HomeMy WebLinkAbout829 SAINT CLAIR ST - Building Permits(714) 754-5273 • F� (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job nddress: 829 SAINT CLAIR ST
Suite:
Viciniry: RESIDENCE & ATTACHED GARAGE
Parcel Number: 14154127
Applirant: PATOCKA, NICOLE
Address: 1653 SUPERIOR AVE
COSTA MESA, CA
Owner: BELLEW, CHRISTOPHER M
Address 829 ST CLAIR ST
Status: ISSUED
Applied: OB/3 V2001
Issued: OB/31I2001
Zoning:
ISSUED BY: '
Phone: (949)642-7222
Zip: 92627
Phone:
COSTA MESA, CA Zip: 92626
Contractor: LEE ROOFING OF COSTA MESA
Address: 1653 SUPERIOR AVE
COSTA MESA, CA
Zip: 92627
Arch :
Address:
Phone: (949)642-7222
License: 349686
Eng:
Address:
•
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1� r
',
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF: T/O EXISTING ROCK ROOF, INSTALL 2 LAYERS OF 15# FELT, APPLY 25-YEAR DIMENTIONAL SHINGLES.
32SQUARES
Plan Check: $0.00
Permit: $125.25
SMIP Res: $0.58
SMIP Com: $0.00
Other. $0.00
Inspection: $0.00
Total: $125.83
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existina: o
NOTES:
Rear 0-0
Rear 0. 0
ReQuired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Pr000sed: 0
Calc Valuation:
Claim Valuation:
Right 0-0
Right 0-0
$5,800.00
ss,eoo.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically explre and become void if work Is not commenced within 180 days, or it work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authonzed under this permit to be considared legal, such work must comply with all applicable codes, and all
requlred Inspectiona end final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaaae (aroo)
:
WORKERS' COMPENSATION DECLARATION: �
1 hereby aHirtn under penalry ot perjury one ol the lollowing declarations:
❑ 1 have end wlll maintain e cenificate at consent to sell-Insure for workers' compensation, es provided for �y saction 3700 ot Ihe Labor Code, for the pertormence of tne
/^ork tor which lhi5 Darmit 15 i5sued.
B' I have entl wlll maintain vrorkers' compensation Insurence, es requlred by section 3700 of the Lebor Code, for the pertortnance oi the work for which this pertnit is lsweA.
My workers' Compensalian Insurence carrler end policy number ere:
Cartier: Policy Number:
(This section need not be cromple(etl il fhe pelmif !s valued et one huntlretl tlollers ($f 00J or less.)
❑ I certify that in iha peAortnence oi tha wark tor which t�is pertnit is issued, I shall not employ eny person in eny manner so as to become subjact to lha warkars'
compansatian lews of Celitomle, and egree that if I should become suh�ect to �he workers' compensation provisions of Saction 3700 of the Lebor Cotle, I s�all fotlhwith
comply with th850 D�a�iyons. ' ^ p
AppliCen� Signa�ure: _� � ` Dete: U�,� I�� I
WARNING. FAILURE TO SECURE WORKERS' PENSNTION COVERAGE IS UNLAWFUT AND SHALL SUBJECT AN EMPIOVER TO CRIMINAL PENALTIES PND GVIL FlNES UP TOONE HUNDRED
TFKKISANO DOI.LARE (5100,OW). IN ADDRION TO TME COST OF COMPENSATION, DAMAGES AS PROVIDEO FOR IN SECiION 31060F THE LABOR CO�E. INrEREST, AN� ATTORNE`fS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm that I am licensetl untler provlsions of ChaO�er 9(commencing wil� Section 7000) of Division 3 oi Ihe Business and Profassions Cotle, entl my licensa Is in lull
force end eHecL Lic. # CIa55 k
Contrectofs Slgnature: " 1 e. w7 Date: '.3 /' G I
CONSTRUCTION LENDING AGENCV:
❑ I hereby aMirm Ihat there is a construction lending egency for Ihe pertormance of ihe work for which Ihis permit is issued. (Sec. 3097, Civil Cotle).
Lender's Name: Lendar's Address:
Signeture: Date:
OWNER-BUILDER DECLARATIONS:
I hereby attirtn that under penelry ol perjury that I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business end Professions
Cotla: Any ciry or counry which requires e permit to consiruct, elter, improve, tlemollsh, or repair any structure, prior to its issuance, elso requires the appliwnt for such permlt
to Tile e signetl stetement that he or she is Iicensetl pursuent to ihe proNsions ot Ihe Contrectors lJcense Lew (Chapter 9(commendng wlih Section 70W) at Divislon 3 of the
Business and Prolessions Code) or thet he or she is exempt Iherefrom en0 tha besis for the alleged ezemption. Any violetion ot Section 7037.5 by any applicant for e perrrl'
subjecis the applicant to e civil penalry of not more than five hundred dollers ($500)J:
❑ I, as owner of the proparry, or my employees wllh wages es their sole compensa�lon, WILL DO THE WORK, anC �he siructura Is not in�ended or oHereO for sale (Sec.
7044, Business and Professlons Code: The Conirectors License Lew tloes not apD�Y �a an owner of property who 6uilds or improves thereon, and who does such work
himsell or herselt or through his or her own employees, providetl Ihat such improvements ara not intendeC or o%ered tor sale. H, however, tha building or Improvement is
soltl within ana yeer of completion, the ownerbuilder will have ihe burtlen o� proving that he or she did not builtl or improve for purpose at sale.).
❑ I, as owner of lhe properry, am E%CLUSIVELY CONTRACTNG WI7H LICENSED CONTRACTORS to construct tha project (Sec. 70a4, Business and Pratesslons
Code: The cnntractore IJcense Lew tloes not epply to an owner ol property who builds or improves thereon, and who contracts tor such project with a coniractor(s)
license pursuant to iha Contradors License Lews.).
❑ 1 am e:empt undar sec. Business ana Professions Cotle for this reason:
Signa�ure: Da�e:
Owner ID veriTied by tlriver's license. ❑ Yes ❑ No Drivers License No. Expires:
Vedfication of Ownership hy (type oi Cocument, I.e. - property Iax �III or AeeC):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certily �hat no axcavation five (5) or more teet in tlep1� into which a person is required to descend, will be matle in connection with work euthodzad by this
permit, antl t�at no building structure, sceflolding, talsework, or demolition or dismantling thareof, will be more than thirry-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, 7tle e, Califomle Administretive Catle).
❑ As owner-buildar, I wlll not employ anyone to do work which would require e permit Irom the Division of Indusinal Sefety, es noted abova, unless such persan hes e
permit to tlo such wark tram the division.
Signature: Date:
Division ot IndusMel Safery Parmit Number:
CERTIFlLATE OP COMPLIANCE AND AllTHORIZA710N OF ENTRV: I certity under penalry oi perjury that I have read this application and state ihat the informatlon given is
correct. I agree to comply with all steie laws end ciry ordlnences relating to Duilding construction, end euthorize representatives ot the Ciry ot Costa Mesa to enter upon the
ebove-descnbed proPerty tor inspection purposes. I egrea no� to acupy or allow occupancy ot eny building authodzed by this pertnit until final inspection.
� Signatur I Le wner(s) le
��.�iv�n� P�-3 �'O
And/Or Authodzetl Applicant ate
CODE L INSPECTON7YPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Finel
200 Finel Re-Rooi
201 Finel BIaWRetelning Well
202 Final Faclory Fire Place
203 Finel Sign
204 Finel Demolition
PAiE I[�ELS
COOE I INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing
270 Final Elecirical
212 Final Fire Preveniion
220 Final Planning ApProvel
222 Final Site
250 Final Building/Occupenty
PAIE Ui�LS
PFOJECTRODFESS: Hc�9 SAiNT LLF�1� $T
OWNEfl'SNAME: r��WZN, KENNE'PH E
ADDflESS: ��qW1N� D�HOiZAH L
82° �T CLAIR 'a'T
CQSTA NESA,CA
pflCHIENGINEEfl:
aoonEss:
uNiT:
9`1627
flEG.NO.:
uxir:
PEflMITTEE: JUPERIOR HEAiING F, AIR {7i�)546-2821
nooxess:. q ��p CiiINO AV C
CHINO CA 91710
LICENSEO CONTBACTOB'OECIANATION: I �ere�y aifiim that I am Iicensc0 untler provision5 ot Chapter 9(commencing wi�h Sec�ion
7000� ol �ivision 3 0� Ihe Business and Pm�essions Cotle, an0 my license is in fult lorce antl ei�ec�.
ciTr uc.: ., � 7 y�7 STATE LIC.: �fj g p �� cuss: F_ � Q �
� 0�''��.�(�Q.k2
Daie: L LIT � � Sgna�ure'.
WOBREHS' COMPENSPTION UECNBATION: I herehy aifirm Iha� I have a ceriilicate oi consent �o sell�insure or a certilicate o� Workers'
CompenSalion Insurance, or a cenilied copY �hereo� (Sec�ion 3804 Lab. C).
. ^oucvxo.: 1�00963?A exv.oaTe: 10/70/91
"OMPRNY: ANIERI.C'A.�`I �TP.TnS
�] Ceni�ietl copy is hereby Wmished �,Certified cop is bletl wi�M1 �he city Builtling Divisian.
`-L � �o��—�r�..e2 �
oate � C � ApDliCanf.
EXEMPTION FNOM WOflREflS' COMPENSATION UECUflATION: (Thi55¢dion n¢e0 not b¢ comple�e0 i� Ih¢ permrt i5 for on¢ hundred ($100) ar less�.
I certify Iha� in Ihe performance ol the wark lor which �his permi� is issuetl. I shall not employ any person in any manner so as to become
su0ieci �o the Workers Compensation Laws of Calibmia.
Oaie: SignaWre: '
NOTICE: II. a�ter making this tleclaraiion, you 5�ou10 become sublec� to �he Workers' Compensation D�ovisions of lhe Labor
Cotle, you musl foMwilh comply wilh such Omvisions or �his permit shall be Ueemed revoked.
CONSTPUCTION LENDING FGENCY: I hereby aifirm ihat there is a constmction lending agency for ihe pedormance of Ihe work for
w�ich Ihis permit is i=sue0 (Section 3097. Civ. C�.
LENOEN:
nooxEss:
OwNEP BI11lOEP OECIABR7ION: I hereby aftirm ihat I am exempt imm the Contracrors' State license Law for the following reason
(Sedion 7Q31.5 Business ana Pmtessional CoOe: Any ciry ol counly which BQuires a permil lo cons�mct, alter, lmpmve, tlemolish, or
repair any slmcNre. Dnor Io iIs issuance. alsa requires Ihe apphcan� for such permi� Io file a signea sia�emen� Ihai he/she is litensetl
pursuanl b �he pmvisions o� Ihe Conirac�ors' Staie License Law �ChaD�er 9(commencing with Seclion 7000) ol �ivision 3 0l t�e Busineu
antl Pmiessions Cotle) or �hat �e/she is e�empt Iherelmm and Ihe basis lor the allegeA exemp�ion. Any violalion of Section 7031 5 by
any apDlicam �or a Oefmi� Subjetis t�e apPlicani to a tivil penalry o� noi mOre fhan live hUntlr¢d tlollars (5500).
I, as owner ol ihe property or my employees with wages as iheir sole comDensation, will do the work. an0 ihe
_ � stmcmre is not imen0e4 or oilere0 br sale (Section 70a4. Business antl Pwfessional Code: ihe Coniracrors' State License Law
Ooes not appry �o an owner ol a Dmpehy who butltls ar impmves Ihereon, ana wha does such wo�k himsell/hersel� or Ihmugh �
his or her own emplayees, pmvided �hal such impmvemenis are not in�endetl or oflereA �or sa�e. II, however �he �uiltling or
impmvemen� is soltl within one year of completion, Ihe awner will have �he burtlen o� pmving helshe Oi0 not builtl or impmve
lor ihe purpose ol sale�. �
I, as owner o� ihe pmpehy, am exclusively conUac�ing with licensed conirac�ors lo wnstmq [he pmlec� �Section 70d4, Business
❑ ane Professians Coae: Tne Conlractors' State License Law tloes nol appty ro an owner o� property who builds or im0�oves �he�eon
I antl who conlracls �ar such pmjects wi�h a coniracloqs) hcense pursuant�o �he ConVactors' S�a�e LicenSe Law�.l am awa�e
t�al pmol ol IAei� Worker's Compensation insu�ance shoultl be O�ovi�ed to me.
� I am exem0� untler Seciion: B. 8 P. C.
lor ihis reason:
�ate: Ownec
I do Aereby cenily I�a� I am aware o� an0 untlerslantl Ihe requirements o� Califomia Health and Saleiy Catle Sections 25505, 25533, anA
25534 antl thai I or any Imure ouiltlmg occupan� willlwill nm (circle one) neea �o comply with said s�a�e codes and the requiremen�s for a
permil lor constmction o� modification fmm Ihe Air Oualily Managemeni �isUici. Fe5i0en�ial cons�mction applicaiions are exempi imm
�hese provisians.
�a�e. Appl¢anP.
I �ereby cerlity ihal I �ave reaU Ihis aDO�icalion ane stale �hal the above mlormation is correcL 1 agree Io comply wilh all cily and coun�y
ortlmances antl slalelawsrela�ingio butlding �nsimc�ion and hereby authorizereD�esenlalives of�his ciiyto en�erupon�he a6ove-menlionetl
pmperly �or inspetlion purpo5e5. (� ��("� � /
Oate: L� ` Signamre: �', �A =�-���-
Orrver's L¢ense or Saial Searity N:
1641-t6 Wh��e—Builtling�, Green—Cotle Enlorcemenl: Canary—Applican�; Pink—Revenue'. Goltlenro�—Assessor
CITY UF COSTA NESA - BUILUING PER,UST FEkM NO; v US1.55';
PF.RMIT NO: M U51557 PLAN CHECK NO: N GOVT; ti S�JPP: N,
CONST:tiJCTION TYPc: 5-N PERN,IT TYPE: MiC Pt7�PO�E: UTk
JOB UESCRIPTION ; C/O FAU 6 P.AD CGNDENSOR (3.5 TOi�S) SL r'T;
CLAIM VALuE: CAT.�C-i1ALUE: GRQiTP OCC; r�-3 .�
COMMENTS:•NO BLDG. P�RMIT INVOLVEI)/MECH. "v70�F; ONLY
R 1i� 16 % k if i: ii� if } IE K ih ii Y!E k �C�lf %� %� ?i if li ii� ie 3 ft 3F %1f if� fF 3f Y.-iF iE iF i( 3i� ic 3E iE +c-lf %� i!-?F ## ff # fc iFlf ii� i� V ie':.� fE iF {:. %ik �.1? # a; if� i!� )E i(� ii•+ k Y.�?c K!:�
'L O N I N G R E Q J I� �. N: E N T' S
sE�aAcxs
MAIN BUILDING ---------- ---------- ACCESSORY BUILDING --- ------
eRNT: FT IN REAR; rT IN rANT; =T T_Cd RnAR; =T LN
LErT: FT IN RGiiT: FT iN iEFT: FT IN RGHT; F'i IN
PARKING c"iEL�: PROV: PARCE'L; 14154127 ZNc: REF NO;
ALANhING NC5TE5>
>
iC ie IE iE ii� 3F iE %� �F 3F 1F �F i!� �YE if # iE �(� 1P!(� ip #F ?f Y� !i� 1F?i i!� «; 3F �)c #61E 9F #� iQ YFlf iF IF�1F 3f� iE # 14 iF Y� � if ii•�K• 14 #!C� �• 1!� I4 }; {F iE 1E+F �!'r if 1!� 1f �F'A� iF iF k� �}f� }; K� Y:� 3c M� �l'r M
D? V E L O P M E � T S e. R V I C E S R E Q U T R E N, � � i S
20NZNG APPROVED HY ' DATB:
3UILDTNG APPROVED HY ; DATE;
APPLICATION lSSiJED BY; � DATE; � 1
%�)hlEiflfk�icl:ifiFlEii-IF1Fii#IfiFlF3E3(•IfIFR�i—Fi . . . . x . . . . . . ; ;ielE};iFi(iEli•If#Ei�`�7��*��'��.�.}�.�.� .3Ff±M�
iE 3E �Y k ie K� iF YiE k�?e fF iF 3h 3F k Y.� �E Y� iF �? iE le if� 3E i(� Y:- ff if # 3h �1!-�K 1E 1'r �f u k a> iE 1e 3E 3f 3F ?F ?E if �E ��Y�iF !h �lE If 1!� iF #f ib.y; ie iF 3c i4 # iF 1F i4 �!: �E #� %� iF # iE 1F �k �E ie ii
L�.GAI�IZATIOt�d; N c E E S U M� P, R Y STRUCTURAL Se,GA!ENi : N
BLUG PMT PLIJMHZNG ELECiRIC MECHANIC =IRE SM].F�/RzS GRADING
F�ERN,IT 18 , DO
25& SMIPINpN-R_S
PLAN
I,SSiJE cEE
PUILDING-DZV-> PERNIT ISSUE PLAN-CHcCK
TOTAi,S----> 18.00 15.00 0.00
REVENUE DIVSSION 30TALS--> CGLLECTaU;
BLDG FMT PLUM,BING ELECTR�C MECiiANIC
33,00
15,00
TdTAL PA±D DU�:
33.00 3J,00 ,OQ
33.00 OVER/SHORT; ,00
FIP.E SN,iP/TOT GRADIiVG Pi.AN-CHECFC
# 3F �Y.�±f iF Y.� N� i��,V.� !F �3f 3E �ik s_ N� # K� 3f ii� i? if �E 3h it iF iE 3£ 3E iE 1f #�R if # 3F ii if #?F 1f� 3e #'• 3F �3i� i4 3t� �(�?F?f x.;p !f� 3f ?E if�'ll- # if fe ?F # M� �k 1i� r' iF }�. }'r iF Y� M� �1f� 1E � 1F 1F �f�;E #
I Iv D I i7 I D U A L. F �. 3 B R c A K D O W N
TYPE QiY D E S C R I P T T O'N JNIT COST ;OTAL COST
MEC 1 INST FORC-AiR/Gc-tAV ci7RN := 100 K i3TU 9,00 9,00
MEC ]. RncRIGcRAT10N SYST�M <= lOd Y, bTJ/H 5.00 5,00
END QF r E�:S
r.
V
D1 DODs41�5-OQOS4136 T��3 ",��CC�
OATE: C4i�4;91 TiMf� 2?.:50
CONSTRUCTION AND PI.ANNING� F .& SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
i. Temporery Electriwl Service or Pole � 52. Pool & Equipment location
2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement .
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footin9s 58. Electrical Condui[-Undrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test �.
9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P�Trap, � Undrgrnd. �
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & Hause Connection 62. Backwash & Receptor-Final
12. Sewer Cap , 63. Heater & Vent-final �
13. Roof Drains 64. Plumbing System � Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
76. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING -- <
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT '
20. Rough Factory Fireplace � APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oi1
23. Gas Pipe�Rough & Test � 72. Underground Flush -
24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil ��
25. Roof Sheathing 74, Overhead Hydro
26. T�Bar Ceiling IStructural) & Monocoat � 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
2S. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 76., 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: p 9/ B!L, dJ N u
34. Final Heating & 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 pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations _
47. FINALSTRUCTURE & 6UILD4NG
48. FINAL PLANNING ,
49. Electric flelease to Edison �
50. Gas Release to Southern California Gas Co , ,
51. CERTIFICATE OP OCCUPANCY
No. Date
� � issss �E� R�CE,IU�D
. COSTA MESA BUILDING•SAFETY DEPARTMENy/�'1FlR 7 1962 �t 100 - Tract Lt260
P. O. BOX S77 C08TA MEBA. CALIPORNIA �� FINAP�fCE DEPT. Plan 1��o-n
For A lieanf fo Fill In Com lefel TY Of COSTA MESA
PP P Y APPLICATION FOR PERMIT
TYpE OR PRINT
COSTA MESA CALIFORNIA
OWNER i�?esa Del hlar Development C
h'^'� 3800 �.Coast Highway
aooREss
Olsten
Ca'].7� �, APPROVED
ADDRE6S 3�� E. Coast HighVra,y
c�n Corona Del Niar,Calif.
�;�TNo. 988o8-S�-1 No: oR 3-4220
SIZE i_.._ __ I NO. OF HLAGB
3LDG N� TL
�e PROM !L(%� REAR YARI
9Tx¢¢T
� I��r 6'6" � R���T 5�
DESCRIPTION OF WORK
I x II _____.__.. I II .__.__
TO BE PERFORMED
� w/attached garaoe
BU{LD{NG
For Office Use Only
RECEIM NO. I PERMIT N
BT
COSTA MESA CALIFORNIA
ZONING
ZONE NO. OF UBE OP NEW r�'t' �
�—r I PLANe L I HUILDINa WI��
�°"'- L>� /o0 7"R H z 6 0
DEBCPIPTION
A. P. NO. ��
YARDS EVES
APPROVED
�eermn urve er.�
��-O' FRONT �d
R.SIDE �
L. SIDE �
REAR Z V
'. APPROVED ���n
_ RY
Livin� area
�
�
/O iN.
�erc 2'�i/�6L
S
I XEREBY ALKNOWLEDO! YXAT 1 HAVE R¢AU iH18 MPLIGTION }HE AMOUNT BXOWN UNDER VALUATION 16 FOR THe
AN� 9TATE THAT THE AHO�'Q IB CORPECT AND AGREE TO COM- pUP]09E OF E9TABL18HINp • PERMIT FFE ONLY.
PLY WITH ALL QTY OMINFNCEe AND 9TATE LAWB R8611LATING
Bu1LDIN0 CONBiRUCT10N. VALUAiION l-
BIGNATURE OF,��, � � ��y r ?*P� m , C PERMIT FEE $�P��
PERMITTE / �
gy � $ 18 467 �0� PLAN CHECK $ (�. / A
�.. /�.,_,...�4 �
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