HomeMy WebLinkAbout1157 SALVADOR ST - Building Permits •
ADDR85 BUfl. NO: 1657 SAMAR PL WIT: CITY OF COSTA MESA - BUILDING PERMIT
a"a"BNAIIEI'IDa"NBULKLEY, I4AYNE L TR PERM NO: B 080202
LS1657 SAMAR PL
COSTA MESA,CA 92626 PERMIT NO: B 080202 PLAN CHECK NO: N GOUT: N SUPP : N
a
APPL.MMUR ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE : OTH
I ARCNRECTOREI NEER: UC.NO.: JOB DESCRIPTION : T/0 ROCK, APPLY NEW COMPO W/DBL COVERAGE SQ FT: 3, 500
'-a SACK OR ENOS ADDRESS: WIT:
CLAIM VALUE: 3, 500 . 00 CALC-VALUE: 3, 500 . 00 GROUP OCC: R-3 /U-1
caim.cTDlrstuwBEST ROOFING ( 714 ) 650-1366
caauaowswc 236 VICTORIA ST COMMENTS: INCLUDES TORCH-DOWN ON FLAT AREA IN REAR OF HOUSE
ADDRFss:COSTA MESA CA ue.ND.: 603323 ******iE+L***i ****nil*+E*rt* -*****+r******** End*x****fE****+L**+End**iex*BEnE*** -***********+E+t
92626 MMT: Z ONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby elfin under penalty of perjury lhat I am licensed under proviebne of Chapter 9 SETBACKS
(commenting with Section 7000)of Derision 3 of the Business and Professions Code and my license is in full force and edea.
CITY uc.NO.051718 uc.CLASS-C-39 LICNO' 60�323/) EXP: 09 /97 MAIN BUILDING ACCESSORY BUILDING
1�1�[���/ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dere: /4:4,24 Ci L/{ Contractor: / LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
1
OWNER BUILDER DECLARATION:I hereby Arm under penalty of perjury that I ern exempt from the Cartrerm License Law la the
ddbwkg roam repseaton7wl.s Bettina.and Pncessiens Cde:enY c.yeseemywch p requiem a pen °need,der,improve. PARKING REQ: PROV: PARCEL : 13928126 ZNE: REF NO:
S licensed a repair any sevens..pito Io its issuance,also requires the applicant la such permit to file a signed statement that he a she -
p licensed pursuant to the provisions of the the I, License Law(chapter 9(commencing with Section 7000)ofs Delia,3 d the PLANNING NOT E S'>
Business end Professions Code}a that e a she b exempt therefrom and the basis for Ihe alleged exempllon.My violation d Sadiron >
7031.5 by any applicant for a permit ebjets the Libellant to a civil penalty of nes moa that Me hundred dollars[S5001). ********************************************************************sit.**********
❑ I.esowneroftheproperyormyemployeeswthwagmmtheksolecmpensation,willdotheworh,adthedruauniMintedd DEVELOPMENT SERVICES REQUIREMENTS
or offered for sale(Section 7044.Business end Professions Code:The Contractors License lawdoes not apply to an Owner of popery
who builds a improves thereon,and who des such work Mutat or hand or through his or her own employees.provided that such
eneweereeedetell intended prpoaehed,sbeers't did not hold IXimp pm°medSove lor the sweld wel�)a»yvd°rmptron.the ZONING APPROVED BY DATE:
❑ I.a eater d the property.em extAaively coMndig with licensed pont/atom b<enema the project(Salim 7044.Business and
Professions Code:The Contractors License Law doer rat apply ban owner of property who baits a improves thereon ed wM BUILDING APPROVED B Y \ DATE:
contracts lar such projects with a°Nrada(s)licensed pursuant to the Contreras License Lav). - /
❑ Iamearner uderSeclnn: B.AP.C..Mthis remon: APPLICATION ISSUED BY: DATE: m (O
**************.*********** * *** * + **d ***d ****************** **
Date: _ Owner: LEGALIZATION: N FEE S U M M A Y STRUCTURAL SEGMENT: Y
I do hereby certify that I am aware of and understand the requirements of Causerie Heath end Salary Code Sections 25505.25533.and
25534.and that I or any Muse balding co°pant will/wit rd(circle ono)need to comply with said Mate codes and the requirements for
forfrom BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provision.. PERMIT 87 . 25 • . 50
Date: Apdiaanc SM I P/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby or m under pershy of perjuvy or* the foow
Rbg sideration: I SSU
f
IUILE FEE
❑ Ihave and wJeormnccefithewdmmeryhthisperto nbrwaeen'canperoetion,apmtladlabySadion3T00d1Mlaba BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
cove,f«tMpedDrbaK.dN.waklawnhN®wmnpimae. TOTALS----> 87. 75 0 . 00 - 0 .00 87 . 75 87 . 75 . . 00
p I hews end wit maintain workers'compensation insurance,as required by Section 3700 d the Labor Code,he the performance of IM
xwork for which this perms a issued.My workers'compensation insurance cat and policy number are: •
Carder: RELIANCE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 87 . 75 OVER/SHORT: 00
Policy Number: NWA011 /7F8-01 09/01 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need nes be completed t the permit a b one hudned defiers($1oOJ or rex) 87 . 25 . 50
•
❑ I certify that in the performance d the work for which this perm.p Sued,I shall net employ any person Is any manner so es to
Marne subject to the worker'cmpnvation pew.of California. end agree Nat t I sum
rdd became subject to the eerhn' *******************************************************************************
compensation provisions of
SectionCode.3700 of the Labor I.hell forthwith o it with ptwiiae. INDIVIDUAL F E E BREAKDOWN
Dale: /,(7•Zg' 5C Applicant �t jv
Warning:Failure to secure workers'compensation coverage Is unlawful,and shall subJ«,an employer b criminal penalties and TYPE QTY DESCRIPTION UNIT COST TOTAL COST
civil fines uP to one hundred thousand dollars($100,000A In addition to the cost of conprsatbn damages es provided for In
s«donDloSof M Laborcoa,IntrexLawa omry'aree SFR 3500 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 3, 500 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury That there is a oongin dlon lending agency for the END OF FEES
Performance of the work for which this perm.a Yawed(Section 3097.Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I cattily that I have read his application end Male(hat the above information is coned.I agree to comply with all pry end county ordinances
and state laws relating to building construction and hereby authorize representatives of this tly to enteruponn the above-mentioned properly 01 00217971-00217972 TOT 87.75
for inspedimpurases. DATE: 10/28/95 TIME: 08:46
JIM GOULD
Pubis Name r/
/Ly/// Date: y O'�O /
q
au-re are d Owtw/Apenl/Appkun4Canneda
\ (5151d15.WP) WNe-Buildig&Safey:Green-Fie:Canny-Appicenl:Pink-Revenue:Gadenmd-bama ,
�cTt
CONSTRUCTION AND PLANNING POOL & SPA
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 UFER 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, 0 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 le-3[--t6 6 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 CERTIFICATECISSUED
33. Final Electric Notes: /0/47/96. oh es
34. Final Heating & Air Conditioning ..ee 7 36 4C+1
35. Final Gas Pipe-Test
36. Hood or Canopy I(J7/T• �;t2�✓'�o-cc,�t� ,,c,/
37. Final Factory Fireplace U�1
38. Final Plumbing
39. Water Service-Final
40, Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING II..y_ q (p icy.
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
August 24, 1966
•
• Western Mutual Escrow
P. 0. Box 1106
Costa Mesa, California
ATTENTION: Mr. Sinsley `;
Dear Sir:
In answer to your inquiry regarding t 38 of Tract 5023, 1157
Salvador Street, Costa Mesa, the approved fo tion plan on file in this
office sets forth the follows requirement:
"2 bare of 1/2" steel in 11 footings - Visqueen over
smooth adobe soil and apprLximately 2" of sand (soaked;
over Visque "
• Inspection r algid that all of the above requirements were com-
plied with.
•
Yours very truly,
FRANK J. HRUZA
Assistant Director of
Building Safety
FJR:dh
•
PROJECT ADDRESS: 1157 SALVADOR ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 069179
OWNER'S NAME: BULL, JOHN
ADDRESS: 1157 SALVADOR ST PERMIT NO; B 069179 PLAN CHECK NO; N GOVT; N SUP P; N
COSTA MESA, CA 92626
CONSTRUCTION TYPE; V—N PERMIT TYPE; STR PURPOSE; ALT
7 642-1721
Sol ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION ; T/OFF SHEATH & REROOF W/FIBERGLASS SHING SQ FT; 6, 850
ADDRESS: UNIT:
CLAIM VALUE: 6, 850 , 00 CALC—VALUE: 6, 850, 00 GROUP OCC; R-3 /M-1
PERMITTEE: CRANK BROS ROOFING CO ( 714 ) 548-5569
ADDRESS: 126 COMMERCIAL WAY COMMENTS: SMOKE DETECTORS REQUIRED PER 91 UBC . REROOF 3000SF RESIDENCE
COSTA MESA CA 92627 *********** tr* r* rr****x***y *+ ************* r* E** t**********aS V KfiD ETCT
LICENSED CONTRACTOR DECLARATION: I hereby affirm that am licensed under provisions of Chapter 9(commencing with Section Z ON INC R EQU IR EMENTS
7000)of Division 3 of the Business and Professions Code.an y license is in full force and el I. S E T B ACK S 1
CITY LIC.: O05993 STATE UC.: 408677 CLASS: C39 ^ : 06/95 REQUIRED ,
L� Date:—/ O' 7-9fr Signature: p MAIN BUILDING ACCESSORY BUILDING
FRNT; FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
WORKERS'COMPENSATION DECLARATION: Ihereby- a at I have a certilioate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
Compensation Ipsy[a�ce_off9 a4certified cOpy.212 4 .ect 3800.EXP.DATE:b U 1 /0 1 /95
POLICY NO.: LL tltl `J L 9
COMPANY: STATE FUND PARKING REQ; PROV; PARCEL; 14161126 ZNE: REF NO;
❑ Certified copy is hereby furnished. 12 Certified copy iss,f a ith the city Building Division. PLANNING NOTES>
Date: 7•-11: Applicant:
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)or less). DEVELOPMENT SER VICES R EQU IR E M E NT S
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. ZONING APPROVED BY DATE;
Date: Signature: BUILDING APPROVED BY
ode.NOTICE:If.gust making this ywideclaration.you should become subject mit the Workers'mempensation provisions of the Labor DATE;
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that(here is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; S DATE: k13. 17 (c �
which this permit is issued(Section 3097.Civ.C). ********************************************** **********************,.**********
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT; Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'Stale License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC 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 90 . 00 , 69
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 o1 the Business PLAN SMIP/NON—RES
and Professions Code)or that he/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(S500). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, vnn 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————> 90 . 69 0 , 00 0 , 00 90 , 69 90 . 69 , 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 REVENUE DIVISION TOTALS——> COLLECTED; 90 . 69 OVER/SHORT• .00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
Iorthe purpose ofsalel. BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 90 . 00 , 69
❑ and Professions Code: The Contractors'Stale License Law does not apply to an owner of property who builds or improves thereon
and whocontracts for such protects with a contractors)license pursuant to the Contractors'State License Law).l 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.
rorthis reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: SFR 6850 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 6, 850 , 00
I do hereby certify tat 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 Duality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant:
I hereby certify that I have read this application and state Iha�•above information is correct agr to comply with all city and county
ordinances and slate laws relating to building construction and 'by authorize repres tat thr to enter upon the above-mentioned
property for inspection purposes.
-...„p Date: 0 —7—rte Signature 01 00169144-00169145 TOT 90.69
/ l DATE: 10/07/94 TIME: 09:15
Driver's License or Social Security
1641"46 White—Building:Green—Cade Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL & SPA
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, C 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 49.,.t(et y “Gee- 73. Undergrnd.Storage Tank ❑Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26, T-Bar Ceiling (Structural) & Monocaat 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 t�
35. Final Gas Pipe-Test
36. Hood or Canopy
r
37. Final Factory Fireplace
38. Final Plumbing .
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation I
44. Landscape Irrigation System
45. Sound Attenuation' '
46. Handicap Regulations 'el-
, • rn
47. FINAL STRUCTUE� &gU,ILDING ! ��7R'y & GO-
48. FINAL PLANNING-1 --
49. Electric Release to Ediso{il_.
50. Gas Release to Southernf litornia Gas Co
51. CERTIFICATE OF OCCUPANCY
No, ' 'Date
20241
COSTA MESA BUILDING-SAFETY DEPARTMENT FEE RECEIVED
P.O.BOX 317 COSTA MESA.CALIFORNIA JU L N 5 1983 .
Y
For Applicant to Fill In Completely AP LICATII9IrI F?r µE RMR
TYPE OR PRINT VIII BUILDING I'
CFO', Oific4J::i.>:e M$
BUILDING
ADDRESS 1157 Salvador Stree
RECEIPT NO. 21�21�D
ts
COSTA MESA. CALIFORNIA 1� 6}
R DAT 8CEI DATE ISSUED
OWNER Mesa Del Mar Development Co. 7 2Z 63 JUL 2 4 1963
MAIL BUILDING
ADDRESS 3800 E. Coast Highway ADDRESS 1/ �/J�,,,,//
TEL.Or101e FIRE
ZONE TYPE {/ GROUIfl I
CITY Corona Del Mar,Calif..NO. 3 44220
ARCHITECT ARCHITECT TEL Oriole BYPROVED DATE
OR ENGINEER Macco Realty CO.NO.
3-11220 • ZONING
ADDRESS Same as above / ZONE NO.OF USE OF NEVPintl. Thm.
ealty Co. R-1 Pune 2 BUILDINGI,T/ att gar.
CONTRACTOR Macco R
LEGAL
DESCRIPTION Int 38 Tract. 5n93
ADDRESS RAMP PC a hnve
CITY Same as above A.P.NO. noneT 1 1 NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATELIC.No201343-A�B-1. NO. Oriole 3-µ2 Gro 80'TO SIDE Q REAR P.L.
EAVES
SIZE OF LOT 9 X 1 / I No.of BLDG. ALLOWED (U.B.C.REQUIREMENT)
now ON LAT None
YARDS APPROVED YARDS APPROVED
USE OF BUILDING ACCESSORY BUILDING
EXISTING BLDG. None ST EET)
SETBACK LINE FROM I�'� _ FT FF
CENTER OF STREET µl{I • REAR YARD 29 t
R SIDE
SIDE YARD LEFT 1.11 RIGHT 8a FT. FT.
DESCRIPTION OF WORK L.SIDE ��� i Fr. e Fr.
NEW X ALTERATION ADDITION REAR
DISTANCE B T. BET.MAIN S
REPAIR _MOVING DEMOLISH
BLDGS. ACCESS.SLOGS.
BUILDING NO.OF YAR.SC DATE
SIZE AO I XSQI lot'ROOMS A STORIES 1 C.U.P.# APPROVED.
EXTERIOR WALL WoD(I &I ROOF APPROVED
COVERING JJT.UCCCrOVERING Shake Sh1 BY W_T_D_ DATE 7-22-63
USE OF BUILDING AND WORK TO BE PERFORMED
3inglo family d*.,.l;ng-4± +•,r Dwei ling 17G41.11.
garage. PlanIlynGarage 460 0.£.
n
SQ.FT. u
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE t
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
BUILDING CONSTRUCTION. $ !0� �� N
PERMIT FEE D
SIGNATURE OF 3/50 i
PERMITTEE Marro Roa +tv C
by: -7 $ 19,065.00 LA CHEC •
0
b.
AUTHORIZED AGENT .y2(,// f;O
TOTAL FEE $ / / /�/