HomeMy WebLinkAbout1073 SALVADOR ST - Building Permits u ' Mac CITY OF COSTA MESA --• w
4 9 BUILDING DIVISION
•,,,,.,f� ,,. i DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER
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F t ��`� I PERMIT
� B07-00621
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` a 644
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(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BIHLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1073 SALVADOR ST Status: ISSUED
Suite: Applied: 05/08/2007
Vicinity: HOUSE AND GARAGE ROOF Issued: 05/08/2007
Primary Occ: R3U1 Type of Construction: V-N
Parcel Number 14162511 Zoning:
Applicant: LA RUE, CHERYL
Address: 113 SOUTH MINNIE ST
Phone: 714-731-3425 ISSUED BY:
SANTA ANA,CA Zip: 92701
Owner: KERSCH, ADA L TR
Address 1073 SALVADOR ST
Phone:
COSTA MESA,CA Zip: 92626
•
Contractor: WEATHERLINE ROOFING INC
Address: 113 S MINNIE ST
Phone: 714-731-3425
SANTA ANA,CA
Zip: 92701 License: 729560
Arch : Eng:
Address: Address:
•
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF(E)ROOF MATERIAL,INSTALL NEW 7/16"OSB SHEATHING, 1 LAYER OF 30#FELT ON A 5:12 PITCHED ROOF AND REROOF WITH
40 YEAR ELK COMP SHINGLES ON AN ATTACHED HOUSE AND GARAGE,APPROX 32 SQUARES.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $8,000.00
Permit: $153.25 Claim Valuation: $8,000.00
SMIP Res: $0.80
SMIP Corn: $0.00
Other: $0.00 -
Inspection: $0.00
Total: $154.05
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0.0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0.0
PARKING Existing: 0 , Required: 0 Proposed: 0
•
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 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.
FOR INSPECTIONS CALL: (714)754-5626
244646(6/001
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O 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.
Phave'andwill 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 Insur nce carder and policy number are: ppCCQ^�
Carrie .� �'�' E t't11 Policy Number: l�Q5—c2J I.7 —x06
(This section need not be completed it the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these p ovisions. �� On
Signatu e:- . D A Date:
`WARNING:FAILURE TO SECURE WO •COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES uP TO ONE HUNDRED
THOUSAND OOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3m8 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am license. .e .r.visions of Chapter 9(commencing with Section 7000)of Division 3 ofthe and Prolusions Code,and my license is in full
Lforce,and.effect..Lic..a i z r Class.bt_ Ci
Con r�Slgnature: _ ' CFu D. Dater _ . .Ig/0 7
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
' Lenders Name: Lenders 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 property 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 of 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.).
O I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes 0 No Drivers License No. Expires: I
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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 Code 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 California 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 application aEermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LI No
(Section 65850.2 of the California Government Code requires that the requested information 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? ❑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? 0 Yes ❑No
—_ r. __......__._ _...
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,and authorize representatives of the City of Costa Mesa to enter upon the
above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
i.natl • Legal Owner(s) Date
I p --. .r1J fl 07
I ,,And/.rAuthorized Applicant
CODE/ INSPECTION TYPE PdIE MAW CODEC INSPECTION TYPE PATE JNTRIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Finalt}� / 208 Final Plumbing
200 Final Re-Roof 343/ 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
P11etJF,CT ADDRESS: 1073 SALVADOR ST • UPUT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 068553
DWNF.:n NAME: KERSCH ADA L
ADDRESS: 1073 SALVADOR ST PERMIT NO: B 068553 PLAN CHECK NO: N GOVT: N SUPP : N
b COSTA MESA,CA 92626
714 ) 754-7665 CONSTRUCTION TYPE: V PERMIT TYPE: STR PURPOSE: OTH
ARCHIENGINEER: REG.NO.: JOB DESCRIPTION : INSTALL 2 SKYLIGHTS 15SF , ICBO NER216 SQ FT: 3, 000
ADDRESS: UNIT:
PEflmITTEE: JIM BECKER CONSTRUCTION ( 714 ) 650-5402 CLAIM VALUE: 3, 000 , 00 CALC—VALUE: 3, 000 . 00 GROUP OCC: B-2 /
ADDRESS: 1956 ANAHEIM AV COMMENTS: INSTALL 2 SKYLIGHTS WINDOWS 6 MINOR REPAIR
COSTA MESA CA 92667 +eek****Ek**Er**EF***+Eyr********* ** *x-x-***EE*iriF+E***************************EE******EE**
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING R EQU I R EMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACK S
C lc.:Sr� - Signature: L_
05016$, STATELIC.: 506 y CLASS: EXP : 02/95
_ _ _-- MAIN BUILDING ACCESSORY BUILDING
MS'COMPENSATION DECLARATION: thereby of that Ihave acennlcate of consent to self-insure oracenificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
t •Compensation Insurance.or a certified copy thereof(S ion 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
-N POLICY NO.: 1030399-94 ENP.DATE: 07/01/95
omeaxr: STATE FUND PARKING REQ• PROV: PARCEL : 14162511 ZNE: REF NO:
.• Med copy is hereby furnished. a Certified copy( filed with the cit Building Buuiilding Division. PLANNING NOTES>
rsate: s - r o, Applicant: if^ *******************************************************************************
'PTION FROM WORKERS'COM' NSATION DECLARATION: 1s section need not be completed if the perms is lot one hundred(S1 ))or less). D EV EL OP MEN T SERV I C E & REQUIREMENTS
I certify that in the performance of the work for which this it is issued,I shall not employ any person in any manner so as to become .
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY... . O DATE: •
Dale: Signature:
NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor B I LD I NG APPROVED BY : tere• DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for LI CAT I ON ISSUED BY: e:\[********
L� *��� DATE: ��I��
which this permit is issued(Section 3097.Civ.CI• **********************************###MMMFFFlllEEE 3F********* ********• *iE
LENDER: ************************************************ / * *******************
ADDRESS: EGALIZATION: N F E E SUMMARY UCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC F P/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or ERM I T 54 . 00 5 0
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM I P/NON—RES
and Professidns Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by R LAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). . SSUE FEE `
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the ' BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 54 . 50 0 . 00 0 . 00 54 . 50 54 . 50 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale.If.however the building or
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE D IVIS ION TOTALS--> COLLECTED : 54 . 50 OVER/SHORT : . 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
irI.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 54 .00 . 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware **********************************************************.*********************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.&P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Dale: Owner SFR 3000 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 3, 000 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant wit/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant: Z-
I hereby cerldy that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and slide laws relating to building construction ereby authorize rept -es of this city to enter upon the above-mentioned 01 00166283-00166284 TOT
property//�� for inspection purpfo fs. DATE: 08/19/94 TIME: 09:52 54.50
,AP1 ell -7 Cf Signature: `v
is License or Social Security a:
1641-46 Whne—Building;Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
cUNSTRUCTION AND PLANNING
� PC . SPA
Date Inspector APPROVALS Permit# Date Inspector
APPROVALS Permit#
1. Temporary Electrical Service ar Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Ondrgrnd, I 54. Forms
4: Electrical Concluit-Undrgrnd. 55. Electrical Bonding
5' Steel Reinforcement. 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. - 57. APPROVAL TO COVER•GUNITE
7. Fdotings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water P'pe-Undrgrnd, 60. Backwash Lines, P-Trap, 0 Undrgrnd.
I
10. Structural Floor,Sys[em 61. APPROVAL TO DECK
11. Property Sewer Line,& House 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
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring'Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning `� 1 FIRE T- REQUIREMENT
na
20. Rough Factory Fireplace . , - _ - APPRO. VAbS-: . -Permit# --
21. Ducts, in Strunture ' +
]0. Undergrougd.Hyc;ro
22. Ducts, Ventilating ' ' ' y - /1. Productyiiiirhg OGQs 0Od
23. Gas Pipe-dough &•Testt 72. Undergroued Flush; „
24. Roof Framing' - 73. Undergrnd.Storage Tank O Gas 0 Oil
25. Roof Sheathing74. -Overhead Hydro `
26- T-Bar Ceiling (Structural) & Monocoat p 76. .Dry Chemical • •
27. Frame and Flashing f vr.1K -6e.4.1,/. 76. bry Standpipe , -t
8. Lashing& Siding 77. FOXED SYSTEM FINAL
29. Insulation - 7137- IRE PREY. FINAL _
30. Drywall Nailirq g-SC61'iI Wit' HEALTH DEPT. REQUIREMENT
31. Plaster Brown,Coat79. FINAL INSPECTION •• ' I
I
32. Electrical,Power Meter-Final i• 80. FOOD CERTIFICATE ISSUED
33. Final Electric , I, I . Note$:
34. Final Heating Air Conditioning - i -
35. Final-Gas PipelTest "'
36. Hood or Canopy -, - ' . • I Ir - .1
37. Final yactory Fireplace' ' •
38. Final Plumbing • •• I I _ ,
39. Water Service-Final i - ;
40. Gas Service-Final �. ' - •
.�--
41. Solar Domestic-Final - ! "/,
42, Backflow Preventer i ^
I, \
43. Backflow Irrigation ' rr)
-
s`
44. Landscape Irnpation System 'it -
- ?.
45. Sound Attenuation - • - -
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING /1,,.27 pct-& ,L/
i.
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date i.
WU
' r - _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. •_
. ' CI_ T COSTA MESAS� CONASTRUCTION PERMIT i PERMIT NO. TRACT O. LOT NO. - UNIT NO. �d• _
• Proiect'A♦dress} 'pyo/.-i, .lJ/1/.L�/� /P"� slT (/�- !/Q(] �' I�j y �I'r4)'�/Jf, .'H • t,
A4p S°Marnng gddr¢ss S/9/�l -C TYPE OF CONSTRUCTION •fIJVNEW LIO ADD -ALTERATION RIiTION LJ REPAIR ,
rid,
// � �i ❑'CONVERSION ❑ DEMOLISH E OTHi /� • 111
Owger's Name /1c & �t/2S�fi� - Phone L1.-5,--,,a..3--
7 2 C �e� M - apt_ A.P.#MI —COGS— II Zone R /
DESCRIPTION OF�WO. USE eF BLDG. I
Address /,' 7 3 S"j' G L//J-L�e', -e /0/J T 't,�. A..) G/.IS , G' , S Main Building: '' Accessory Building: • Z
Arch/Eng. License No. - TYPE OF PER IT a GRADING •jFOUNDATION U STRUCTURAL T Front/�7f9�,/ "CI - - 0
Address — ❑ TENANT 1+ ELECTRICAL PLUMBING Ilii MECHANICAL A Rear /0e.G ', N
n,, /J / ❑ OTHER . _
Contractor's li ig) / �'y /�✓/i/ lief Phonr� �ys�
7--, PROJECT DESCRIPTION SQ. FT. /2-;e.2 OCCUPANCY�- �'3 K Rightq/ G
Address(mailing) �� • C O; e ^' CONSTRUCTION TYPE - �- . VALUATION$ /S ZOO S• Left J' I' R
City License No. _ ,. Oc ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: • Planning Notes: 2 3�j •� ,� crac: 1�P�./LPa�; M
with section 7000) of Division 3 of the Businesi and Professions Code, and -PC.
�`my license is infull force ay�M efferct. ..•t PC` 299-
!�-�_ �Q C� C' S
License Classk''' t• / License N �—K # T v J V •
,
Date 3-2%-531—Signature/9-- q# T/—tee PLUMBING ' FEES
WORKERS'COMPENSATION DECLARATION Bar Sink Showers 2 D�
. hereby affirm that'I have a certificate of consent to self-insure or a certificate ELECTRICAL ! I FEES
f Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. CJJ _ _ Backflow Preventer Service Sink • _ _ • Automatic Washer . . Transformer ❑ 15-50 KW - .
Policy No. /t-97026 Company 7t✓ELr S Backflow Irrigation Sewer Cz - . cs 0 50 t KW"..
9 P Construction Pole Sub. ;4
❑ OErtlf ted copy is hereby-furnished.- - _ - _ . '
Certylietl c,>(py is filed with the at Wipe Divisi�p Bathtubs Sewer Connection - Cooking Unit Meter ❑up to 100 amps:-
•Date S'2• Y- ��-APplic �/J7"'��] _ _
Clarifiers Solar Collectors Dishwasher Meter Dover 100 am s I
EXEMPTION FROM WORKERS'COMPENSATION DELL ATIOP
(This section need•not be completed if the permit is for one hundred ($100) or _ - - - _
less). Dishwasher Solar Piping • 'Dryers ❑Gas ❑Electric Sub Panel 7
I certify that in the performance of the work for which this permit is issued, I r
shall-not employ any person in any manner so as to become subject to the ' Drinking Fountains Solar Tank -Fan Motors❑0.1 HP ❑i%''.?8 -
Workers' Compensation Laws of California. - - s
. Date Signature _ _ - - Floor Drains Swimming Pool w/Spa • - F.A.U.'NOTICE: If,after' Making this declaration,you should become subject to the f Inc.IncSOlar ❑9-15 HP❑16-15+:
Workers' Compensation provisions of the Labor-Code, you must forthwith Floor Sinks Urinal , O !/n
comply with such provisions or this permit shall be deemed revoked.• - - - - •
2, Fixtures _ - - Microwave STT/
CONSTRUCTION LENDING AGENCY Gas Service- Outlets / ; Water Closet - . ' o •Device Boxes
'1 hereby affirm that there is'a construction lending agency for the performance / % "POIe Light A
of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors ' - Water Heater ,. 4' Outlets ,Range •y i' - l 20
Lender's Namer ,
Lender's Address /00A/E.- Kitchen Sink ' Water Service �I Switches Sign l,'? '.-4 Q
OWNER BUILDER DECLARATION - - - _
I hereby affirm that I am exempt from the Contractor's License Law for the / Lavatories Auto-Wash oo . Garbage Dis oral
' following reason (Section 7031.5 Business and Professional Code: Any city or • - - 2 9 P •
;Standing Sections ••("�
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap -
any structure, prior to its Issuance, also requires the applicant for such permit Laundry Trays Generator ❑0.5 KW❑5-15 KW Trash Compactor •
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains •
the Contractor's License Law(Chapter 9(commencing withiSection 7000)of ' •
')ivision 3 of the Business and Professions,Code) or that he/she is exempt - ,
herefrom and the basis for the alleged exemption. Any violation of Section
•
' /031.5 by any applicant for a permit.subjects•the applicant to a civil - • ' '
malty of not more than five hundred dollars($500). - • .. •
'
. U 1,-as owner of the property or my employees with,wages as their sole Reinspection Fee I $15 Issue Fee $ 3 , _
compensation;will do the work, and the structure Is not intended or,offered Reinspection Fee $15 Issue Fee • $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's • MECHANICAL , FEES
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such•work himself/herself or through his or her own Boiler - Hood or Type I 0 DEVELOPMENT SER ICE REQUIR ENTS: •
employees, provided that such Improvements are not intended or offered for yp ZoningApproved By �^s
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 pP r - • Date -a41-
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground- - Building Approved By. • ' Date
prove for the purpose of sale): �4.J
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System - ,Application Issued By'• Dat: �/
tractors to construct the.project (Section 7044, Business and Professions Code: - _
The Contractor's License Law does not apply to an owner of property who / Duct-Ventilating • 0o-100,000 BTU 0100,000 BTU 2 • . ' 511���yyy111MARY OF FEES
builds or improves thereon, and who contracts for such projects with a con- . 7��'�. / O�
tractors) license pursuant to'the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 •
System Repair/Alteration BUILDING PERMIT $ / SMIP $ `.
proof of their Worker's Compensation insurance should be provided to me. • _ • - ,PLAN CHECK .$• 7S.7Z. PERMIT
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIL ICBG# Fire Dampers • �
PLUMBING - ;$ • 00•- ISSUANCE '$ '
Date • Owner Heating System& Ducting / Registers / 00 PLAN CHECK 25% $ /" s ENERGY P.C. $ -
I hereby certify that I have read'this application and state that the above ❑0-100,000 BTU 0100.000 an. -, _ r ELECTRICAL�- $ �.et-0 GRADING, $ '• '
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building c struction, and hereby authorize repre- • I 20 MICROFILM $ -
•sentatives of this ty to enter 1cDL-Nle abovp,entioned property for PLAN CHECK 50% $
inspection pu -• es - MECHANICAL $ 6. 00 TOTAL FEE $ 2/'7./3
Signature �� / Date 7-2-2-Sv. .. i
� •
•
\ Drivers' License or SS# ' Reinspection Fee ( $15 Issue•Pee . $ 3 PLAN CHECK 25% $ t'• 7S .
CMP 0865-46,rev.10/84- White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor - ' ' - - • '
. /I
1. I
'•eQNSTRUCTION AND PLANNING POt,L & SPA - ,I
• Date Inspector Date Inspector
ROVALS Permit# APPROVALS Permit # lil
i. I
1� emporary Electrical Service or Pole 52. Pool:&Equipment Location •
.
2. i( Pipe-Undrgrnd. •,`7,1/'7/Jf Og0 53. Steel Reinforcement II
• 3. lectrical Conduit Utility-Undrgrnd. • '54. Forms II
' 4. Electrical Conduit-Undrgrnd. '
.,1t.b " L _ 55. Electrical Bonding
5. Steel Reinforcement • 56. Rough Plumbing & Pressure Test /
, - 6. Electrical UF ER Grnd. - lin Js •- �C 57. APPROVAL TO COVER-GUNITE
7. Footings /• 58. Electrical Conduit-Undrgrnd. . II
8. Foundation S(P& ) 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd:' 60. Backwash Lines, P-Trap, 0 Undrgrnd. i .
10:- Structural Floor System - 61. APPROVAL TO DECK it -
11. Property Sewer Line &'House Connection -6/0- V00 62. Backwash & Receptor-Final I
1-2. Sewer Cap 63. Heater & Vent-Final II
13. Roof Drains • 64. Plumbing System - Final - �I
14. Rough Plumbing- 6/.7/jc (,W 65. Electrical-Final •
. 15. Rough Electrical-Conduit 66. Solar System-Final
16, Rough Electric Wiring • 451'11 e C 67. Fencing & Access Approval
i
'17. Rough'Wiring Sign 68. APPROVED FOR PLASTERING 1
18. RoughElectrical-T Bar Ceiling'. 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning aVer ail FIRE DEPT. REQUIREMENT
20. Rough'.Factory Fireplace • APPROVALS Permit# -
21. Ducts,,in Structure , 70. Underground Hydro !I
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil - '
23. Gas Pipe-Rough &;Test 72. Underground Flush -• ,
24. ,Roof Framing Ø,,/S;1///E�` 73Utlergrnd.Storage Tank 0 Gas ❑Oil
25: Roof Sheathing 1 6/ 74. Overhead Hydro i
26. T-Bar,Ceiling (Structural) & Monocoat 75. Dry Chemical 1 -
27!, Frame and Flashing b like vL 76. Dry Standpipe .
28. Lathing'
,&Siding11
7 ,f/�fp t� 77. FIXED SYSTEM FINAL
29. Insulation fn 78. FIRE PREV. FINAL
30. Drywall Nailing ,-• 7/S/K' �C/ HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat ;
' PROJECT ADDRESS: 1073 SALVADOR ST IT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 070052
,,..OWNNE1'S NAME: KERSCH, ADA L
AODflEs5: 1073 SALVADOR ST ' PERMIT NO; B 070052 PLAN CHECK NO: N GOVT; N SUPP ; N
COSTA MESA,CA 92626
CONSTRUCTION TYPE; 5—N PERMIT TYPE: SIR PURPOSE: ALT
•
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION ; T/OFF S REROOF W/FIREFREE SHAKE 3 . 5PSF SQ FT: 5, 000
ADDRESS: UNIT:
CLAIM VALUE: 5, 000 , 00 CALC—VALUE; 5, 000 . 00 GROUP OCC: R-3 /M-1
PERMITTEE: ISLAND PACIFIC ROOFING ( 714 ) 444-7683
ADDRESS: 32923 S. PULLMAN AV B COMMENTS : DETECTORS IN BEDROOMS & HALLWAYS
S .A. CA 92708 ************************************** *****4E****a< 1F*+.***+r******.e***************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACK S
CIT . 057709 STATELI .: 631472 , CLASS: C-39 EXP : 10/95
4. Signal e: — ,My, MAIN1�BUI�L}D IPTG N Rj�]'j' A7C'CESSjO[RjYp BUILDppNG FT j�]
'CD ENSATIN DEC RATION: I hereby. rm that I have a certificate of consent to self-insure or a certificate of Workers' FRNTi
LEFT: F1 N i7 i T IN EFTS FT IN R •HTi FT IN
.mpensation Insurance.or a certified copy thereof(Section 3800.Lab.C).
POLICY NO.: EXP.DATE: PARKING REQ: PROV: PARCEL: 14162511 ZNE: REF NO:
COMPANY: PLANNING NTES>
D Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. >
*******************************************************************************
Date: Applicant: DEVELOPMENT SERV ICES REQU IREMENTS
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (this section need not be completed if the permit is for one hundred($100)or less).
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become
subject to the V orkers' ompensabon Laws of California., n ZONING APPROVED BY DATE:
(/TIC :If.a.- ma ng this declaration.y. d become subject to the Workers'Compensation provisions of the Labor BU I LD Z NG APPROVED BY DATE;
ode.you must forthwith comply with such provisions or this permit shall be deemed revoked. �+
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: DATE:
which this permit is issued(Section 3097.Civ.C). ********************************** * ********************************- **i.* **a•
I LENDER: ********************************************************************** ********
ADDRESS: LEGALIZATION;N F E E S U M M A Y STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHAI IC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 72 , 00 . 50 '
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN •
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by S SUE FEE '
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).
'BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
I. as owner of the property or my employees with wages as their sole compensation, win do the work, and the —
structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS—— —> 7 2 , r 0 0 , 0 0 0 , 0 0 7 2 , 5 0 7 2,. 5 O . 0 0
❑
does not apply to an owner of a property who builds or improves thereon.and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 72 . 50 OVER/S"HORT : . 00
Improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
mr the purpose of sale). 72 . 00 50
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
❑ and Professions Code; The Contractors'state License Law does not apply to an owner of property who builds or improves thereon *******************************************************************************
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me. IND I V IDUAL F E E BREAKDOWN •
❑ I am exempt under Section: B.8 P.C. ,
for this reason: tY E. FT'? ti E W 0 R I ? T I 0 N UNIT COST TOTAL COST
Date: Owner: — SFR 5000 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 5, 000 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES '
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions.
•
Date: Applicant: • /
I hereby certify that I have read this application and state that the above information is correct.I agree l0 comply with all city and county
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
propert for inslection pu .oses.
ill 00172351-001723; , rr_rr 72.50
0 L _ i 14� UATE C 11/2s/ MEI 14:17
It641-46 White—Building;Green—Code Enforcement;Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
-S.
PO. A SPA
{ CONSTRUCTION AND PLANNING '
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation - . ' 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd, 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House/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
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT
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 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29, Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79, FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33, Final Electric Notes:
34. Final Heating & Air Conditioning 9/9/?s_ _mica srl�PT�L r - b,
35. Final Gas Pipe-Test /'ln,f /*�r/ C
36. Hood or Canopy
37. Final Factory Fireplace _1
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer //-2.
/ -Z O-ep/7 - ecedy43. Backflow Irrigation _
01
44. Landscape Irrigation System •.l2-_ /_1y11 ` 674- 4 k@ p��
45. Sound Attenuation l 1._ -0Tel
- � "L.0
46. Handicap Regulations
C �m J-.z ca..� 'K_j���
47. FINAL STRUCTURE& BUI LDING R. pA� 6 f2_/Y-4�-- a... . O 5 cnsose
46. FINAL PLANNING ! /tK-
49. Electric Release to Edison `LWT
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
(1/1'71 ;' �' '56 12/07/78 4.32 TL
COS1tA MESA BUILDING-SAFETY DEPARTMENT
0.0.BOX 1200 COSTA MESA,CALIFORNIA 92626 ;
A" 1 f ATI NN FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely —Use Ink Only
RE• D / DATE RECEIVED O• E ISS ED -
BUILDING ADDRESS /0 S . L ► a. r` - - - �f
/►� 'ERM! NO.
OWNER CARL lesn,H A.P. NO.r�/.^J moo.
MAIL ADIDRIE S/,L/ F 3S /vQf�e� c/`� .
' ADDRESS I o73 SAL-VA-7MJZ ST- / /� //�� •
CITY COSTA 44rS, TENOI.x/40/(p TRACT502I LOT1� BLOCK
CONSTRUCTION ,t/� NEW APD ALTER f REPAIR MOVING�••TTr1FMOLISH
LENDER A/{/
BRANCH
OWNE pppp C
Ir
ADDRESS NA49 ALUE
'
ARCHITECT TEL.., _„/_, - - •�" �./ f/O s/
OR ENGINEER ' ' • I . -. N• -coo r
7341. FIRE
ADDRESSQ/ LCJ/4Siiii f SI-VD/ ZONE VP /
', GROUP...VAPPROVED �//7
CONTRACTOR - BY C DATE /27 i
ADDRESS
TEL. ZONEII INO.OF i/ USE OF NEW .Iy^'
CITY NO. PLANS V BUILDING /2`/ J• f
F STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC.NO. MAIN BUILDING ACC ESSOR VRV BUIL
CU SIZE ( 1 jNO.OF BLDGS. (FROM aC/ STREET)
M OF LOT 'J3 K IQZ 'NOW ON LOT I FRONT .YfV/tli
Q USE OF •
.N,, EXISTING BLDG. R.1.517,>£'UGC. B.SIDE I F
Vvjetia
•
Separate permits are required for L.sIDE/'�
O electric,plumbing and heating work. REAR r.rJam' FT.
1�., USE OF BUILDI�UG AND W RK TO BE�PrERFQR�MFaD 1- DISTANC BET. BEll MAIN&
Aft 2.42- JA y'{ I _ p[�(H�a te.o'y �To MAIN BL . ACS.BLOCS.
U 319 fi 2' .�Q.- VAR.qlt I DATE
J /) 1 nTT ,F,[�pvy(aly //)j _C.U.P.& ryT APPROVED
>-, '7L /Coci/t Lea aw+-f. no.•sc/A�.0. APPROVE(/,/ Q �(.� 5r^•�
ds RV /t DATE/2 -5-76
N
LM
3 I hereby acknowledge that I have read this application and state n
g4 that the above information Is correct and agree to comply with m
p+ all laws regulating building construction, and I shall not employ
i
Z any person in violation of the workman's compensation laws of m
the State of California. 5/ A
3 I hereby certify that I am properly licensed as a contractor under (e(/ SQ. FT. w
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business v
and ProfessionsSignature ioCod
(�qqq/jI Division 3,(Chapter ` VALUATION I�P�RMIT FEE $ //��QO N
PLAN
Permit-tee /� V� `l'� $ 24 COO TAX vf
CHECK $ mss/ /vJ LL
Authorized Agenen� ! / TOTAL PAID $/y�3 C /+
20227 1
COSTA MES/'BUILDING-SAFETY DEPAn IMENT (� 1 J
P.0.190X 317 COSTA MESA,CALIFORNIA FEE RECEIVED
E1 1(
pp��''ll 2 5 196$
For Applicant to Fill In Completely KpPLIGATIONFORPERMIT
TYPE OR PRINT FIN AFE UIL6WI&,
BUILDING Forop hic useL
ADDRESS 1073 Salvador Street Chi
Vt/g1R I/1
RECEIPT NO. /PpRM1(p(L_
COSTA MESA, CALIFORNIA �14JIL/'"LJ. /
REEF BY DATE RECEIVED DATE ISSUED
OWNER Mesa Del Mar Development Co. `12-4-3 - JUL 2 4 1862
p BUILDING
MAIL
ADDRESS 3800 E. Coast Highway ADDRESS
Oriole FIRE /!/ 7
CITY Corona Del Mar, Calif. NO. Oriole
ZONE TYPE / GROUP /
TECT �rt� Ori 0 APPROVED
OR ENARCHI IN EER MaDDO Realty Co. TEL. BY DATE
3-422 ZONING
ADDRESS Same as above
- ZONE NO.OF USE OF NEW singl• Iam•
PLANS BUILDING
R-1 2 w/ att fir.
CONTRACTOR hiarrn Pon l}v CO- _
LEGALDESCRIPTION Lot 214 Tract 5023
ADDRESS Same as above
CITY Same as above A.P.NO. none
pO NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE LIC..NO. 20 I3113-A-SB-1N0. Oriole 3-Lt220 90"TO SIDE&REAR P.L.
EAVES
SIZE ^^�� ppppp----7777 (((((ggqqqo.op BLDGS, ALLOWED (U.B.C.REQUIREMENT)
OF LOT /6�n ( 7 Blow on LOil'IOne
USE OF � . cam? YARDS APPROVED YARDS ROVED
BUILDING
EXISTING BLDG. None MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STREET)
SETBACK LINE FROM 5-0
CENTER OF STREET 501 REAR YARD 361 FRONT FT. FT.
SIDE TARO LEFT 5111 I RIGHT RI R.SIDS, 1FT. FT.
DESCRIPTION OF WORK L.SIDE ^,]5—FT. 4 FT.
NEW X ALTERATION ADDITION REAR .[/^.FT. FT.
DISTANCE BET. BET.MAIN @
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLOCS.
BUILDING-, 1 11 NO.OF �/ VAR.# DATE
SIZE 7111 xitl U ROOMS 1 STORIES 2 C.U.P.# APPROVED
EXTERIOR WALL Wood & ROOF Shake APPROVED
COVERING COVERING BY . J , DAT- - -.
USE OF BUILDING AND WORK TO BE PERFORM •
Single family dwelling w/attached Dwelling 2266 S �.
garage. Plan 500-BR Garage 1160 S.F.
N
SO.FT. B
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE F'
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION N
0
, BUILDING CONSTRUCTION.P - PERMIT FEE $ 7 5+'� j
SIGNAITTTERE DUE OFL.Ot O. G
ERM3 P7
By: $ 23,925.00 PLAN CHECK $ 7�sco
AUTHORIZE. AGENT
TOTAL FEE $ // ,.,q
O•/ D