HomeMy WebLinkAbout2741 SAN JUAN LN - Building PermitsADDRESS OF BUILDING: 2741 SAN JUAN LN
ONNERS NAMEIF KNowN: JEFFR I ES , ELAINE C
`�AD°RE 2741 SAN JUAN LN
i COSTA MESA,CA 92626
641-0306
APPL. MMUNG ADDRESS,
ARCHITECT OR ENGNEER:
ARCH. OR ENG'S ADDRESS:
UC. NO.:
UNIT:
UNIT:
CONIHACTOMIUME: CRANK BROS ROOFING CO (714)548-5569
CONMACTOWS MMUIG _126 COMMERCIAL WAY _
mmtEss: COSTA MESA CA ucfio.: 408677
92627 UNIT:
LICENSED CONTRACTORS DECLARATION: I hereby "son under Penalty of Perjury that I am licensed uMm praism t of Chapter 9
(camoumcmg In Section 7000) of Clvisten 3 of the Buaimss and Professions Code, end my license is in full face end effect.
crryuc.No.:005993 UC. CLASS: C39 UC.NO.: 408677 EXP -
06/97
Dia:Z �--1 S — / � Connecta: �y
OWNER BUILDER BUILDER DECLARATION: 1 hereby affimr under pan"y of perjury, that I an exempt from the Comadm license law for Ota
following reason (Session 7031.5 Bueines. and Professions Coda: Any city or county which requires a permit to construct, after,'empore.
demolish, or repair any structure, poor to its asuamce, also regires the applicant for such Permit to fib a signed statement that he or aha
is licensed Wnuaut to the povisbm of the Contractors License Lew [Chapter 9 (commencing with Section ]000) of Division 3 of the
Business ant Prdeeslons Code) or that he or she m exempt therehom and the basin for the alleged exemption. My vkNetion of Session
7031.5 by any applicant for a Perms subjects IM applicant to a owl panahy of rM more then Me hundred doAem ISSOOD.
❑ 1. as owmr d the Property a my employees with wegss as thew Bole mmpemiion, will do the work. vol the structure is no, medal
or offered for sets (Section ]Osis. Sumnams an! Profession. Code: The Contractee License Law does not apply loan owner of property
wM bulla or inpovea thereon, and vine dose such work Iimseff or here" or through he or her own employees, podded that such
improvement are not inteMed or Weed for sets. 9, however, the Wilding or tmprovamenl a sold within ore year of completer, dna
owmnWilder will have the burden of pmvirg M or sM did not bald w improve for the purposes of safe).
❑ I, as ovine of the property, am exclusively contradng with licensed contractors to construct the project (Swum 7Oa 1, Business and
Prolemuc m Code: Tim Contractor license Law done rot apply to an owner of Property sho Wilda or sprovss thereon and who
contram M eeh Projects wsh a commetorm) licen.ed pureuem 10 the Contractors Uceme Law).
❑ 1 am exempt urder Section: B. d P.C., for this naso
Data Chener:
I M hereby certiy lust I we awes of aM uMeatM IM m,smmens of California Ms"h and Safely Coda Sections 155(15.25533. end
15531. and that I or my future Wilding omrpent will i wM cwt force one) mad to comply with said same codes ami the requ'vemont for
WORKER'S COMPENSATION DECLARATION: I hereby affirm uncle penally of perjury one of the fallowing Mderaltena:
❑ I have and wilt minter acendimte d mnaenl to seNinsum ter waken' ampatmten, m povided Na bySession 3700 d the Leber
Cam, for the mdermance of tM work for which this perch u issued.
❑ I haw sM wil maiden worlare' canpemiten insurance , ss required by Secamn 37W of we labor COM. for IM performance d the
j� woM to whitlt th® inennh o ®ued. MY waken' compenW ion inwreme retdar end Pdiq number ere:
Came: CTATP PUND EXPIRES
Policy Number: 285_CIAr1 ITT99n 01/01/97
(this section need nor be complared a the Pam, is ho oro hundred dollars (SIO01 or Ales.)
❑ I tardy that in the pertormeme d tM work la whteh Ina perms is sound. nd. I shell rot employ any person in an)' mamwr soasto
become subject to the waken' ccenpen.mbn home of Caldomie, art rte tines N 1 shout bm
ecoe eubjw to 1M wavers'
commnseiion p d Sectan 3]00 d theLabor Code. I ahellwith a povaLom.
Die:
Applicant:
Warning: Failure m secure wehsn'ronyemenon coverege Is uNewNf, and when sublept en wooloyse, M cdoiff elf pe "and
doll Ors W As oro hmdred thouserd ofdMn /5/000001 M addith n b Ms cwt of comperuat/on damages As provnlsd for In
Samm 3716 of Me Leber Cob, Irdsesek and amarney's fees.
CONSTRUCTION LENDING AGENCY: I hereby corm uMar pethy d perjury that them is e cematmdton wridteg agency for the
mdameroe of the wale for which this permit is atuad (Section 3007, Civ. C).
LENDER'S NAME:
LENDER'S ADDRESS:
ropy rmh aft city erd county actress
iter upon IM above.menliome! pmeny
Data a-Ifir.9G
(SI51-s6,WP) Whim-SuiMkg 8 Safety: GreerrRle: Canary-AppEcent: Pink -Revenue: Golden •wars err
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: B 080034
PERMIT NO: B 080034 PLAN CHECK NO: N � GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N , PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : T/OFF AND REROOF W/COMP SHINGLES SQ FT: 5,359
CLAIM VALUE: 5,359.00 CALC—VALUE: 5,359.00 GROUP OCC: R-3 /U-1
COMMENTS: REROOF 2600SF REISDENCE W/COMP
IE*iE RF iE NE S,6 iE lE ii lE*S,6 iE*1E RE*iE iE 1E iE*iE 9E*RE RE IE*IE RE RE IF R6*IE*♦E 1616**IE*1E RE iF IE 1E IE NE IE IE IE IE if ii IE IE Rf 9E 1E 1E 1E ♦E IE IE ♦E ♦E 1E*IE IE if If RE iE IF
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------- MAIN BUILDING ---------- --------- ACCESSORY BUILDING---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RIGHT: FT IN LEFT: FT. IN RIGHT: FT IN
PARKING RE • PROV: PARCEL: 14164309 ZNE:._ REF NO:,_
PLANNING N TES>_,
1E irk iEl6 iE iE RE If REM 1E iE*♦E iEM iE RE♦E♦E1E*1E IE RE RE*iE*4IE IE RE*iF REMREIE*IE iE***♦EIE*♦E 1E IE iE****IE iE Sf*IE*3Efat ♦E IE iF if IE 161E lE iE RE *iE IFkiE
D E V E,'L O P M E N T S E R V I C E S R E Q U I R E M E NrT S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY: DATE:
RE R6** it RE R6 RE S,6 S,6 iE iE iE iE 1E RE# RE RE 1E lE lEiF*iF7FiFiFiF3f if7F3FfFiFiFiFTF ififiF±FTFiF 3Fi,fTlsfT err iElFiE iE iE* 1E* N.* *
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 112,25 .54
SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS ---- > 112.79 0.00 0.00 112.79 112.79 .00
REVENUE DIVISION TOTALS--> COLLECTED: 112,79 OVER/SHORT:00
BLDG PMT PLUMBING ELECTRIC MECHANIC_ FIRE SMIP/TOT GRADING PLAN—CkECK
112.25 .54
IE RE IE IE 1E ♦E 1E IE IE If * RE 1E IE RE iF if IE iF irk iF IE IF IF 1616 * iE lE * iE IE 1E * 1E IE IE ♦E 161E 16 * RE irk RE>E iF iF RE IF iE IE IE IE IE 16 Rf 1E * IE RE IE IE IE IE 16If 9E ♦E * iE IE 1E If * {♦ * ♦E IE
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 5359 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 5,359,00
END OF FEES.
01 00217421-00217422 TOT 112.79
DATE: 10/18/95 TIME: 11:03
CONSTRUCTION AND PLANNING
`APPROVALS Permit #
a. Temporary Electrical Service or Pole-
Date
-
Inspector
- • POOL &SPA
APPROVALS Permit #
52: Pool & Equipment Location -
Data
r
FI-spe,1011.
2. Soil Pipe-Undrgrnd. - +
53. Steel Reinforcement
4
.�
-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.
B. Foundation
59. Gas Pipe, O Undrgrnd., Test
t .
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P_Trap, O Undrgrnd.
vt
'
10. Structural Floor System -
-
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash &. Receptor-Firial
12. Sewer Cap
63. Heater & Vent-Final
13. Roof Drains
64. Plumbing System -,Final
14. Rough Plumbing -
65. Electrical-Final
15. Rough Electrical'- Conduit r
_
66. Solar System-Final 1, -
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
APPROVALS: _ Permit #
20. Rough Factory Fireplace - -
<
-
;+
21. Ducts, in Structure
,
70. Underground Hydro r
22. Ducts, Ventilating
71. Product Piping'ErGas G Oil
23. Gas Pipe-Rough & Test
72. Underground F,lysh:,
24. Roof- Framing - - -
73. Undergr6d. Storage Tank O Gas 0'0il
25. Roof-Sheathing
1-22-0
74. Overhead Hydro -
l
26. T-Bar Ceiling (Structural{ & Monocoat
75. Dry Chemical -
r
27. Frame and Flashing _ _
_ '
76. try Standpipe .'
28. Lathing & Siding -
77.- FIXED SYSTEM--FINAL '
29. Insulation' - - ' �_
r
78, FIRE PREY. FINAL - ?
- 30. Drywall Nailing -
-
- .-HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat _
.-
79. FINAL INSPECTION
32. Electrical Power Meter-Final
• 80:- FOOD CERTIRICATE ISSUED
33. Final' Electric,
Notes: t is
34. Final-Heating & Air Conditioning.'
35. Final Gas Pipe=Test-
-
36. Hoodor Canopy ., -
- - ---
37. Final Factory Fireplace,
38. Final Plumbing
-r
-_ •. r r. +--
39. Water Service-Final
40. Gas Service-Final'
41. Solar Domestic-Final ••
-
42. Backflow Preventer
•.
- - , - -
43. Backflow Irrigation -
44. Landscape Irrigation System
X
45. Sound Attenuation •-
- =-
-' -
46. Handicap Regulations
- -
47. FINAL STRUCTURE & BUILDING
.-
48. FINAL PLANNING-
49. Electric Release to Edison
.4
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
PROJECT ADDRESS: 1658 SANTA ANA AV UNIT:
OWNER'S NAME: CIRCLE K CORP,
ADDRESS: 3003 N. CENTRAL AV
PHEONIX AZ 85012
ARCHIENGINEER: REG.NO.:
AGGRESS: UNIT:
PERMITTEE: DELTA GROUP (714)537-1308
ADDRESS: 11121 PALMWOOD DR
GARDEN GROVE CA 92640
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am license under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Cotle, and my lice in full force and
effect.
CITY LIC.: 0 6 3 811 STATE LIC.:4 8 5 0 6 2 CLASS: EXP: 12
Date: �2=�� Signature: _
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a cendicat co nt to self -insure or a certificate of Workers'
Compensation Insurance. or a cenited copy thereof (Section 3800. Lab. Cl
POLICY NO.: EXP. DATE:
COMPANY:
❑ Codified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division.
Dale: Applicant:
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section neeti At be cornifeled if the permit is for one hundred (S1OOlorI
I certily that in the performance of the work for which this permit is issued s aA1 no
toy any person in any mal o-erm'become
subject to the Workers' ompensalion Laws of California.
ACCESSORY
Dale: �2'"�� Signature:
FRNT; FT IN REAR:
NOTICE: If, after making this declaration, you should ome subject to the W
er mp,modion provisions of the Labor
Code. you must forthwith comply with such provisions or this permit shall b
revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a constructio e
- g agency for the performance of the work for
which this permit is issued (Section 3097. Civ. C).
FT IN
LENDER:
PARKING REc�"• PROV;
ADDRESS:
00000000
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 071094
PERMIT NO: E 071044 PLAN CHECK NO: N GOVT: N SUPP: Y
CONSTRUCTION TYPE: V—N SP PERMIT TYPE: ELE PURPOSE: ALT
JOB DESCRIPTION REPLACE EXISTING DRYCLEANING MACHINE SQ FT:
CLAIM VALUE: CALL—VALUE: GROUP OCC; ;
COMMENTS; ELECTRICAL WORK AS DESCRIBED, RE;#E70838
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING
----------
---------
ACCESSORY
BUILDING---------
FRNT; FT IN REAR:
FT IN
FRNT:
FT IN
REAR; FT IN
LEFT: FT IN RGHT:
FT IN
LEFT:
FT IN
RGHT: FT IN
PARKING REc�"• PROV;
PARCEL:
00000000
ZNE:
REF NO;
PLANNING NOTES>
>
D E V E L O P M E N
T S E R V I
C E S R
E Q U I R
E M E N T S
ZONING APPROVED BY
DATE:
BUILDING APPROVED BY ; DATE:
APPLICATION ISSUED BY- DATE; 2' E5 (C
######################
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the ContractorsState 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 7.50
repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed 50% SM I P /NON—RES
pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ISSUE FEE 4 .50
I, as owner of the property or my em loyees with wages as weir sole compensation, will do the work, antl the BUILDING
PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
f ❑ structure is not intended or altered for sale (section 7044. Business and Professional Code: The Contractors' Slate License Law TOTALS — — — — > 7, 50 4,50 0,00 12,00 12,00 .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 her own employees. provided that such improvements are not intended or offered for sale. If, however the building or
improvement n f pr REVENUE DIVISION V I S ION TOTALS --> COLLECTED: 1 2 . 00 OVER /SHORT -
sold within one year of completion, the owner will have the burden ff proving rte/she dttl not build or improve .00
for the purpose or sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CRECK
I. as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business 12.00
El 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 contracor(s) license pursuant to theContractors' Stale License Law). l am aware
that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U A L F E E B R E A K D O W N
❑ I am exempt under Section: B. 8 P. G
for this reason. TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
Date: owner: ELE 1 MOTOR/POWR APPARATUS 1,1 — 10,0 HP 7,50 7
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 .50 50
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 auality, Management District. Residential construction applications are exempt from
mese provisions.
.Dale: Applicant'.
I hereby cerlify that I have read this application and state that the above inform
a
ordinances and slate laws relating to building construction and hereby authorize r
property Im innssppection purposes. T
Date: OG—_ L Signature:
Driver's License or Social Security it:
1641-46 While—Building, Green—Code Enforcement. Canary—Applicant
I agree to comply with all city and county
his city to enter upon the above-mentioned
Goldenrod—Assessor
01 00174328-00174328 TOT 12.00
Dkc; 02/03/95 TIME_: 11:53
i90I75ffok"o
OF WORK
AP No 141-64'1—DQ LOT TRACT FIRE ZONE VALUE S 200.00
~INSPECTIONS Signature Date GROUP T TYPE V ZONE g-1
Soil PERMITS ISSUED
SUBCONTRACTOR
y Gas Date Number Signature
Water Plumbing
(� Rough Plumbing r
Prop. Swr. Line 0 House Con. ,0
J�Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole '
Underground ❑ Power 0 '
Rough Wiring - 3 ( 7 Heating and Vent.
Trenches 0 Forms 0 Steel Reinf. 0
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing — In 0 Out 0
Plaster, Brown Coat
Structural, Final Electric
Heating, Vent., Refrig. and A.C., Final
Plumbing, Final and Gas Test 0
Electric, Final r _
Building, Final
2
.f.� G
6 1 bb
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92828
STATE
For Applicant to Fill In Completely
TYPE OR PRINT
COSTA MESA, CALIFORNIA
NO. OR
DESCRIPTION. OF WORK
TO BE
HAVE READ TNI/ APPLICATION
CORRECY AND AORES YO WK.
AND STATE LAMS REOULATINO
Or'
AUTHORIZED AGENT
SEP 16-66 00 397A7*****3.00
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
RICK]" NO.
"I,""
RO^
RECEIVED BY
OATERSCEIVED
DAIS IeGUeD
BUILDINGADDRESS
PIR[
20NQ�/ TYP GROUP
APPROVED
By/ / DATE
ZONING 17_ 4
ZO NO. O► U6K0FNzW T/
1 PLANS Z OUILDING- llle
.1
�`
D[SCIIIPTION Q
A. P. NO..
NOTE: NO EAVE OVERHANG SHALL BE LEES THAN
SO- TO SIDE B HEAR P. L.
EAVES
ALLOWED (U. B. C. REQUIREMENT)
YARDS APPROVED
YARDS APPROVED
MAIN BUILDING
ACCESSORY BUILDING
(FROM
PROM C1L RREQT
�
-771T
FRONT (�
PT.
��// I
R. 610 d0 rr.
Fr.
L. BID FT.
FT.
REA
FT.
DI ANCE BET. I
BET. MAIN B
MAIN SLOGS.
ACCESS. BLDGS.
VAR.*
DATE
C. U. P.
APPROVED
AFFROV[D .y�
DATE
/ SQ. Fr.
THS AMOUNT SHOWN UNDER VALUAnCH IS FOR THE
PURPOGE Or ESTABLISHING A PERMIT PEE ONLY.
VALUATION
D=
PERMIT FEQ 5
r PLAN CHECK S --
�• m�
TOTAL PEE
COMPLAINT INVESTIGATION
Rece
Made
Again
Nature of Complaint:
COSTA MESA BUILDING SAFETY DEPARTMENT
P. O. BOX 1200
COSTA MESA, CALIFORNIA
646-2411
Complainant Yes
No Interviewed: No
FORM BU41-2M-5-94- CP
By
Date:
/0
Dater �]
.Ph. No.�J
18910
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
BUILDING
ADDRESS 2741 .San Juan Ln,
COSTA MESA CALIFORNIA
1'P rn -mBA was*94.50
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
OWNER Mesa Del Mar Development Co.
RECEIPT NO. 8l}J[`LJJ
19
rn
MAIL
RECEI ED BY GATE CEIVED DATE ISSUED
/o3
ADDREss3800 East Coast Highway--
pFq
Corona del Mar No`: OR 3422
UILDING
CITY .
ADDRESS
ARCHITECTTEL.
Macco Realty Co. 3422
COSTA MESA,
CALIFORNIA
OR ENGINEER NO. OR
ADDRESS Same as above
FIRE
ZONE TYPE
7
,/
GROUP
CONTRACTOR Macco Realty Co.
APPROVED
BY
DATE
ADDRESS Same as above
ZONING
CITY Same as above
ZON
�Y
NO. OF•
I PLANS Z/I
DBE OF "E
BUILD( ,
uc oEio?07343-A-SB-1 NO. OR 34220
LEOAL Lot 48
DESCRIPTION
A. -P. NO.
Tract 4 O8
H IZE NO. OF BLOGB.
OF LOT 6510 S.F. NDw ON LOOT none
USE OF none
YARDS
EVES
EXISTING BLDG.
APPROVED
ALLOWED
SETBACK LINE FROM/ 11
50
(CENTER LINE BT.
CENTER OF STREET REAR YARD 22'2"
FRONT
FT. IN.
I 51 I
51
F
SIDE YARD LEFT
RIGHT
R. SIDE
IT. IN.
DESCRIPTION OF WORK
—�
L. SIDE
IN.
I
II I II I
NEW X
ALTERATION ADDITION
REAR
/FT.
FT. IN..
REPAIR I
II MOVING I I DEMOLISH
APPROVE
�J S_
DATE J' J —lt
NO OF
6 1
eZE.9bU-x50'QQ-10" RRROOMS STORIES
EXTERIOR WALL ke
UCCwo01 dRSCR
COVERING , OVOERINGG
B OOGA
USE OF D WORK TO B PERFORMED
SingILDINe Family Res. watt. Gar.
Plan #450 -DR
Living Area: 1780 S.F.
Gar Area:
460 S.F.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
THE AMOUNT SHOWN
UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COM.
PURPOSE OF ESTABLISHING
A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
VALUATION
BUILDING CONSTRUCTION.
PERMIT FEE $ GF' ✓ l
SIGNATURE OFMeSa Del Mar Development Co.
PERMITTEE
By:sl9,065.00
PLAN CHECK S cJ/
AUTHORIZED AGENT r
TOTAL FEE
m