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Home My WebLink About2524 COLBY PL - Building PermitsCITY OF COSTA MESA , 'a� � B!/ILDING DIYISION F .� 77 FAIR DRIVE, COSTA MESA, CA 92626 •(774) 754-5273 • Fax Q14) 754-4856 •�w+w.ci.costa-mesa.ca.us � FOR INSPECTIONS CALL: (714) 754-5626 •!^eawnr A•• PERMIT NUMBER: P08-002$� PERMIT TYPE PLUM APN: 14142413 JOB ADDRESS: c2524,GOLBYuPL�?CI1A"' vicinity: , „ - , , _ STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: � ISSUED 12108/2008 KJB SCOPE pF WORK: STORAGE'fANK WATER HEATER CHANGE OUT. NO CHANGE IN LOCATION. OWNER: SHOCKLEY, MICHAEL J PHONE: 949-249-0646 • . APPLICANT: BARNYASNEV, MIROSLAV P PHONE: 800-898-0008 ' . Address: City/State/Zip: Address: City/State/zZip: CONTRACTOR: CALIFORNIA DELTA MECHANICAL INC Address: 1235 GRAND AVENUE City/State: SPRING VALLEY, CA ZipCode: 91977 ARCHITECT: License No. ENGINEER: � _ License No. 2524 COLBY PL COSTA MESA,-CA .. , 1235 GRAND AVENUE � : _ SPRING VALLEY, CA , License No. 811114 PHONE: 800$98-0008 - CELL: PHONE: PHONE: � PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: PERMIT. FEE: TOTAL FEES: $0.00 $35.80 $35.80 � � � � i'•i�,� t�� n.• ' f..�t.. NOTICE; The work authonzed by lhis permit shall comply with all applicable hantlicap access requirements under Califomia sWtutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. - INSPEC710NS: In order for the work authonzed under this permit to be considered legal, such work must comply with all applicable codes, and all required inspeetions and final approval must be obtained. Failure lo obtain inspections and final approval will result in the ezpiralion o( this permit. cODEt, i�saEcnoxTrve � ixTm��s CODE/ INSPEC710NTYPE . � INTI71�L5 7876 Fixed System Final Fire Prevention 206 Final Mechanical 1266 PoplSpaFinal 208 FinalPlumbing �H'"�"�� 200 Final Re-Roof 210 Final Electrical 201 Final Blotk/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fira Place 220 Final Planning AOProval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy �� WORKERS' COMPENSATION DECLARATION: . I hereby aKrm under penalty o( perjury one of the tollowing tleclarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensalion, as provided for by, section 3700 of the Labor Code, for the pedormance of the work for which this permit is issued. ❑ I have and wlll maintain workere' compensation insurance, as required by section 3700 of the Labor Code, tor the peAormance of the v.ork fw which this pertnit is issued. My workers' compensalion Insurance carrier and policy number are: �/ �/7 Carrier: ��L- C1Y (This sedpn neetl�rof bpNn�qle�!(he pe(mR is val� a1 me h�M.etl tla�a�larslSf00) wless) � C � % D Policy Number: ( 2 ❑ I certify lhat in the peAormance ot the work for which lhis permit is issued, I shall not employ any person in any manner so as lo become subject to the workers' compens n laws nf Califomia, and agree that if I shoul0 become subject to the �ers' compensation provisions of Section 3700 of ihe La6o e, I sh ohhwith mply with these p�visions. � � Aop� s Sig lure Da�e WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNL4WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IM'EREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm Ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) o! Division 3 of IMe Business and Professions Code, an0 my license is in u /foJ ce and effect. C � Lic. # �( �� Class #' �� S � /` "-�d C ratlw's Signy re Date CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrtn ihat there is a construction lending agency for the peAonnance of the work for wfiich this pertnit is issued. (Sec. 3097, Gvil Cotle). Lender's Name: LenCer's Atltlress: SignaWre Date OWNER-BUILDER DECLARATIONS: I hereby aPorm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW f0� the following reason (Sec. 7031.5. Business and Professions Code: Any ciry or county which requires a permit t0 wnslruct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such pertnit to 51e a signed statement that he or s�e is licensed pursuan� to the provisions of [he Contrectors License Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business and Pro(essions Code) or that he or she is exempt there(rom antl ihe basis (or the alleged exemption. Any violation of Section 7031.5 by any applicant for a peimit subjects the applicant ro a civil penalry o( 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. antl the structure is not intendetl or oRered for sale (Sec. 7044, Business and Professions Code: The Contracrors License Law does not apply lo an ovmer of property who builds or improves IhereOn, and who doe5 5uth work himsell or herself or Ihrough his or her own employees, provided that such improvements are not intended or offered for sale. I(, however, the building or improvement is sold within one year of completion, the ownervbuilder will have the burden of proving that he or she did nol build or impmve for purpose o( sale.�. ❑ I, as owner of lhe property, am EXCLUSIVELY CONTRACTING WITH LICENSEO CONTRACTORS to construct the project (Sec. 7044, Business antl Pro(essbns Cotle: The contraclor5 License Law dces not appy to an owner of property who builds or improves thereon, and wfio contracts fw such project with a conUactor(s) license pursuant to the Gontract«s ucense Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: _ SiBnamre - Oa�e JOS]-d6�3/0)) Owner ID.verified by drivei ., .�cen, ❑ Yes ❑ No Driver's License No. Expires:�-- Venfication of Ownership by (rype of Oocumen[, i.p. -yropE�y axgi�[ I or deed): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: '� � ❑ I hereby certify that no excava[ion frve (5) or more feet in depth into wfiich a person is required to descend, will be made in connectbn wi�h work authorized by this permil, antl that no huilding strucWre, scaffdding, falsework, a demolition or tlismantling thereof, will be more than Ihitly-six (36) teet high. (Chap. 3.2, Grp 2, M 2, Sec. 311, TUe 8, Califomia Adminislra�ive Code). � As owner-builder, I will not employ anyone to tlo vrork which vrould require a permit from the Division of Industrial Satery, as notetl above, unless such person has a permit to do such work from Ihe division. ADOlifanCs SignaWre Division of Induslrial Safety Permit Number. _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will Ihe applicaN or present or fuNre building occupant neeA to file and certity a Business Plan for emergency response to release or Ihreatened release o! a hazardous material? ❑ Yes ❑ No (Section 25505 of the Califomia Health and Safery Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Depanment by every business whic� has at any one time during a reported year a quantiry ot hazartlous materials equal ro or greater than a weight ot 500 pountls, or a volume of 55 gallons, or 200 cubic teel of compressed gas at standard temperature and pressure�. 2. Does or vrill the applicant or present or Wture building occupant need to file a registration form for acutely hazardous matenals? ❑ Yes ❑ No (Section 25533 0( the Cali(omia Health and Satery Code, with some ezceptions, requires registration wilh the Cosla Mesa Fire Department by each business which at any one time has on hand a quantity of acu�ely hazartlous matenals equal to or grealer than a weighl of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas al stantlard temperaWre and pressure). 3. Does or will the applicant or presen[ or future building occupanl need to prepare an RMPP (Risk Management and Prevention Program (or acutely hazartlous matenals)? ❑ Yes ❑ No (Section 25534 of the Califomia Health and Safety Code provitles that the Costa Mesa Fire Department may require the preparation, cerlificalion antl filing with the Fire Department of an RMPP by businesses which are requiretl to register acutely �azardous materials with the Fire Department. 4. If an RMPP is preseNly required, has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future builtling occupant require for the work which is the subject of ihis application a permit (or such wnSWction or modification from the Sou[h Coast Air Quality Managemenl Dislrict or from any olher air pollu�ion control tlistnct or agency? ❑ Ves ❑ No (Sectbn 658502 of Ihe Califomia Govemment Code requires Ihal the requestetl informalion 6e fumished on applications (a non-residential building pertnits). 6. Will any part of Ihe facility to be constmcted under this permi[ be wi�hin 1000 feet from the outer boundanes of a school? ❑ Yes ❑ No Qf'yes", the (aciliry musl meet the requiremenl o� Seclions 25534 and 42303 o( �he Califomia Health antl Sa(ery Code). 7. If a permit trom the South Coast Air Qualily Management District or other air pollution control tlistrict or agency is required for the work which is the subject o! this application, �ave all of the disclosures prescribed by Califomia Health antl Safery Code Section 42303 been matle? ❑ Ves ❑ No 8. (If'yes", allach certificate of compliance from the appropriate air�pollWion control otficer). ' " � CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury lhe info�mation given above is wrrect I.agree to comply with all state laws and city ordinances regarding Hazartlous Materials and Emissions. � SignaWre CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury t�at I have read this application and state Ihat Ihe information given is correcL I agree to comply with all s�ate law5 and ciiy ortlinances relating to building consWction, and authonze representatives of the City o( Costa Mesa to enter upon the above-tlescribed pmpeRy lor inspection purposes. I agree not to occupy or allow occupancy of any building authorizetl by this permit until final inspection. �� Si re o vmeqs Oa�e - /'z-�-�j, Pn0/o� NulM1onzeE ApPLtnnl Dale P.GD�icant to fill in all spaces excep.�.��....�...,.,.....a..r'voraer lines antl s19� all apvropriate aeclarations. Ci7Y OF COSTA MESA CONSTRUCTION PERMIT ProjectAddress 2524 COLBY PLACE, C.M. 92626 Applicant's Mailing Address 126 Commerc i a l �"iay � C.M. 7wner'stvame Alfreda F. Kreutzer Phone 751-9643 ddress 2524 (:olbv�L,, C.M. 92626 ...rchlE�g, �icense No. "�ontractor's nlame Crank Bros. Roof i nq phone548-5569 Addresslmailin9) 126 Commercial Wav, C.M. 92627 C�w �icense tdo. 005993 LICENSED CONTRACTOR DECLARATION I ltereqy aflltm thdt I am licensetl untle� p�oviSiOns of Chdr[e� 9(ComTencing witn sCction �000) 01 Division 3 of the Business antl Pro�essions Cotle, antl mv iicense is in ruii t�ryre ana e�tect. " QOB677 �icense,�lass �' License No. Dale — Signature l/r WORKERS'COMPENSATION DE RATION ''hereby af(irm that I have a cer(' ate oi consent to selHnsure or a certifiwte �f Workers' Compensation 1 rance, or a cerNfietl copy thereof ($ectlon 3eoo, �ao. r��9/224-89 State Fund - Polity No. Company x�Cer�ifiq copy is hereby furnishetl. Ccrti pyffi ed with the city Buil DI ' fon. Date �� Applicant EXEMPTION FROM WORKERS' COMPENS ON D LARATION (This sCclion neetl not be comple[etl it the mit Is tor one huntlretl (E100) or icss). I cerli/y that in Ihe per/0/manCe of t wo�k for whictt this pe�m�t Is i55uetl I s�all rlot emPloy any person in an manner so as to be<ome subject to t�e Workers' Compenution Laws ot Califomia, Oale $i9natu�e NOTICE: If, after making this tleclarafion, you sM1oultl become subject to the Workers' Compensation provisions of the Labor COCe, you must forthwith I comply with such provision5 or IniS permlt Shall be tleemetl revoketl. CONSTRUCTION IENDING AGENCV I ltereqy affi�m that there is a cons[ruction lentling a9ency for the per}ormance �� of lhe work for which this permi[ is issuetl (Section 3097 Civ. C.) �entlar's Name L.entler's Atltlress OWNER BUILDEp DECLARATION I herqby affirm Lhat I am exempf from the Contractor's License Law for the follov.�{ng reason (Sectlon �031.5 Business antl Professional Cotle: Any city or couNy wbich requires a pe�mit to construtt, alter, imOrOve, AeTolish Or re0air any s�ructure, prior to i[s issuance, also requires the applicant for such permit to filq a signetl Statem¢nt thdt he/she is IiCens¢tl pursudnt to tne prpvisions of a Contractor's License Law (Chapter 9(commencing with Section 7000) of rision 3 oi the Business antl Protessions CoOe) or that he/she Is exempt ,ve(rom antl the basls (or tbe allegetl exeTP�ion. AOy violatiOn ot Sectlon i031,5 by any applicant tor a pe/mit SubjeGts the applicant t0 a civil �nalty of not more than five huntlretl tlollars (E500). LJ I, as owner ot the prooerty or my employees wlth wages as their sole cOmpensation, will tlo the wOrk, antl the St�uctu�e is not intentl¢tl o� offe�etl for sale (Section 7044, Businezs anE Professional Cotle: The Contractor's LiGeng¢ �aw tlOeS nol apply LO an owner of a prOP¢rry Who builtl5 0� improves there�n, antl wh0 tloes such work him5elf/herselt o� through his O� h¢� own em0lvyee5, prOvitletl tna[ sucb Improveinents are not intentletl or offaretl fo� Shce. H, howeveq Ihe bulltlin9 or improvement is soltl within one Y9ar oi com- pletipn, the owner will have the burtlen oi provin9 he/she tlitl nol hulltl or Im- prov0 �or tne purpose of sale). ❑ I, as owner of the property, am exclusively contracting with Ilcensetl con- t�attb�s t0 construct the pro)eCt (Settion 7044, Business antl Professions Cotle: The ConVac[or's License l.aw tloes mt apply to an owner of property who builtls or Imo�oves thereon. ana who contractt for suth oroiects wlth a ron- fractor�s Iwense pursuani 20 [ne ConVactor•5 License L.aw). I am aware thai prooi o� tneir Worker's Compensation insurance shoultl be provitlea to me. ❑ � 8m exempl untler Section B, & P. C. for this reason Da[e I hereby certiry f informatlon is mrr antl tate laws relz sentatives ot this . InSpe�(lan pu�poSe� �'Si9ndture Orivgrs' license or 0865.46,rev. r _ Owner have reatl this applicatlon antl state that tne above agrea to compry with all city antl coun[y Ortlinances ��Du tling con5tructlon, antl hereby authO�iie �epre- To ter upon the above-men[ionetl roperty for - ,�,.,.,�oSo6 � ....._..._. 7VPE OF CONSTRUCTION NEw ❑ CONVERSION ❑ DEMOLISH ❑ C DESCRIPTION OF WORK/USE OF BLDG. ALTEkAT10N LJ REPAIft TVPE OF PERMIT LJ GRADING L1 FOUNDATION LJ STRVCTURAI. ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER � � PROJECT DESCRIPTION S�.FT, OCCUvaNCv_��_�� CONSTRUCTIONTYPE residential V VALVATIONS 6,235.Ob ZONE GRADINGCU.VDS. ACRES Remarks: �C .. . . / 1_ _ _ _l�Gl _�n_._.�_ _� ri_n Bar Sink Backflow Preventer Backflow Irrigation Bathtubs rinking Fountains loor Drains loor Sinks asService Outlets Kitchen Sink Lavatories P—Trap Roof Orains Rainspection Fee � $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit �C80 d`- Heating System & Ducting ❑ o-i oo,000 sru O � oa,000 Reinspection Fee � $15 White � Builtling: Canary -.4pP��cant; Pink - Accountin9: Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collecmrs Solar PiPin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Laundry Trays Isue Fee Hood or Typel ❑ Canopy Typell � Fefrigeration System ❑o-ioo,000sru ❑ioo,000 System flepair/Alteration F ire Dampers Registers laue Fee FEES A.P. # S Main Buildi E T Front B Rear A C Right K g Left Ping. Ref. # Planning Notes: Accessory Building: Parking Req./Provided ElEC7RICAL AutomaticWasher Transformer ❑ 15-50KW Construction Pole Sub. � 50 + KW Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes OuLets $wifche5 Garbage Disposal Generator �p�5 KW �5-75 KW Zone Mecer ❑up ro 100 amps Meter ❑over100amps Sub Panel . �,. . Motors �0.1 HP �i'f.:8 Inc.Soiar �&15 HP []16-15+ Microwave � Pole Light Range Si9n Standing Sections Trash Compacmr Pee �$15 � � Issue Fae $ 3 DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approvad By FEES - � Building Approved By � '� Applintion Issued By $ 3 BUILDING PERMIT $ � PLAN CHECK $ 7LUMBING $ ' r PLAN CHECK 25% S 5 'ELECTRICAL 5 .r PLAN CHECK 5046 $ " MECHANICAL $ PLAN CHECK 25% $ L O N I N G H E Q M T S. FEES $ 3 SMIP $ ..'�_v PERMIT ISSUANCE $ ENERGV P.C. $ GRADING $ MICROFILM $ TOTALFEE $ �p.s� ' .'t- ��:. � -- : . .. . ;G ,..,? ,:- - , �� • ;�., CONSTIiUCTl074 AND PLANNING - APPROVALS Permit # 1. Temporary Electrical Service or Pole 2. Soil Pipe-Undrgrnd. 3. Electrical Conduit Utility-Undrgrnd.' 4. Electrical Conduit-Undrgrnd. 5. Steel Reinforcement 6. Electrical UFER Grnd. �� 7. Footings ' r 8. Foundation ' r 9. Water'Pipe-Undrgrnd. - -- - • - 10.' Structural Floor System 11. Property Sewer Line & House Connection 12. Sewer Cap 13. Roof Drains 74. Rough Plumbing 75. Rough 'ectrical-Conduit �1�6� Rough ctric Wiring 17. Rough Wiring Sign � r 1�8. Rough Electrical-T Bar Ceili�ngt�" �19. Rough Heating & Air Conditioning 20. Rough Factory Fireplace �`-� 21. Ducts, in Structure �� 22. Ducts, Ventilating �, ' 23. Gas Pipe-Rough & Test , �'i: 24. Roof Framing '� .�' 25. Roof Sheathing � ' . � 26. T-Bar Ceiling (Struat`ural) & Monocoat 27. Frame and Flashing � � , 28. Lathing & Siding .�;� , 29. Insulation ,�' '� 30. Drywall Nailing ' � � V 37. Plaster Brown Coat ` � 32. Electrical Power'Meter-Fi�al; '�. 33. Final Electric �� 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Fac[ory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation ! 44. Landscape Irrigation System � 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 57. CERTIFICATE OF OCCUPANCY No._ Date 1 PO : SPA Date Inspector AppROVALS Permit # • • 52. Pool & Equipment Location 53. Steel Reinforcement . • - 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER-GUNITE , 58. Electrical Conduit-Undrgrnd. � 59. Gas Pipe, O Undrgrnd., Test �,� - = 60. �Backwash Lines, P-Trap, �.Undrgrnd. 61. APPROVAL TO DECK ,� 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System - Final 65. Electrical-Final 66. Solar System-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hydro 71. Product Piping O Gas ❑ Oil 72. Underground Flush . 73. Undergrnd. Storage Tank � Gas O Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: ♦�r s� ��y1� � /i.�( Date �Inspector OWNER COStB MB98 EStat@S DATE 4-12-5b JOBADDRESS 272l1 C'O�-bY P�aCE3 BUILDINGPERMITNO. 2�38 GENERALCONTRACTOR Roven-Spie�el Co VALUE $ 1��2��.�� LOT 138 BLOCK TRACT 2�50 Single Res. W�att gar . GROUP I& J TVPEV ZONE � FIRE DISTRICT 2760 PERMITSI$SUED INSPECTIONS DATE SUBCONTRACTOR DATE I NUM9ER Foundation Forms and Grade to Rough Framing Plumhina. Rouah to Slab 1 i �J%L�JIS J D SL J � Final sc.rnct lii-�.c61d?.Kt K. (-',,-,�u . Irr.it•s�l .�S.a<io� Septic Tank or Cesspool Lathina.ln Out Plumhing, Final Gas Wiring, Final Occupancy FOflM 210 3M 10�^u5 ; Costa Mesa Building Department � APPLICATION FOR PERMIT : T ' COSTA MESA,OCAL FORNIA �� D�l N G ' &'OR OFFICE USE ONLY FOR APPLIC T TO FII.L IN Receipt No. Permit No. a��d,�s ��'y � c�/ 3�' Address � CiOSt$ esa, Cal OPII18� Rece(ved by Date Rec'd. ' Date Issued Nearest / n / � � e ��'x � CroSSSt. �'�'v � Building /�� l � /, Tel. 7 zSONo.L Lic. ��7 wi.. Nearest Cross St. Costa Mesa, California o. Date .�' �1�.�/�!'>y-, ach Metes and Bouni of Lot /J�-ii �� < Llne TPom �� oT Street New No. of Bldgs. Now on Lot No.of No.of Familles Rooms RearYard 37 Demolish tsuutlm9(/�X/ No.oT / Size T �k-� Rooms v StoAes � Exterior Wall q Roof N' ' Covering �'7G�1' � Covering �ii�/�(/Z��` APPROVALS Use of New ' n _ Building �� e( it�({((, �- ��,�{'�� Foundation Location Inspector /,�/ Forms, Materials, '� (,C/r,((_(.(��.C.C.f3.�(/ ✓ Under-Pinning / ' Frame: Ffre Stops, Bracing, Bolts I hereby acknowledge that I have read this Applicatlon and state that the above is correct and agree to comply Lath. Int. with all Clty Ordinances and State Lxws regulating building mnstruction. Lath. Ext. Signatureof f��s�t, l� /�� S(�(�j Permittee �1' � �t Plaster, Int. Valuatlon Permit Fee $ $ /�?nA � PlanCheck$ / � L� � Total Fee $ AM 9116 F�RP RM Q-c¢.. _ M7 J d a` Street " PLO� PLAN Bhow locatlon and dishanees from property Iina and between buildings. .� : �' -. , p COST^7��rs +.' '�i'�1% (�i� r�i � i G�.I D'JES,+ - J. L . ' .