The URL can be used to link to this page

Home My WebLink About1852 SAMAR DR - Building Permits 1 4. CITY OF COSTA MESA 4 BUILDING DIVISION >: j r ,,,r. , DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER 1. 1i PERMIT J' 1100 . 40wan V EO6-00024 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1852 SAMAR DR Status: ISSUED Suite No Applied: 01/10/2006 Vicinity: Issued: 01/10/2006 Parcel Nunmber: 13925323 Applicant: ELLISON, PAUL Address: 1111 N ARMANDO ST ISSUED BY: Phone: 714-630-7040 ANAHEIM,CA Zip 92806 Owner: SPENSER, CHRISTOPHER Address ALLEN COSTA MESA,CA Phone: 1852 SAMAR DR Zip: 92626 Contractor: NOW ELECTRIC INC Address: 1111 N ARMANDO ST Phone: 714-630-7040 ANAHEIM,CA Zip: 92806 License:487854 SCOPE OF PERMIT SERVICE TO 200 AMP FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(34-units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 • Service to 200a $30.50 1 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 f Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $54.00 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS 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 2446-46(8/00) WORKERS'COMPENSATION DECLARATIO . 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 rk for which this permit is Issued. + -I��and will 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. orkersglyp§n, a n Insurance,carrier and policy number are: / v� l fl'��' FVNb Policy Number: 1‘5 30 - action-heed not be completed If 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 compl witl7.tbese,pro�sions. A kart Signature: ----t ---__, W IN . AILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EM/ NAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37050F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: •efebyafflrmmat'Pam.licensedy er per i ns of Chapter 9(commencing with Section 7000)of DIvisio 'oftha:BUslness end P .fessions Code,and my license Is in full } itEDa'delleci'Uc.;u_ 41- d . JC-/ •dlmctor's SlgnatUfalli ., f®/ 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). Lender's Name: Lender's 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(commenting 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.). • O 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.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I 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: I 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 ❑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 greeter 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? ❑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 ap ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No (Section 65850.2 of the California Govemment 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 Na (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ..o_ Maag. _. _._ ._ _ __._ _ 7 a a cation hav the South isclst s prescri ed bygement aiHeal or ndother epollution coon 4r'district3 agencyis 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? ❑Ves 0 No 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 AUTHORIZATON 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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. �' 7,/• ,r1T/ sate r o///,/ :wr ..rzed.,.•licant - '—' Italia' _. 0S"`'t DODE I INSPECTION TYPE I PATE NTITIALS CODE( INSPECTION TYPE ME !MAS 1616 Fixed System Final Fire Prevention 206 Final Mechanical (!�yf��,(�,''`'� 1266 Pool Spa Final 2081Final Plumbing ��'r U 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention P 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy SOIL and TES' VG ENGINEERS I11C. 41‘ ORANGE COUNTY COACHE L1 VALLEY BAN EERNAROINO 167 W.ORANGETHOFPE• PLACENTIA,CA 92670 79-607 COUNTRY CLUB.#5 1894 COMMERCENTER WEST.a SUITE 305 (714)524-9130 BERMUDA DUNES. CA 92201 SAN BERNARDINO.CA 92408 (619)345-8869 (714)381-3528 REPORT OF COMPRESSION TESTS FILE NUMBER: 8842196 DATE: 6/1/89 0 CONCRETE Joe: Steve Gallina - Chris Spencer 0 MORTAR ADDRESS: 1852 Samer, Costa Mesa 0 GROUT CLIENT: K GUNITE ARCHITECT: Adams 0 LIGHTWEIGHT CONCRETE ENGINEER: CONTRACTOR: Owner CONCRETE SUPPLIER LOCATION IN STRUCTURE: Wall SLUMP, in inches CONCRETE TEMPERATURE AIR TEMPERATURE: UNIT WEIGHT: CEMENT: AIR CONTENT: ADMIXTURE: MIX NO. FINE AGGREGATE: TIME IN MIXER, MINUTES: COARSE AGGREGATE: WATER ADDED, GALLONS TIME FABRICATED: FABRICATED BY: Steve Gallina TRUCK NO: TICKET NO: LABORATORY NO: 2692 MARK: Set 106 DATE MADE: 5/15/89 DATE RECEIVED: 5/19/89 DATE TESTED: 5/29/89 'DIAMETER. INCHES: 6. 0X12. 3 AREA.SO. INCHES: 28. 27 MAXIMUM LOAD, LBS.: 51 ,000 COMPRESSIVE STR..PSI: 1, 800 AGE TESTED.DAYS: 14 REO'D PSI AT 28 DAYS: 2, 000 UNIT WT/CU FT(PLASTIC): Samples Delivered to lab on 5/19/89 by Steve Gallina. DISTRIBUTION: (3) Steve Gallina SOIL and TESTING ENGINEERS INC. REVIEWED B `^J 100- 5/86 OWNER MANLEY, K. R. DATE 8-1-61 `7 JOB ADDRESS 1852 Samar Drive BUILDING PERMIT NO.15058 GENERAL CONTRACTOR Anthony Pools -. — - 'I VALUE $ 2,600.00 AP. No. LOT 63 TRACT 3380 FIRE ZONE DESCRIPTION OF WORK Pvt.swim pool INSPECTIONS DATE I GROUP TYPE ZONE R-1 Underground Soil U.G. Water --ttom�-- SUBCONTRACTOR PERMITS ISSUED Underground Gas �-er? 74Th�7 DATE NUMBER Overhead Water and Gas Rough Heating Rough Plumbing Ar.., 9'yyty, Y fu/-G/ / Miscellaneous F,4} . /f g.flt. .Q,:Itw... PaoR.� 1-31-LI 3^3-X? Prop. Swr. Line House Con. St. Swr. , Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole Underground Power f Rough Wiring _ L 5' no�L.,� 4 - )A (I- /1'113 Trenches/4Ft4. Y-Forms Steel . /c/ h,C Floor System Steel Reinforce Chimney Re-Rod Bond Beam Sheathing - Frame and Flashing Lathing, In Out Plaster, brown coat Plumbing Fixtures, Final /%O Electric Fixtures, Final , /' 6/ _ Building, Final � j� OCCUPANCY Form 210-5M-11-59 S-B P 15058 EE RititIVto jgo31 JUL 311961 COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P. O. BOX 917 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING 1852 SAMAR DR ADDRESS COSTA MESA. CALIFORNIA For Office Use Only OWNER K R MANLEY I RECEIPT NO. I NO �P�o yr MAIL 5511. WHITTIER REM).BY Dw REc VED/ pDATE ISSUED ADDRESS (/C. 7.5/"'l/ 0 -4-61 CITY COSTA MESA TEL.. BUILDING ADDRESS 1852 SAMAR ARCHITECT TEL. COSTA MESA, CALIFORNIA OR ENGINEER NO. ADDRESS FIRE ZONE PE GROUP CONTRACTOR ANTHONY POOLS BBYPROVED4F DATE 7�/".;4.1A � // ADDRESS p 5871 FIRESTONE BLVD. ZONING �Lvv KXXi11 SOUTH GATE zoite_/ I HD.DF I UBE OP NEW.1 .o...7 CITY �.0 PLwHB��777y BUILDING I // fyp�f" STATE TEL. LEGAL lv / :3 /-1 ; 3 p D LIC.NO. NO. DESCRIPTION f l0 -/ /1 SIZE 9 a I. !1 0I NO. OF BLDOS. �• OF LOT l� ( \' NOW ON LOT A.P.NO. USE OF YARDS EVES EXISTING BLDG APPROVED ALLOWED SETBACK LINE FROM (CENTER LINE GT.) CENTER OF STREET REAR YARD FRONT 7 FT. in IN. SIDE YARD I LEFT I RIGHT R.SIDE 3 -- FT. IN. DESCRIPTION OF WORK L.SIDE /f! FT. N. NEW I XII ALTERATION I II ADDITION I REAR S ///F��T. IN. REPAIR II MOVING I II DEMOLISH I BYPROVED (1/ i// 1 DATE 17 -3/. 6 / SIZEBUI LDING 556 ROOMS STORIES NO. OF 0171._.."..-...-r EXTERIOR WALL I ROOF COVERING COVERING USE OF BUILDING AND WORK TO BE PERFORMED SWIM POOL I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CI •'• ANCES AND STA GI L REGUATING BUILDING CON.• -U-- ION/ VALUATION �I SIGNATOR- O- PERMIT FEE $ /0- PERM ITTE= 0 - -.�"/ N /,'� 2600.0a PLAN CHECK 5 .5 - i AUTHORIZED AGENT 44 $ %�'"� O TOTAL FEE ( r OWNER MANLEY, K. R. DATE 8-31-61 JOB ADDRESS 1852 Samar Drive BUILDING PERMIT NO. 15229 GENERAL CONTRACTOR C. W. White VALUE $ 480.00 AP No. LOT 63 TRACT 3380 FIRE ZONE DESCRIPTION OF WORK Block wall INSPECTIONS Signature DATE GROUP J TYPE 11j ZONE R-1 Soil PERI ITS ISSUED Gas SUBCONTRACTOR DATE NUMBER Water Rough Com. Refrig. 0 Air Cond. 0 Rough Heating Rough Plumbing Miscellaneous Prop.Swr.Line ❑ House Con. 0 St.Swr. 0 Sprinkling System Construction Pole Underground 0 Power C Rough Wiring _ Trenches .ft Forms 0 Steel Reinf. 54 W �'�7 61 71 at 9 — Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing Lathing — In 0 Out ❑ Plaster, brown coat Refng. ❑ Air Cond. 0 Final Heating, Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final - g- ti Building, Final �/ —�T OCCUPANCY •,;„ FORM BUR•5M - 7.61 15229 FE\F RECEIVED 15229 AUG 31196) COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P. O. BOX 917 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE gOR�gPRINT BUILDING ADDRESSBUILDING /�" _?d/T/J'�/y/(��C COSTA MESA. CALIFORNIA For Office Use Only RIfkr � 'x/ I RECEIPT NO. I PERMIT NO. OWNER Y 15` 1°1) MAIL �j _�I �7�j RECEI'�f� BY DA,RE IIVEO/ Dyye�IEBUE. ADDRESS /i! S K SAita R P �i(� I (—/J '�• j �4'I I o ' city • S"—' 6 ' NO. ADDRESS II 5— ,5TEL. -Q.N+.O.A_. 0 r • ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER NO. ADDRESS FIRE ZONE TYPE GROUP r CONTRACTOR / APPROVED ( BY 8T DATE ADDRESS /�/A�/�Or'I&d/x(2 /ILS /�•� ZONING CITY C /J/ OE,V vl` QV`_ ZONE /RI I PLANS /v� I BSE OP NEW /_,. /K ..�.PNB / BUILDING /!�1 (I/x�/V�/U STATE //1 TEL. TE i/5'V LEGAL STI /// 3i TYl•s3 Vq LIC.NO. 7.0 NO.H h d DESCRIPTIO /C'•J-1 (J SIZE Q / No. OF moos. / OF LOT /Cs-^ I NOW ON LOT A.P.NO. e----7/1---41--•-7"--1/-C USE OP let, YARDS EVES EXISTING BLDG '-v APPROVED ALLOWED SETBACK LINE PROM (CENTER LINE STA 9v CENTER OP STREET REAR YARD FRONT J V FT. I N. SIDE YARD LEFT I RIGHT R.SIDE FT. 9/t4N. DESCRIPTION OF WORK V P/ L.SIDE FT. NEW I (\II ALTERATION I II ADDITION I REAR � ) FT. P�Tj/�--IN./// • I II MOVING I II DEMOLISH I APPROVED//., So O DATE a 3 i-C REPAIR / BY (�/ // / jam/ SIZE /Go/I/NEIL ROOMS STORIES EXTERIOR WALL I ROOF COVERING COVERING USE OF BUILDING AND WORK TO BE PERFORMED A /HiyL4, H"8Lo c1f 111 AL C. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION A SIGNATURE OF �.� i�n.Y, O - PERMIT FEE $ PERMITTEE �KJ- yy�� NB $ 4'16.47° PLAN CHECK S >,. AUTHORIZED AGENT TOTAL FEE $ G 1 RECLOL.D COSTA MESA BUILDING-SAFETY DEPARTMENT MAR 20 1%1 P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE DEPT. CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT 'TYPE OR PRINT BUILDING BUILDING ADDRESS 1852 Samar Drive COSTA MESA. CALIFORNIA For Office Use Only RECEIPT NO. P MIT NO. OWNER Carriage Ranches Inc . -14419S MAIL RECEIVED ByDATE RECEIVED DATE Issued ADDRESS PO Box 783 /)tom 3-I 3- .2-o- c/ I ^O O n TEL. BUILDING v Vu CITY _ _ _ _ _ _ NO. , ADDRESS n J �• 1 ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER . ♦ 1 - _ ' et I . E S - . FIRE - ! - ! - _ - - ZONE TYPE !/ GROUP ,XI- APPROVED CONTRACTOR i A •A hflAtT , g Carr C Co-Cc- BY DATE ADDRESS 1 19 NIhri 110 St ZONING / zOR-1 I PLANS 2 or I USE DINGNEW W/SAttlgar.I • CITY costa mesa calif. STATE TEL. LEGAL o^ LIC.NO. ' r• •NO. •• • • DESCRIPTION Lot 63, Tract 3380 SIZE I NO. OP SLOGS. OF LOT QIW =Of 1eh NOW ON LOT —i— A.P.NO. =Me USE OF - YARDS EVES EXISTING BLDG APPROVED ALLOWED SETBACK LINE FROM (CENTER UNE ST.) ��-O CENTER OP STREET 30' REAR YARD '281l1 FRONT •J FT. / IN. SIDE YARD I LEFT 513 R I RIGHT 511?? R.SIDE 5�FT. 1 IN. DESCRIPTION OF WORK / - L.SIDE S FT. / IN. NEW I . . II ALTERATION I II ADDITION I REAR c)--NC3 FT. IN. REPAIR I D MOVING I D DEMOLISH I APPROVED BY L. D.nc DATE`20-61 SIZEBUILDING2503aq.ft.WA ROOMS NO. OF ZO STORIES 1 EXTERIOR WA ((iJJ7 WALL COVERING COVERING ._ USE OF BUILD( 1• •RK TO BE PER OR -D 3 0 garage_ - 1.83 sq.ft. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION SIGNATURE OF PERMIT FEE S ei.c: .1-o PERMITTEE CV::e nst],+.C.11• _ $ 25 , 235 .00 PLAN CHECK $ aa•S c7 -I AUTHORIZED AGENE TOTAL FEE 6 7- S"a rt