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Home My WebLink About2757 SANDPIPER DR - Building Permits 1 It 40 4`, A5tp ' CITY OF COSTA MESA • BUILDING DIVISION F •iOt PLOP/CO Ft 41 DEVELOPMENT SERVICES DEPARTMENT PERMIT-NU ER PERMIT J *u .Pligh M05- 082 .aw.4* (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2757 SANDPIPER DR Status: ISSUED Suite No Applied: 02/23/2005 Issued: 02/23/2005 Vicinity: 2ND FLOOR DUCTING 4E ISSUED BY: /�//L Parcel Number 13954128 '/ Applicant: HATRIDGE, KEN Address: 2952 CENTURY PL Phone: 714-546-1653 COSTA MESA,CA Zip: 92626 Owner: GROTH, DON F TR Address: 2757 SANDPIPER DR Phone: COSTA MESA,CA Zip: Contractor: DEPENDABLE GRAHAM AIR CONDITIONING Address: 2952 CENTURY PL Phone: 714-546-1653 COSTA MESA,CA Zip: 92626 License:472690 SCOPE OF PERMIT CHANGE-OUT OF EXISTING 2ND FLOOR DUCTING&10 SUPPLY DUCTS IN AN EXISTING SFD. 1 REPAIR/ALT COOLING HEAT NO OTHER WORK AUTHORIZED WITH THIS PERMIT. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 • Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Ref rig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically 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(6/00) DECLARATIONS /41 WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: ❑ 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. xj.{I have 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. D'� My workers'compensation Insurance carrier and policy number are: Carrier: 3fAIC £ ch PLA, i1?-7)0) J-S L% ,Co Policy Number: 6/-,-2GY] (This section need 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 comply with these provision Applicant Signature: !1 �< Date: 0 ✓�-3/-5 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND IOL LLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.a 7-26 90 Class e C 0 Contractor's Signature: Date: 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(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 properly,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 properly,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.-properly 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(38)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 Califomia 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? ❑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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LLII Yes LJ 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? 0 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 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 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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si nature OfLLee all ner(s) ate? And/Or Aut im1zed Applicant De CODE 0 INSPECTION TYPE GAIL INITIALS CODE; gNSPECfION TYPE �� I IS 1616 Fixed System Final Fire Prevention 206 Final Mechanical z�Z /'..-S 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 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 •,aii, //C Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. ( T O. LOT r O. U O. I`7c1_E�1 I jJ / 'CITY OF COSTA MESA CONSTRUCTION PERMIT / Z NIT= A.P.# ) J 1 --- /lJ Zone IC L • 02757 5n4'D',aee t'X. -393143 77 Project Address 7 _ S Main Building: Accessory Building: Applicant's Mailing Address o?752 5fji1/.0 P/Pr7C P2 . CM TYPE OF CONSTRUCTION LI NEW Li ADD H ALTERATION U REPAIR E �� Oy'yrl' Nra &CO7/4 Phone-5374r$47 _❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' B Fronts 0, It l �j N Addressan�t,�,7 5gaPP/Pax D� DESCRIPTION •• 4 R. SEOF B s O _ A Rear i Z, / I Arch/Eng.w,6 /4243a. & License No. TYPE OF PERMIT M GRADING I FOUNDATION U STRUCTURAL I C Right �S N Address/D9 5Z0 5T• £i� • ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL S Left ( 1 R Contractor's Name 1074.)/Uf-`�aPhone ❑ OTHER----- Ping. Ref.# Parking Req./Provided E Alidress(mailing) - PROJECT DESCRIPTION.SQ. F/2-C7-10 Tj OCCU PAN/CV `L�'L'/ - 12tt I 0 /nun- CO - M CONSTRUCTION TVF�j (20 0 VALUATION$ !It OTT Planning Notes: T �l T City License No. ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION S. I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. ELECTRICAL FEES License Class License No. Date Signature PLUMBING I FEES Automatic Washer Transformer 0 15-50 KW WORKERS' COMPENSATION DECLARATION •Bar Sink Showers Construction Pole Sub. 0 50+ KW h 'hereby affirm that I have a certificate of consent to self-insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter Dup to 100 amps ,00, Lab. C.) • Policy No. Company Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps • U Certified copy is hereby furnished. Dryers ❑Gas ❑Elec — tric Sub Panel Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Date Applicant Fan EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Motors 00-1 HP 01%-8 (This section need not be completed if the permit is for one hundred ($100) or Dishwasher Solar Piping F.A.U. Inc.Solar 09-15 HP 016-15+ less). I certify that in the performance of the work for which this permit is issued I Fixtures shall not employ any person in any manner so as to be om4 a subject to the Drinking Fountains Solar Tank Microwave dr Workers Co:WM: aLon Laws of Calif /JGijfLy.,(� Date %- d V/V- Signature 4L" Floor Drains Swimming Pool w/Spa Device Boxes Pole Light i NOTICE: If,after making this declaration,you should become subject to the - Outlets Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Range comply with such provisions or this permit shall be deemed revoked. . CONSTRUCTION LENDING AGENCY Switches Sign Gas Service Outlets Water Closet g I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) • Garbage Disposal, Standing Sections Interceptors Water Heater Lender's Name Lender's Address l 'fJAla Kitchen Sink Water Service p- Generator 00-5 KW 05-15 KW Trash Compactor .. _ OWNER BUILDER DECLARATION • I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash - following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays - ' 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 Roof Drains the Contractor's License Law(Chapter 9 (commencing with Section 7000) of rhvision 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee , [ -efrom and the basis for the alleged exemption. Any violation of Section P $15 Issue Fee $ 3 1.5 by any applicant for a permit subjects the applicant to a civil , salty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIRE `(--eft �•j b I, as owner of the property Reinspection Fee I $15 Issue Fee $ 3 l.( ( 1/ 1 / gir�pps ' -' " n, will do the work, and the structure is not intended or offered Zoning Approved By Date 1 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES -, Building Approved By Date License Law does not apply to an owner of a property who builds or Improves _ r <' thereon, and who does such work.himself/herself or through his or her own - Application Issued By- Date 9 employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I ❑ sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 'z, SUMMARY OF FEES pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground • prove for the purpose of sale). - BUILDING-PERMIT $ i?C.0&1 SMIP $ 0,7 , ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System _ PLAN CHECK $ AI 7• 7S PERMIT 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 00-100,000 BTU 0100,000 BTU PLUMBING '. $ ISSUANCE $ builds or improves thereon. and who contracts for such oroiects.with a con- - ENERGY P.C. $ tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration I PLAN CHECK 25% $ proof of their Worker's Compensation insurance should be provided to me. ELECTRICAL ,' $ GRADING $ ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG dk Fire Dampers MICROFILM $ $ x Date »�_7 Owner ii✓-f-1 �- PLAN CHECK 50°,6 Heating System & Ducting Registers MECHANICAL $ TOTAL FEE $ '��•s2 I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BTU Information is correct. I agree to comply with all city and county ordinances ' PLAN CHEOK 25% $ and state laws relating to building construction, and hereby authorize repre- sentatives of t Is city to enter upon the above-mentioned property for inspection l00 P SeS./'' ��/r�Ae, '` p -y '- _ ' - ^ /�9J TUT N„ Signet ur .rlG(/ q/H"'I' Date ��7—p� r�. nr, -.. -,1 – 4 Drivers' Lice se or SS# " - - - Reinspection Fee $15 Issue Fee $ 3 s;_4 ' s T _ :.rt,-.. a,,<->/_9 TIi7>=a 11:34 0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor tl.. CONSTRUCTION AND PLANNING POO' SPA `'r 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.-Elecfrical Conduit Utility-Undrgrnd. 54. Forms i n - 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 1,• 7.. Footings ' ,it - 58. Electrical ConduitUndrgrnd.l U , 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 d/ 63. Heater & Vent-Final ! • ' 13. Roof Drains 64. Plumbing System - Final ' i 14. Rough Plumbing 65. Electrical-Finale 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 i 70. Underground Hydro 22. Ducts, Ventilating • . 71. Product Piping 0 Gas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil s 25. Roof Sheathing • 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat ` 75. Dry Chemical 27. Frame and F}eshiaW OA0tr I/�/�"/ 76. Dry Standpipe 28. Lathing & Siding J l/ 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION . 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: do ,,,,�..,.s/s7 .r%, ,9 34. Final Heating & Air Conditioning g/�+r /" on IC r-feir 35. Final Gas Pipe-Test ler 36. Hood or Canopy ' cAvoi{ J Ate 37. Final Factory Fireplace ` 38. Final Plumbing /�/�/ �� °I- - 39. Water Service-Final'-; '40. Gas Service-Final •741. Solar Domestic-Final 42.'Backflow Preventer• . 43. Backflow Irrigation • 44. Landscape Irrigation System 45. Sound Attenuation ... 46. Handicap Regulations ••••••"*...-----;7 - 47. FINAL STRUCTURE & BUILDINGfine _- 48. Special Requirements Completed ,t 49. Electric Release to Edison• - - .-50. Gass Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY ' No. ' Date _ .. ,:' •i 28024 • COSTA MESA BUILDING-SAFETY DEPARTMENT JAN 12-6 ° .4.436* ***154.50 P.O.BOX 317 COSTA MESA,CALIFORNIA 12. For Applicant to Fill In Completely APPLICATION FOR PERMIT Tr . 5492 TYPE OR PRINT Pl . 68,»A BUILDING For Office Use Only BUILDING ADDRESS 2757 Sandpiper Drive RECEIPT NO. PERMIT NO. COSTA MESA, CALIFORNIA R� •IBY DATE RECEIVEDk GATE IEAIE`^M1 1D OWNER MPS a, Verde Buildersau h'7 ' F ,. MAIL ADDRESS17('/�� '' a 6' ADDRESS 2850 Mesa Verde Drive FIRE crry Costa Mesa 5494'01:0395 ZONE TYPE OARCHITECT R ENGINEER Kaltenbach TEL BY DATE DATE / �I ZONING r ADDRESS 182:3 F. 17th St , S A. ZONE I NO.OF USE OF NEW � Rl PLANS Z /BUILDING watt ea CONTRACTOR Mesa Verde Buildess _ C ADDRESS 2850 Mesa Verde Drive GL DESCRIPTION Lot 12. Tract 5492 CITY Costa Mesa A.P.NO. non NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATETELTEL SO'TO SIDE P.L. LIC.NO. 181269 EAVES OF LOT 58 x 105 x 84 I N.o.w. ON LOTSIZES O ALLOWED (U.B.C.REQUIREMENT) YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. (FROM C/L STREET) . SETBACK LINE FROM I I FRONT LL FT. FT. CENTER OF STREET 48 REAR YARD 40 7 SIDE YARDI LEFT 141 - I. RIGHT 5 ' R.SIDE .��FT. -1.- FT. / DESCRIPTION OF WORK L.SIDE //f FT. FT. , I NEW X ALTERATION ADDITION REAR L�� FT. FT. DISTANC/E BET. BET.MAIN& REPAIR MOVING DEMOLISH MAIN BLOCp9, ACCESS.SLOGS. BUILDING - VAR.# DATE SIZE L612 sq I ROOMS 9 STORIES 2 C.U.P.# • APPROVED EXTERIOR WAL1,rWood ROOF Wood APPROVED COVERING LStUCC oI COVERING Built up BY W. L. D. .`ATE 1-1.-68 USE OF BUILDING AND WORK TO BE PERFORMED , Single family residence IBJ/ Ste4/. , _fi/ v?lo/4BQ.F47.74/-4-2b o 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SH N UNDER VALUATION IS FOR THE F AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF E ABLIEHI NG A PERMIT FEE ONLY. G PLY WITH AL C ORDINANCES AND STATE LAWS REGULATING VALUATION p,_,� p BUILDING cox TRUCTION. PERMIT FEE $ AO Vv j SIGNATURE O�, C� OJC)/.�e `/1 F PERMITTEE A�7 F� K� ` G AUTHORIZED AGENT � v 6-4 7�(J N CHECI( S/1/45711\7yb 0 LL TOTAL FEE $ T‘S2)