciry of Costa Mesa to enter upon the ebove-dq�x7�ed pr(qp9t(y� tor inspec purp,oGs�esQ I agree ^not to occupy or allow occupancy of any building authorized by this p i� uMi finel inspection. �C �-��-x+.� � �-/�-�LL �a � � 0.� Signature Ot Legal Ownet(s) Data AnNOr Aulhonzed Applicanl COOE �. IN57EGTIONTYPE O�TE 1676 Fi:etl System Final Fire Prevention 1266 200 201 202 203 204 Pool Spa FinaV Final Re-Rooi Finel8lock/Retaining Wall Final Factory Fire Place Finel Sign Final Demolition ItIIps6@ 4qpit wsveenoxTrve 206 Final Mechanical 208 Final Plumhing 210 Finel Elecirical 272 f(nal Fire Preven�ion 220 final Planning Appmval 222 Finat Sfle 250 Final BuildinglOccupancy P�IE U�L@ (774) 754-5273 • Fax (714) 754-4856 • www.ci.cos�a-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: Address Contrector. Address: ISSUE fEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting FiMs Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over t000a Motors to 1hp Molors to tOhp Motors lo SOhp � Motors to 100hp Motors over 700hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermetl Pole 2855 CORVO PL 13933402 O'NEIL, RICHARD M TR 2855 CORVO pL COSTA MESA, CA �,�� . O'NEIL, RICHARD M TR 2855 CORVO pL COSTA MESA�, CA OWNER-BUILDER � � P "gn�: �434-6230 Zip� 92626-4816 Phone: Zip: 92626-4816 Phone: Zip: License: 000000 ISSUED 8Y: Status: ISSUED Applied: 12I272005 Issued: 1227/2005 SCOPE OF PERMIT ADD 291 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: EXPAND EXISTING BEDROOMS AND MASTER BEDROOM AND REMODEL EXISTING MASTER BATH. REF.: BOS-02252 ELECTRICAL TO INCLUDE: 15 LIGHT FIXTURES, 13 OUTLETS AND 10 SWITCHES. $23.5D $0.00 $O.OD $0.00 $0.00 $0.00 516.50 514.30 $71.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 15 13 10 0 0 0 0 '0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System I Lighting Busway/100ft Standing Sedion Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misa Conductor Cirws ( gen or ride) Circus (mech ride or lighis) Christmas Tree Stand Fireworks Stand Other Eleclrical Fee Invesligation Fee Plan Check Fee Reinspection Fee $0.00 $0.00 50.00 50.00 50.00 50.00 50.00 50.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES E65.30 COMMENTS / SPECIAL CONDITIONS �uantity 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) f" �' �', EXPIRATION: 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 app�ble codes, and all required Inspectlona end final epproval must be obtained. Failure to obtain inspections and tinal approval will resufl in Ihe expiration of ihis permit. FOR INSPECTIONS CALI: (714) 754-5626 Yl°L'aryl.iCUl WOAKERS'COMPENSAnON DECLARATON: � _ I he�eby aMirtn under penaliy of perjury one of Iha following daclarations: ❑ I have antl will maintain e certificate ol consent to self-Insure lor workers' compensetion, es providetl for by section 3700 0l t�e Labor Code, for t�e peAortnence of the work for which ihis permit is issued. ❑ I have antl will maintain workers' compensa�on insurance, es raquire0 by saction 3700 of the Lehor Code, lor ihe perto�ance ot the work for whlch tnis pertnit Is Issuetl. My workers' compensatlon Insurence carner and policy number are: Ca(�er: Policy Num6ec (Tl1is section need not be comp/etetl i/ the pertnif Is valuetl et one huntlred dollers ($100) or /ess.J I certify Ihat in the pedormance ot Ihe work tor which this permit is issued, I shell not employ any person in any manner so as to become suDlect to Ihe workers' compensetlon laws of Califomia, antl egree that if I should become sublect m ihe workers' compensetion provislons of Sectlon 3700 ot the Lebor Cotle, I shall tohhwith comply with these ' ions.�a _ � � , anFSignature:' � Date: � � a �a'� (� � 'INO; EAILURE-TO SECIIRE WORKERS' COMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPCOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED iAND DOLIAFE (5100,000), IN ADOITIIXJ i0 THE COST OF COMPENSATIIXJ, OAMAGE$ AS PROVIDED FOR IN SEGTION 3]OB OF iHE IABOR CODE, INrEREST, AND ATTOHNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I he�eby aHirm that I am licensed under provlsions of CheO�er 9(commencing with Section 7000) ol Dlvlsion 3 of �he Business and Pwtessions Code, and my license Is In full force and eHacL Lic. # Class A COMractor's Signature: Date: LONSTRUCTION LENDING AGENCV: ❑ I hereby aHittn that there is a consimction lending agency br ihe pertormance of ihe work br which �his Dermit is issuetl. (Sec. 309�, Civil Code). . Lentlefs Name: Lentler's Adtlress: Signeture: Dete: OWNER-BUILDER DECLARATIONS: I he�eby aHirtn Net under penelty of perjury thet I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, BuSiness antl Professions Cade: Any city ar coun�y which requires e permit to cons(mc6 alter, improve, demolish, or repair any stmcture, prior to its issuence, also requlres the epplicant for such permit ro file a signed stetemeN Ihet he or she is licensed pursuant to t�e pravisions of ihe Contreaors License Lew (Chepter 9(commencing with Section 7000) of Division 3 at the Business and Prolessions Code) or t�at he or she is exempt Ihereirom entl tho 6esis for the allaged examptlon. Any violetion o� Section 7031.5 by eny applicenl tor e parmit subJects the epplicent to a civil penalry of not more than five hundred tlollars (5500)J: ❑ I, as owner of the propeny, or my employees with wages es their sola compensetion, WILL DO TME WORK, entl �he sWcture Is not intande0 or otteretl for sale (Sec. 7044, Business and Professions Code: The Conirectors License Lew does not epPly to an owner of property who 6uilds or improves ihereon, and who tloes such work himsetf or herself or through his or her own employees, provitled ihat such improvements ere not IntenOetl or offerea for sale. II, however, Ihe bullding or improvement is sald within one year ot compleUoq the ownerGuilder will have Ihe hurtleo of proving that he or she tlid �ol huild or im0�o�e tor purpose of sale.J. • �� I, as�owner o� the propeny, am EXCLUSIVELV CONTRAC7ING WITH LICENSED CON7RACTORS to wnstruct the projecl (Sec. 7044, Business antl Professions �1Cotle: The conirac�ors License Lew does not epply to en ownar ol property who builtls or Impmves t�ereon, entl who coniracis br such project with e contractor(s) license pursuant to Ihe Contractors License Lews.). 8usine55 and Profe55ions Cotle for lhis reason: venfied by drivefs litense. ❑ V05 ❑ No Ventication ot Ownership by (type oi tlaument, i.e. � property taa hiil or pry�S10N OF INOUSTRIAL SAFEN PEHMIT GERTIFICATION: No. ❑ I hereby cenity thel no excavation five (5) or more fee� in depih into whiCh a parson is requiretl to descend, will be matle in connection with work euthonzed by Ihis pertni�, and that no buil0ing s�rucWre, scallolding, falsewoM1c, or tlemoli�ion or tlismantling ��ereot, will be more than thirry-siz (36) feet high. (Chap. 32, Grp 2, An 2, Sec. 341, Title B, Califomia Adminisiretive Code). � As owner-builder, I will not employ enyone to do work which would require e permit from the Division of Industrial Safety, es notetl above, unless such person hes a permit to do such work trom the division. Signature: Oate: DiviSion ot Industrial Safety Permit Numbar: CER7IFlCATE OF GOMPLIANCE ANU AIJTHORIZAiION OF ENTRV: I cenity under penaly of perjury ihat I have read this epplicetion and state thai the informatlon given is cone�t I agree to comply with all stete laws end ciry ortlinances relating to Duiltling consiruction, and euthonze representalives ot the City ot Cos�a Mesa to enter upon Iha ebov cn opeRy f ec ucposes; I agree not to occupy or ellow occupancy ot any building aulhorized by this pe t un�il ( al inspaction. _�_. _� �, la�ati-�oS Signa� Lepel,Owner(s_). ,_ �- , l_ at� AnNOr Authonzetl Applicam Date f,Q0�1, INSPECTIONTYPE PAIE INTRIAL$ 1616 Fixetl System final Fire Prevention 1266 200 201 202 203 204 Pool Spe Final Finel Re-Roof Final BIocWRetaining Well Final Factory Fira Place Finel Si9n Final Demolition �ODE� INSPECTIONTYPE 206 Finel Mec�anical 208 Flnal Plumbing 210 Final Electncal 212 Final Flre Prevention 220 Final Planninq Appro�al 222 Final Site 250 Final6uiltling/Occupancy PA7E It�IS (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT JobAddress: 2855 CORVO PL Suite No Vicinity: Parcel Number: 13933402 1 Applicant: O'NEIL, RICHAR � Address: 2855 CORVO pL � Phone: 714-434-6230 COSTA MESA, CA Owner: O'NEIL, RICHARD M TR Address: 2855 CORVO pL COSTA MESq, CA Contractor: OW N ER-B U I LDE R Address: Zip: 92626-4816 Phone: Zip: 92626-4816 Phone: Zip: License: 000000 Status: ISSUED Appfied: 12/27fZ005 Issued: 12/27/2005 SCOPE OF PERMIT ADD 291 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: EXPAND EXISTING BEDROOMS AND MASTER BEDROOM AND REMODEL EXISTING MASTER BATH. REF.: BOS-02252 � MECHANICA� TO INCLUDE: 1 FAU < 100K BTU, 1 REPAIR/ALT COOLING/HEATING, AND 1 VENT FAN. ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt CoolingMeat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Re(rig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Ezhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl,Vent Air Handlers < t0000cfm AirHandlers> t0000cfm Floor Fumace � Floor or Suspend Heater 523.50 $14.80 $0.00 51370 $0.00 $0.00 $0.00 so.00 50.00 $0.00 $0.00 57.25 $0.00 50:00 50.00 $0.00 50.00 $0.00 50.00 $0.00 Quantity 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 FEE SUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillation System Evaporative Cooler Com me rcia l I ncinereto r Domestic Incinerator Comoressors / Absorotion Svstems Upto3hp/100kBTU 3 To 15 hp / 500 k BTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp I 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Up to 3 hp 3To15hp 15 to 30 hp 30 l0 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Quantiry $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 50.00 $0.00 $0.00 E59.25 NO710E: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Cali(ornia statutes and related regulations. (Ord. No. 92-28, § 7, 1241-g2) � EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspendad�or ebandoned tor a period oi 180 days. /j �✓ INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply wNh�all epplicable codes, and all requlred Inapectlona end finel approval must be obtalnad. Fallure to obtain Inspections and final approval will result in the expiratlon of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaae�ae �aw� WOPKERS' COMPENSATION DECLAqA710N: I hereby afiirm untler penelty of perjury one of Ihe following tleclaretions: � I have end wili maintein a cerlificate of consent to seli�lnsure for workers' compensatlon, es providetl for by section 3700 of the Lebor Code, for the pertormance oi the work tar which t�is permit is issuetl. ❑ I have and will maintain workers' compensation insurance, as requlred by sectlon 3700 of Ihe labor Cotle, tor Iha pertormence of Ihe work tor which this pertnit is issuetl. My workers' compensation Insurante cerner entl policy number are: Cartier: p0licy Number: (lhi3 section need nat be crompieted if the permit 15 valued ef one hundred dailers /$100) oi less.) {�'I certify that in the peAormence of the work tor which this pe�it is issuaQ I shall not employ any person in eny manner so as to become subject ro the workers' �compensation lews ol Calitomia, en0 agree Inat If I shoultl become subject to Ihe workers' compensation provisions of Section 3700 of ihe Lebor Code, I shall torthwith comply wit� the ' visi� O ��O I .PP��nCSignature=.' _ Date:, ~,1, ��0.� qprylNG: FAILURE TO SECURE WORKERS' CAMPENSFTIdJ COVERAGE IS UNIAWFUL AND SHP1L SUBJECT AN EMPCOYER TO CFIMINAL PENALTIES AND CML FlNES UP TOONE HUNDRED TFIOUSAND OOLLARE (5100,000), IN ADOITION TO iHE CAST OF CAMPENSATION, DNMAGES AS PROVIDED FOR IN SECTION 3]O6 OF THE LABOR CAOE, IMEFEST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirm that I am licensetl under pmvisions of Chapter 4(commencing wilh Section 7000) ot Oivision 3 of the Businass antl PrWessions Code, eM! my license is in full force antl eHect. Lic. N Class a Contractors SignaWre: Dete: I CONSTRUCTION LENDING AGENCV: . ❑ I hereby attirm that ihere is a construction lentling agency for the pertormanca ol ihe work lor which this pertnit is issued. (Sec. 3097, Civil Code). Lentlets Name: Lendels Addresr. ' Signature: Dete: OWNER-BUILDER DECLARATONS: I her�by eNirm that untler penalry of Derjury ihat I em E%EMPT FROM TME CONTRACTORS LICENSE LAW lor ihe tollowing reason (Sec. 7037.5, Business and Professions Code: Any city or county which requires e pertnit to construct, alte�, improve, tlemolish, or repair any alructure, pnor to its issuance, elso requires the epplicant tor such pertnit to file a signed siatement that he or she is licensetl pursuanl to the pmvisions of ihe Contraaors License Lew (C�aD�er 9(commencing with Section 7000) of DlNsion 3 oi ihe Business and Professions Cotle) or Ihat he or she is axempl theretrom end tho hasis lor the alleged exemption. Any violetion of Section 7031.5 by any applicant for a permit subjecis the eppliwnt to a civil penalry ol not more Ihan five hundretl Oollars (5500).): ❑ I, as owner ot t�e propany, or my employees with wages as Iheir sole compensetion, WILL DO TME WORK, and Ihe structure Is no� intendetl or otteretl for sale (Sec. 7044, eusiness and Professions Code: The Contractors License Lew does not apply to an owner of propeny who builds or improves thereon, and who tloes such work himsetl or herselt or through his or her own employees, provided ihat such impmvements are noi Intended or offered for sale. It, however, Ne builtling or improvement is soltl within one year of complation, ihe owner�builder will heva the burtlen of proving Ihat he or she did not build or improve �or purpose ol sale.). � �—'. �. �s'owner of Ihe propetly, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS t0 construct Ihe prolett (SecJ044, 8u5iness and Professions Code: The contractors License Law does not apply to an owner ot property wtw huilds or Impaoves thereon, a� who contracts tor such pro{ect with a comractor(s) license pursuant to ihe Contractors License Laws.). ❑ I am � e sac. Business and Prolessions Cotle br ihis reason: . s��e,�,ayj� ,�� I Expires: 6` �T��/ VeritiWtion of Ownership by (type ot documem, i.e. - properry tax bill or tleedJ�� DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity ihat no excavation five (5) or more feat in tlep�h into which a person is requlred to tlescend, will be made in connection wi�h work euthonzed by Ihis permit, and t�at no builtling structure, scaHolOing, falsework, or demolition or dismentling ihereof, will be more than thirry-siz (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title e, Califomia Administrative Code). ❑ As ownervbuilder, I will not employ anyone to do work which would require e permit irom tne Divislon of Industnel Sefery, as notea above, unless such person hes e permit to do such work from the tlivision. SignaNre: Date: Division of Intlustnal Safery Permit Number: CERTIFlCATE OF COMPLIANCE AN� AUiHORIZATION OF ENTAY: I cenify under penalry of perjury ihat I have read ihis eppliCation and state I�et the inlormation given is correq� � eqree to comply with all state laws and ciry ordiqancas relating to hullding construction, aM authodze representatives ot Ihe Ciry al Cosla Mesa to enter upon the �ebove ��e �p perty for�" eCtio purposes. I ag�ee not to acupy or ellow xcupancy of any building euthonzed by this permil until linel in ection. ��.�-��.-4 � .a.(-a� �o_s- � Sign�LegalOwner(s=��'� Dat� AnNOr Am�orizatl App{icaM Date COOE t. INSPECTIONTYPE W E �$ 7676 Fixed System Final Fire Prevention 1266 200 201 Pool Spa Final Final Re-Roof Final Block/fletaining Wall 202 F�nal Factory Fire Place 203 Final Sign 204 Final Demolition COOEI INSVECTIONTVPE ' 206 Final Mechanical 20B Finel Plumbing 210 Finel Elec�riCal 212 Finel Fire Preventlon 220 Final Planning Approvel 222 Final Slte 250 Finel BuiltlinyOccupancy •al .IW. / .._.r �r i�� i.�-.au.a - � o.. �, .�� .... � ...... .......�..�__._ ...___'__.__ JobAddress: 2855 CORVO PL Suite No Vicinity: Parcel Nunmber: 13933402 Applicanl: O'NEIL, RICHARD M TR Address: 2855 CORVO PL COSTA MESA, CA Owner: O'NEIL, RICHARD M TR Address 2855 CORVO PL COSTA MESA, CA Coniractor: O W NE R-B U I LD ER Address: PLUMBING PERMIT � Phone: 714-434-6230 Zip: 92626-4816 Phone: Zip: 92626-0816 Phone: Zip: License: 000000 �SlaWs: ISSUED �� Applied: 1 212 7/2 00 5 � Issued: 12/272005 ISSUED BY: SCOPE OF PERMIT ADD 291 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: EXPAND EXISTING BEDROOMS AND MASTER BEDROOM AND REMODEL EXISTING MASTER BATH. REF.: B05-02252 PLUMBING TO INCLUDE: 7 BATHTUB,.1 SHOWER, 2 WASH BASINS, 2 WATER CLOSET, AND 1 WATER PIPING. FEE SUMMARY , AMT aTY AMT gTY AMT sTY ISSUE FEE 823.50 Laundry Tub / Washer 30.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation 50.00 0 Swimming Pool $0.00 0 Backflow Preventer 50.00 0 P-Trap � 50.00 0 Trep Primer $0.00 0 Bathtub 59.80 1 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System 50.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(7-4) 50.00 0 Connect (Ice,Soda,etc) 50.00 0 Receptors 50.00 0 Vacuum Brkr Bkflow(5+) 50.00 0 Denlal Units 50.00 0 SepticTank $0.00 0 Wash Basin $79.60 2 Dishwasher 50.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Sel 50.00 0 Drain, Floor $0.00 0 .Sewer Connecl $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater 50.00 , 0 - Sewer Private Line $0.00 0 Water Closet (Toilet) 59.80 1 Drain,Roof 50.00 0 Shower $9.80 1 WaterHeater/vent $0.00 0 Drinking Fountain 50.00 0 . Sink, bar 50.00 0 Water Piping pnst or Rep.) $9.80 1 Expansion Tank 50.00 0 Sink, commercial $0.00 0 Water Re-pipe 50.00 0 Gas Earthquake Valve 50.00 0 Sink, Floor 50.00 0 Water Service $0.00 0 Gas (1-4 outlets) 50.00 Q Sink, kitchen $0.00 0 Water SoNener 50.00 0 Gas (Over 4 outlets) 50.00 �. 0 Sink, service/mop $0.00 0 OTHER $0.00 Gas Repipe 50.00 0 Spa (private) $0.00 0 VIOLATION $0.00 Gas Service 50.00 0 Spa (public) � $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) 50.00 0 REINSPECTION $0.00 0 Interceptors (Sand Aulo ) $0.00 0 TOTAL CALCULATED FEES: 582.30 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and i regulations. (Ord. No. 92-28, § 1, 12-21-92) � EXPIRATION: This permit shall automatically expire and become void iF work is not commenced within 180 days, or if work is suspended or gban for a period ot 180 days. �� INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inapaetiona end final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration oYthis permit. � FOR INSPECTIONS CALL: (714) 754-5626 24a8d8 (8�00) WpRKERS'COMPENSAnON DECLARAnON: I herehy aHirtn under penalry ot per�ury one of the tollowtag deGarations: ❑ I have entl will maintain a cenilicate of consent to self�lnsura tor workers' compensation, as provitletl for by section 3700 of ihe Lahor Cotle, fo� lhe pertortnance ot Ihe wark lor which t�is permit is issuatl. ❑ I have and wlll maintain wo�kers' compensatlon insurance, as requiretl by secuon 3700 of the Lsbor Code, tor �he peAortnance of the work tor whiGh this pertnit is �ssued. My workers' compensation Insurance carrier antl policy number ere: Cattiec Policy Nomber. (Thls section need no( be compleretl i/ the permif is veluetl at ane huntlred dollars ($ I00) ar Iess.J �I cenity t�at in Ihe peAormence ot Ihe work br which this permit is iuued, I s�all noI employ eny person in any manner so as to become suqect to the workers' companseilon laws ol Cellfomia, anA egree Ihet If I shoy�d Decoma sub�ect Io Ihe workers' compan5ation provisions ol Section 3700 qf Ihe Labor Cotle, I shell foRhwlth comply with ihesp�ryvis' � � ��a� /O� qpplicant Signature: O� Date: � WAqNING FAILURE TO SECURE WORNERS' COMPENSATION CpVEPAGE IS UNLpWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENPLTIES AND CIVIL FINES UP TO qJE HUNDRED THpUSAND DOLL4PE (5100,000). IN ADDITION TO THE COST Oi COMPENSATION, OAMAGES AS PiiOVIDEO FOR IN SECiION 3]W OF THE LABOR CAOE, IMEREST, AND FTTORNEYS FEES. LiCENSEDCONTRACTORSDECLARARON: I hereby aHirm thet I am licensed under provisions of Chepter 9(commencing with Saction 7000) of Division 3 0l ihe Business antl Protessions Code, end my license is in tull force antl etted. Lic. N Class a Con�rector's Signature: Date: CONSTRUCTION LENDMG AGENCY: ❑ I hereby aHirm that ihere is a consiruction lending egency for the peAormance of ihe work for which this permit is issued. (Sec. 3097, Civil Code). Lendefs Name: Lender's Atltlress: Sigaeture: Date: OWNER-BUILDER DECLARATIONS: I hereby aMirtn the� under penelry of parjury t�at I em EXEMPT FROM THE CON7RACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Business entl Professlons Cotle: Any ciry or county which requires a permit to construct, elter, improve, demolish, or repair any simcWre, prior to its issuance, also requires the applicant for such pertnit to file e signed statemenl that he or she Is IlcensaE pursuant ro the proNsions of the Contrectore Llcense Law (Chapter 9(commencing with Section 7000) at DlWslon 3 of the Business and Pro�essions Code) or Ihet he or she is exempt Iherefrom end the basis for the alleged exemption. Any violation of SecUon 7031.5 by eny applicant for e permit subjects the epplicem to e civil penalry ot nol more Ihan tive hundred tlollars (5500).): ❑ I, as owner ol the propeny, or my employees with wages es thelr sole compensation, WILL DO THE WORK, entl the structure is not intentled Or oHeretl for sale (Sec. 7044, Business antl Professions Code: The Con�ractors License Lew does not apply to an owner ot properry who Ouilds or impro�es Ihereon, a�d who tloes such work himselt or hareelf w through his or her own empbyees, provided that such improvements a�e'wt intended or oNered tor sale. q, however, iha buildi�g w improvement is —' sold wilhin one year ot completion, the ownervbuilder will heve Ihe burtlen of p�oving t�at he or she did not build or improve tor pwpose of sale.l. ' p� I, as owner ot Ihe property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS lo construct the project (Sec. 7044, Business antl Profession5 Code: The comractors License Lew tloes not epply to en owner ol propeny w�o builds or improves ihereon, and who contracts tor such project with a contrac�or(s) license pursuant to lhe Contractors Licanse LewsJ. ❑ I am exe un ec. SigneWre: Owner ID verifietl Dy drivefs licensa. ❑ ves ❑ No Business and Professions Code for this reason: Date: � � .S Dnver'sLicenseNo. ��"�$� E:pires: >� O Venfication oi Ownership 6y (type ol document, i.e. - property te: bill or tleed): DIV1510N OF INDUSTRIAL SAFETV PERMIT CER7IFICATION: ❑ I hereby cenlfy Ihat no exca�a�ion five (5) or mora feel in tlepih into which a person is required to descentl, will be matle in connection with work authonzed by ihis permit, and that no Duiltling siruc�ure, scallolding, falsework, or demoli�ion or disman�ling ihereof, will be more fhan �hirry-six (36) �eet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tltle 8, Calilomia Administrative Cotle). ❑ A5 owner-builtler, I will not employ enyone to tlo work which would require a permit irom ihe Division ot Industnal Setery, as noted above, unless such person hes e pertnit to do such work from ihe division. Signa�ure: Date: Oivision ol Industnal Sefety Permil Number. CERIIFlCA7E OF COMPlJN10E AND AUTHORIZATtON OF EMRY: 1 certity unde� penalry ot periury that l have read this applicatioa a�tl state that the infortnatio� given is correC�. I agree b comply with ell stete laws enC ciry ortlinances relating to building consiruclion, antl authorize representatives of the City ot Costa Mesa to emer upon the ebovo-d bed etly tor i tion u oses. I egree no� to occupy or allow occupanty ot any building authorizetl by Ihis pe it uNil al inspection. ""'_ �� ."s� � � �i� os � re Ot Legal Owner(s) Date AnNOr Aut�onzetl Applicant COOE L INSPECTIONTYPE Beff. �1fiITIpLS }6}6 Fixed System FinBl Fire Prevention 1266 200 201 202 203 204 Pool Spe Final Final Re-Roof Final Black/Reteining Well Final Factory Fire Placa Finel Sign Finel Demoliiian CODE 1 INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electncal 212 Final Fire Prevention 220 FinalPlanning Approval 222 Final Site 250 Final Building/Occupancy �$ � (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.��LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2855 CORVO PL Suite: Vicinity: ROOF, EXISTING PORTION OF SFD Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Construction: V-N Parcel Number: 13933402 Zoning: R1 npp�icant TIM MCCARL Address: 126 COMMERCIAL WY COSTA MESA, CA Owner: O'NEIL, RICHARD M TR Address 2855 CORVO PL COSTA MESA, CA Phone: 949-548-5569 Zip: � 92627 Phone: Zip: :. 92626-4816 Contractor: G L R ENTERPRISES INC--DBA CRANK BROTHERS ROOFIN Address: 126 COMMERCIAL WY � , Phone: 949-548-5569 COSTA MESA, CA Zip: 92627 � Arch : Address: Zip: Phone: License: License: 828379 . Eng: ! Address: Status: ISSUED Applied: 05/172006 Issued: 05/17/2006 > ISSUED BY: Phone: License: SCOPE OF PERMIT PARTIAL TEAR OFF, APPROXIMATELY 22 SQUARES. INSTALL 1 LAYER OF 30# FELT, 40 YEAR ASPHALT SHINGLES, AND REPAIR/REPLACE SHEATHING AS NEEDED. 36 SQUARES. Plan Check: $0.00 Permit: $19525 SMIP Res: $1.08 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 r FEE SUMMARY g Total: $196.33 "PLANNING &•ZONING SETBACKS MAWSTRUCTURE Front 0�0, {-: -.;,;Rear 0-0 ACCESSORY .Front�� 0-0 ��. ,Reai 0-0 PARKING Existina:� 0 Renuired: 0 Calc Valuation: $�o,�a3.00 Claim Valuation: Sio,�as.00 Left 0-0 �._, .. Right 0-0 � Left 0- 0 Right 0- 0 Pr000sed: 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 7 BO days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244fi3fi (CY00� WORKERS' COMPENSATION DECLARATION: I hereby aHirtn under penaity ot perjury one of ihe following declarations: ❑ I have antl will maintain a certificate ot consent to selt-Insure for workers' compensatiorr, as provitled for by section 3700 of the Labor Code, for lhe peAormance of ihe wark tor which Ihis pertnit is issuetl. � I�"'Phave and will maintain workers' compensation insuranca, as requiretl by section 3700 of the Labor Code, for the perfortnance of the work for which Ihis pertnit is issued. �;., �pMy'wfykers' Fompensatioqlnsurance carrier and �olicv number are: atone PolicY N�umb�er:�`i�� d� � ?7�-I i-�% � ❑ I certity that in the pertormance of the work for which this permit is issued, I shall not employ any person in any manner so as !o becoma subject to iha workers' compensation laws Calif rnia, antl agree that if I shoultl become sublect to iha workers' compensation provisions of Section 3700 of ihe Labor Code, I shall torihwith c= ly with�(hese v i n. LA�licant SignaNre: ` �Dat�e;_= ��_-ri' � �� o� WARNING�FAILURE TO CU WO KEPS' COMPENSATION CpVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EM �OPC VER TO CRIMINAL PENALTIE AND CIVIL FINES UP TOONE HUNDRED THOUSANDOOLLARE($100, ,INADOITIONTOTHECOSTOFCAMPENSATION,DAMAGESASPROVIDEOFORINSECTION3/O60FTHELABORCADE,INTEREST,ANDATTORNEV'SFEES. LICENSEU CONTRACTORS DECLARATION: of Chapter 9(commencing with Saction 7000) of antl eHect Lic. 8 and Professions Code, and my license is in full CONSTRUCTION LENDING AGENCY: ❑ 1 hereby aRirm that ihere is a constmction lending agency for ihe performance of ihe work For which ihis permit is issued. (Sec. 3097, Civii Code). Lender's Name: SignaWre: _ Lender's Adtlress: Date: OWNER-BUILDER DECLARATIONS: I hereby attirm that under penelty of perjury tha� I am EXEMPT FROM THE CON7RAC70RS LICENSE LAW tor ihe following reason (SecJ031.5, Business and Professions Code: Any city or county which requires a permit to consimct, alter, improve, demolish, or repair any stmcture, prior to its issuance, also requires ihe applicant tor such pertnit to file e signed statement tha� he or she is licensetl pursuant to ihe provisions ot ihe Contrectors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or ihat he or she is enempt iherefrom and the basis for ihe allegetl enemption. Any violation oi 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 tha property, or my employees with wages as Iheir sole compensation, WILL DO THE WORK, and Ihe stmcture is not intended or offered for sala (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves ihereon, and who tloes such work himself or herself or ihrough his or her own employees, provitletl tha� such improvements are not intended or otteretl For sale. fl, however, the building or improvement is sold within one year of completion, Me ownar-huilder will have the burden of proving that he or she did not build or improve tor purpose ot sale.). � ❑ I, as owner of Ihe propetly, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consimct the project (Sec. 7044, Business and Protessions Cotle: The contractors License Lew tloes not apply to an owner oi propeny who builds or improves thereon, and who contracis br such projact with a comractor(s) license pursuant to Ihe Coniractors Licanse Laws.). ❑ I am exampt under sec. Business and Professions Code for this reason: Signature: Oate: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Veritication ot Ownership by (type of tlocument, i.e. - property tax bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Ezpires: ❑ I hereby cenity that no excavation five (5) or more faet in depih into which a person is requiretl to tlescend, wi�l be made in connedion with work authorized by ihis permit, and ihat no building siructure, scaftoltling, falsework, or demolition or tlismantling ihereof, will be more ihan thirty-siz (36) feet high. (Ghap. 32, Gry 2, Art 2, Sec. 341, Title 8, Califomia Adminisiretive Cotle). ❑ As owner-builder, I will not employ anyone to do work which would require a permit fmm Ihe Division of Industriai Safety, as noted above, unless such person has a permit to tlo such work fmm Ihe division. SignaNre: Date: Division of Industrial Safery Permit Number: CER7IFICATE OF COMPLIANCE AND AUfHORIZATON OF ENiRV: I certify under penalry of perjury that I have read Ihis application and state that ihe information given is correct. I agree to comply wilh all s�ate laws end ciry ordinances relating to building consimction, and authorize representatives of ihe City ot Costa Mesa to enter upon Ihe above-described property for inspection purposes. I agree not to occupy or allow ocapancy of any building au�horized by ihis permit until final inspection. C OE t. INSPECTIONTYPE 1676 Fixetl System Final Fire Prevention 726fi 200 207 202 203 204 Pool Spa Final Finai Re-Roof Final Block/Retaining Wall Final Factory Fire Place Final Sign Final Demolition OATE INTITIAL CODEN INSPECTIONTVPE 206 Final Mechanical 208 Final Plumbing 210 Final ElecVical 212 Final Fire Prevention 220 Final Planning Approval 222 FinalSite 250 FinalBuilding/Occupancy ATE INTITUL . - �� r,'t,� �^+ • �_.a�_,�L e COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 377 GOfffA MEBA. CALIFORNIA For Applican+ fo Fill In Compleiely TYPE OR PRINT BUILDING � C�� O �L�G� ADDRESS � ' COSTA MESA CALIFORNIA OWNER Pacesetter Jt. Venture MAIL 1653 &[inorca ADDRESS 1 cin Costa Mesa No: 9-039: ARGHITEGT TEL. �� '��na �p-� A� JUL 311961 ��6a- • FINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Offiee Use Only rseceirr No. rE�ppITANO�' A �UiB BY I pATE RECEIVED D.�TC 164Um ->_�.�/_/� �_-�1_�i GOSTA MESA. CONTRACTOR �:eSa Verde BlL11i�eP$ IIIO. APPROVED 1 53 Minorca �'1V@ BY DATF ADDRE58 ' ZONING CITY COS 4a MCSa ZONE ^_, I pu BF � I BUIISINO STATE 1812 9 THI. Kl 9-0395 �g�pK / LIQ No. NO. oeacn�vTlox Z Z T/� ' SIZE nSM C� iLL r NO. OR BLDOB. O �� OF LOT � VV JQ.l 4 NOw on LOT A. P. NO. USE OF - YARD6 EVES EXIBTING BLDG APPROVED SETBACI( LINB RiOM 12 28 ICENTCR LINH 8T.) CENiEN OP 6iff8HT �Y REAR YARO FRONT SIDE YARD LEtT J I RIGHi � R. SIDE DESCRIPTION OF WORK L. SIDE .._... I X II .. __�......... I II ....,._._.. I BUILDING ].750 S F.�J�O. OF '� 1 SIZE Q• '1200M6 STORIE6 E%TERIOfl WALL�t11I�jCO IROOF COVERING �u COVERING e ��gl USE OF BUILDING AND WORK 70 BE PERFORMED Standard Plan No. 750 AR 1 HEHEBY ACKNOW OH TXAT 1 MAVE RBAO TN�9 PPI�GT�ON AND eTAT! THAT T ABOV IB CORPECT AND AGR B TO CON- PLY WITH ALl CITY IN C88 AND A I.�W9 U TNO BUIlDiN6 CONBTA D . 91GNATURE OF � PERMITfE AUTHORIZED AGENT AoPPROVED � � TXE AMOUNT BXOWN UNDHq VqLUAT10N 19 FOR THC PUPP08E OF EBTq8L18HING q PERMIT FEE ONLY. VALUATION PERMIT FEE $ L��_ N $ PLAN CHECK S ��+' ��/ OO TOTAL FEE I03 � �