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Home My WebLink About892 SENATE ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 892 SENATE ST Suite: Vicinity: ParcelNumber: 42238504 App�icant: WHITNEY, ROBERT Address: owner: CUSHING, BRETT Address 892 SENATE ST COSTA MESA,CA Contrador: WHITNEY ROOFING Address: P015396 NEWPORTBEACH,CA Zip: 92659 Arch : Address: Zoning: Phone: Zip: Phone: Zip: 92627 Phone: (949)548-0769 License: 406022 Eng: Address: ISSUED BY: Status: ISSUED Applied: 12/01/2000 Issued: 12/Ot/2000 Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING. RE-ROOF W/ 25 YEAR COMP. Plan Check: $0.00 Permit: $97.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $97.75 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Ezistin : 0 NOTES: Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING 8 ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0-0 Righl 0- 0 $3,307.00 $3,307.00 NOTICE: The work authorized by ihis 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 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order tor ihe work authorized under this permit to be considerad legal, such work must comply with all applicable codes, and all requlred Inapections and (inal approval must be obtained. Failure to obtain inspections and final approval will resufl in Ihe expiration of ihls permit. FOR INSPECTIONS CALL: (714) 7545626 �aafrae �aqa� WORKERS'COMPENSAnON DECLARAnON: � I hereby eMlrm untler penelry of perjury one ot the �allowing declarations: ❑ I heve entl will maln�ein e certificate of consenc ro self-Insure for workers' compensetion, es Drovided tor by section 3700 at the Lebor Code, tor the peAartnence oi the work tor which Ihis permi� is issuetl. ❑ I hava end will maintain workers' compensatlon insurance, as r uiretl �y section 3700 0l Ne Labor Code, for t�e pertortnance of the woAc for which Nis pertnit Ls Issued. My workers' compensation Insurance carne� en policy nu er are: Garrier: �_ _ • Poliry Number. (Tbis seclion nse0 nat be canpleteU' e pertryf'is veluetl one hundred dollars ($100) or less.) ❑ I certity that in the peAo�ce of FAIIURE ch ihis pertnit is issued, I: I should become suDject L WMPENSATIQV CAVERAGE IS UNLAWFUL I TO THE COST OF COMPENSATION. DAM4G LICENSED CONTRACTORS DECLARATION: I hereby aflitm ihat I am licensetl unde� pmvis' lome anC eflact. Lic. a �� not employ eny person in any manner so es to become sublect to iha workers' �vorkers' compensation provlsions of Sectlon 3700 f the Lebor Code, I shall iorthwlth � oa�a: /�� /�o �HP1L SUBJECT AN EMPLOVER TO CRIMINAL PENALilES AND CIVIL FWES UP TOONE HUNDAED PRWIDEO FOF IN SECTION 3108 OF THE LABOR CODE, INiEREST, M!D ATTOiiNEV'S FEES. with Sectfon 7000) ot Division 3 of the Buslness end Prolessions Code, antl my Ilcense Is In tull Class a Dete: / fYC7 CONSTRUCTION LENDING AGENCY: ❑ I hereby attirm ihat Ihere is a construction 18nding agency for ihe pertormance ol Ihe work lor w�ich ihis permit is issuetl. (Sec. 3097, Civil Code). Lenders Name: Lenders Atltlress: SignaNre: Date: OWNER•BUILDER DECLARA710NS: I hareby aHlrtn Ihat untler Oenalry ol perjury chel I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the lollowing reason (Sec. 7031.5, Busineu end Professions Code: My ciry or counry which requires a permit m wnstruct, alter, improve, demalish, or repair any structure, prior to its issuance, elso requires the applicant tor such permit to tile e signed sletement Ihat he or 5h8 i5 IlcenSBtl pursuent to Ihe provision5 0l Ihe Conlrectors License Lew (Chapter 9(commencing with Sectlon 7000) ol Dlvision 3 of the Business ena Professions Code) or ihat he or sha is ezempt therefrom end tha Desis for the elleged ezemption. Any violation o� Sectian 7031.5 by any epplicant for e pertnit subjects the eDP��nt to a civil penalry of not more ihen live huntlretl tlollars (5500).): ❑ I, es owner of the properry, or my employees wlth wages as their sole compensatlon, WILL DO 7HE WORK, and the structure Is not intentletl or oHered tor sele (Sec. 7044, Business and Professions Cotle: The Conirectors License Law dces not apply to an owner ot properry who builds ar Improves iherean, and who does such work himself or herselt or through his or her own employees, providetl Ihat such improvements are not intended or oHered for sale. If, however, the builtling or improvement is soltl within one year ot completion, t�e ownBr-builder wiil have the burtlen of proving ihat he or s�e tlid not 6uild or improve for purpose of sele.). ❑ I, es ownar of the pmperty, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmct the projact (Sec. 7044, Business antl Protesslons Code: The contrectors License Law does n0� apply to en owner ot property who hulltls or Improves thereon, and who conirects for such prolect with a coNtactor(5) license pursuant to ihe Coniractors License Lews.). ❑ I am ezempt untler sec. Business and Professions Code for t�is reason: Signature: Date: Owner ID veritied by tlriver's license. ❑ Ves ❑ No Driver's License No. Expires: Venficatlon ai Ownersnip by (type of dxument, i.e. � property tas bill or deed): DIVISION OF INDUSTRIAL SAFETY VERMIT CEATFICATION: ❑ I hareby certity �hat no excavation fiva (5) ol more leet in depth into which a person Is required to descend, will be made in wnneciion with work authorizetl by t�is permit, and that no building structure, scafla�tling, lalsework, or demolition or Aismantling thereol, will be more ihan thirty-six (38) teet high. (Chap. 32, Grp 2, AN 2, Sec. 341, 71t1e B, California Administrative Catle). ❑ As owner-builder, I will not employ enyane �o tlo work which would require a parmit from Ihe Division of Indus�nel Safety, es notetl ebove, unless such person has e permit to do such work from the tlivision. Signature: Division oi Intlustrial Safery Permi� Number: 2 J Date: W ill the epplicant w p�asant w tuWra �uiltliag �cupant naetl to file antl ce�tily a Business Plan tor emergency respo�se to release or threataned release at a hazardous malerlel7 ❑ Yes � No (Section 25505 of the Califomia HeaIN end Sefety Code repuires, with some eaceptions, t�et e Business Plan De filed with the Costa Mesa Fire Departmem Dy every business which has at eny one time during a reponed year a quantity of haiartlaus metenals equal to or greater than a weight of 500 pounds, or a volume o155 gallons, or 200 cu6ic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................. Does or will the epplicant or present or luture builtling occupant naetl to lile a regisiretion form tor acutety hazartlous materials? ❑ Ves ❑ No (Sectlon 25533 of the Califomia Health antl 5afaty Code, wiih some exceptions, requlres registratlon with the Costa Mesa Fire Department by each business which et eny ona Iime hes on hend e quantity ol acuiely hazardous malenals equal to or greeter Ihan e weight ot 500 pounds, or e volume of 55 gellons, or 200 cubit feet of compressetl gas at stendard temperelure ana pressure). .............................................................................................................................................................................................................................................................................................................................................................................. Does or will ihe eppliwnt or present or tu�ure building occupant need to prepere an RMPP (Risk Management enG Preventlon Program tor acutely hazartlous materlals)? ❑ Yes ❑ No (Section 25534 of ihe Califomia Health and Safety Code provides tha� �he Coste Mesa Fire Department may require �he preparation, certification and liling with the Flre Depanment oi en RMPP by 6usinesses w�icP are required to register aatety hazerdous materiels with ihe Fire Depenment. ....................�.......................__..........................................,............... __......................................................................._............................................ .............._................._....................._..........................._...... It an RMPP is presenlly required, has Section 25534 ot the California Healih end Safery Code been fully wmplietl with7 ❑�Yes ❑ No ......................_._......................."'._._.............._............_..................................—_..........................._......................................—.............................................................._._.._............__..............._............_............�._... Does or will Ihe eppllCant or preseni Or fuWr� building occupant require for the work which is Ihe subject ot tNs e plication e ermit tor such consiruc�ion or modificatlon irom t�e South Coast Air �uality Menegeme�� Disirict or from eny other air pollution conirol tlisirict or agenc�? � Ves � No (Section 658502 of the Califomia Govemment Code raquires that the requested inlormation Ge furnished on epDlica�ions tor non-residential building pertnits). ............................. .._..............-.____....._....................................—......................................'__............................................................... .......................... .............._.............._.............._._.........._. Will any pan of the laciliry to be wnsiruaed Under Ihls permii De wit�in 1000 feet Irom the outer boundanes of a school7 ❑�Ves ❑ Na (If yes", tha facility must meet the requireme�� of Sections 25534 and 42303 ot the Califomia Healih end Safery Cotle). ........................................................................................................................................................................................................................................................................................................................................................... _............... _ If e pertnit Irom Ihe SouN Coasl Alr �ueliry Menegement Disinc� or other.eit Oollu�ion control tlisirict or agenry is requireC for ihe work which is Ihe sub�act of ihis epplicatlon, havo ell of the disclasures prescdDetl �y Calitomia Healih end Sa ry Cotle Section 42303 been made7 ❑ Ves ❑ No ............... . . ........................................................................................................................................................................................................................................................................................................................... Qt'yes", ettach certificate oi compliance irom tha eppropnate air pollution contr I oflicer). CERTIFICATE OF COMPLIANCE: I cetlily that under penalry of perjury the i formation given ebove is correct. I egree to comply with all stata laws antl ciry ordinences regartling Hazartlous Matenals antl Emissions. Signature: Date: CER7IFlCATE OF COMPLIANCE AND correct. I agree to wmpty with all stat ebov0-de5tribed pmpertyforinsp� GODE N, INSPECTIONTYPE 1616 Fixed Sys[em Final Fire Prevention 12fi6 Pool Spa Final 200 Finel Re-Rooi 201 Flnal BIocWRe�aining Wall 202 Final Factory Flre Place 203 Finel Sign 206 Finel Demolitian pR�A710N NiAY: I ce under Oenalry ot peryury that I have reatl this epplication antl state that the inlortnation given is and ��ry inances relati to building consiruction, end authorize representaWes of the Ciry of Costa Mesa to enter upon Ihe ises, grea n to or allow occupency of any building authonzed by this permit umil tinal inspection. er(s /�� pate ed plitant ' �/oate QAjg INTRIpLS CODEA INSPECTIONTYVE QA¢, �$ 20fi Final Mechanical 20B Final Plumbing i^( G-ov � 210 Final ElecMcal 212 Final Fire Prevention 220 Finaf Planning App�aial 222 Final Site 250 Final BuiltlingiOccupancy \ CI7v OF COS7A MESA . CON TRUCTION �ERMIT f, Project Address ' _ Applicant's Mailing A dress Owner's Name n �n Phone jln�� Address --�lxsG/L(, D � Arch/Eng. License No. Address Contractor's Nam Phon Address (mailing) City License No. LICENSED CONTf3ACTOR DECLARATION I hereby aftirm that I am licensetl untler provisions ot Charler 9(Commencinq with Section ]000) ol D(vi5lon 3 O/ the Business antl P�ofessiOns Cotle, antl my license is in full i tl effect. License CI �/�']j/ �/�/ �/'��' e o. nate � 5'9 t '^��"� � 1RKE 5' C MPENSATIONrDECLARATION ereby atfirm thal 1 have a cer[ificate ot consent to seH-Insure or a certificate ol Workers' Compensation InSurance, Or d certifi¢tl tOpy I-yher¢Of (Se<tion 3800. Lab.��/ ^/��'O� ComPany ��; %�� PoIICY NO. �%� �, erti(ietl copy Is hereby furnishea. ppp Cer ' ip�j o I flletl wi[h tlte city B��jny�DitiiSD�n.p�� ate_.PX��_ APPlicant ��/ / ! —�" —� � EXEM ION ROM WORKERS' COMPENSATION DECLARATION (Thi55etlion n¢¢tl nOl b¢ comple[ed H[he permit is ior one huntlretl ($100) or less). I certify that in lhe perfOrmance ot tM1e wo�k fo� which this perm�t is Issuetl, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws oi Califomia. Dale $ignalure NOTICE: I(, aiter •making ihiz tleciaration, you shoultl become subject to the Workers' Compensalion Drovisions of the Labor Cotle, you must forthwith comply with Suth provi5ion5 or this p¢rmi[ shall be tleem¢tl revoketl. CONSTRUCTION LENDING AGENCV - 1 hereby affirm Ihat [h¢re is a construclion lentling agency for [he peifo�mance ot the work tor whicn t�is Oermit is issuetl (Section 309] Civ. CJ Lenaer's Name Lentler'z Atltlress OWNER BUIL�ER CiECLHRATION I hereby aHirm that I am exemo� irom the Contractor's Llcense L.aw for the following reason (Sectlon 7031.5 Business antl Professional Cotle: Any city or counly which reQuires a permi[ to consl�ucl, alter, improve, tlemolish o� repair any structure, prlor to its Issuance, also reqWres the aoP�icant for such permit to flle a signetl statemenl thal he/she is licensetl pursuant to Ih¢ Provisions of 1e Contractor's License Law (Cnapter 9,(commencin9 with Section ]000) of �ivi5ion 3 ot tbe Bu5ine55 antl Protessions Cotle) or that he/she is exempt .herefwm an0 Ihe basis tor the allegetl exemp[ion. AnY violation o( Section 7W1.5 by any applicant for a permi[ subjects the applicant to a civil �ndlty of not mo�e than five huntlretl tlolla�s (E500). I, a5 owne� ot the prOPerry or my employees with wages a5 [heir sole compensation, wi11 tlo the work, antl the structure Is not intentletl or ofteretl fOr sale (SeCtion 7044, BuSiness antl Professional Cotle: The Contrac[Or's Litense Law tloe5 not apply to an ownet of a property who builtls or improves � thereon, antl wno enes such work himseli/herseli or througn Ois or her own em0�oyee5, prOvitletl lM1at such ImO�ovements are noi inlentletl or offereC for I yyle. If, however, the builtling or improvement ii Soltl wi[hin one yea� of com- pleliOn, the Owner wlll M1ave Ihe bur0en of proving M1e/she tlitl not builtl or im- I prove tor tha purpose of sale). ❑ I, a5 owner ol th¢ property, am ezclusively contrac[ing with licensetl Con- tractors to canstruct che project (Section 7044, Business antl Protessions Cotle: The Contractor'S License law does nol apPly [o an owner of O�operfy who builtls or improvns thereon, antl who conVacts for such projects wltn a con- bactor(s) ucense pursuant to ihe ConVactor's License Law). I am aware thai p�oof of their Worker's Compensation Insurance shoultl be provided to me. ❑ I am exempt untler Section B. & P. G(or this reason Date I hereby certif� inlormation is c dOtl SSdIE �dWS I SCl1(dSIVCS O/ [1 in5peclion purp< Si9nature Oriver5' License _ Owner that I have reatl tnis application antl state that the above rect. I agree l0 compty wlth all city antl <ounty ortlinances atinq to Cuiltling constructlOn, antl hereby authorixe repre- �iqity tg j�n[m upon the above-mentionPH property fo� 55 pplicant to fi11 in all spaces exceot those within neavy eoraer Ilnes ana sign al1 avvropriate tleclarotions. PER �. •'/� ^ TRACT NO. LOT NO. UNIT N6. 5� `; TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, # DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi E TYPEOFPERMIT GRADIrvG OUrvDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear ❑ OTHER %� PROJECT DESCRIP710N 54. FT. OCCUaANcv C Right CONSTRVCTIONTYPE VAI.UATIONS S L¢ft ZONE GRADING CU. VDS. ACRES p�ng. Ref. # Remarks: � Planning Notes: Sink Preventer Irrigation Drinking Fountains Floor Drains Floar Sinks GasService Outlets Intercepmrs Kitchen Sink Lavatories P—Trap Roof Dreins Reinspec[ion Fee � §15 Duct� UnderGround Duct - SVuctural Duct - Ventilating Exhaust SYstem ❑ Multiple ❑ FirepUFacL Blt ICBO # Heating System & Ducting ❑0-100,000 BTU 0100,OOOBT� ReinspeMion Fee � $75 CMF 0865-46, rev. 10/84 Whi[e - - ApplicanL Pink - Acwunting; Goldenrotl - Assessor FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Issue Fee $ 3 Automatic Washer Consvuction Pole Su Cooking Unit Dishwasher Dryers ❑Gas ❑EI Fan F,A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generaror �0-5 KW A Building: Zone ELECTRICAL Transformer ❑ 75-50 KW ❑ 50+KW Meter ❑up Lo 100 amps Meter ❑over100amps Sub Panel .Motors00-7 HP�1Yx-8 � Inc.Solar 09-15 HP �16-15+ Microwave Pole Light Range Standing Sections 5 KW Trash Compactor Reinspection Fea I$15 luue Fee IANICAL FEES Hood or Type I ❑ DEVELOPMENT SERVICESREQUIREMENTS: Canopy Type II ❑ Zoning Approved By Date Building Appraved By � Date Re(rigeration System ❑0�100,OOOBTU ❑700,000 System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 SUMMARV OF FEES BUILDING PERMIT $ SMIP PLAN CHECK S PERMIT PLUMBING $ �� SSUANCE PLAN CHECK 25% $ ENERGY P.C. ELECTRICAL S GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL 5 TOTALFEE PLAN CHECK 25% $ Z O N I N G R E Q M T S FEES $ 3 CONSTRUf,TION AND,�PLANNING POOL & SPA� � � Date Inspector ' Date Inspector AQPROVALS Permit�# APPROVALS Permit # ' . 1.r,Temporary;,Elecvica6.Service or Pole 52. Pool & Equipment Location � 2. Soil Pipe�Undrgrnd. f f 53. S[eel Reinforcement ' 3. Elecvical Conduit Utility�Undrgrnd. 54. Forms � ��,� 4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding �� Y, 5. Steel Reinforcement 56. Rough Plumbing & Pressure.Test . � 6. Eleccrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE , 7. Footings,�� 58. Electrical Conduit-Undrgrnd. ' 8. Foundation 59. Gas Pipe, � Undrgrnd., TEsi �. 9. Water Pipe�lJndrgrnd. 60. Backwash Lines, P-Trap, �,.Undrgrnd. 10. Structural Floor Sy�'stem - 61. APPROVAL TO DECK �� ' �e 71. Property Sewer Line'& Fiouse Connection 62. Backwash & Receptor-Finzl 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrica6Final 75. Rough Elec[rical-Conduit 66. Solar System-Final - 16. Rough Electric Wirinq 67. Fencin9 & Access Approval ' 77. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rou9h Electrical-T Bar Ceiling 69. POOL/SP.4SYSTEMS FINAL 19. Rough Heating & Air Conditioni�g FIRE DEPT. REQUIREMENT • 20. Rough Factory Fireplace APPROVALS Permit # _ 21. Ducts,in Structure 70. Underground HYdro - 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & TeSt 72. Underground Flush ' � . 24. Roof Framing 73. Undergrnd. Storage Tank O�ias ❑ Oil 25. Roof Sheathing 74. Overhead Hydro i 26. T-Bar Ceiling (Structurel) & Monocoat 75. Drv Chemical �i, 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYS7EM FINA� � 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: - i'� ' 34. Final Heating & Air Conditioning . . _� �-� 35. Final Gas Pipe-Test - 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing � 7hZ.r�'� L�� 39. Water Service-Final ' 40. Gas Service-Final . - se 9 41. Solar pomesticFinal . � ��=j � 42. Backflow Preventer - ' � a 43. Backflow Irrigation � . `� 1 �,. 44. Landscape Irriqation SYstem � , "" . 45. Sound Attenuation i�� r 46. Handicap Regulations �'� , 47. FINALSTRUCTURE&BUILDING � • ' 48. Special Requirements Completed . , ' - � 49. Electric Release to Edison . . 50. Gas Release to Southern California Gas Co ' ��. 51. CERTIFICATE OF OCCUPANCY N0. Date � " ! . ' �� ' � -OWNER S.� V. H[TNSAKER & SOIQS DATE ��?��TK7 — )os ADD�ss � 8q2 Senate St. BUILDING PERMIT N�j _��07 GENERAL CONTRACTOR $yRg VALUE S �0(11 (lh AP. No. LOT [o TRAC'I' » uC FIRE ZONE DESCRIPTION OF WORK ' Ro� o, /�++. .,�.. I; 'ECTIONS _ I DATE I SUBCONTRACTOR I DATE PERMITSNUMB coat z�wr�s �� : �: r - 519� COSTA MESA BUILDING DEPARTMENT P. O. BOX 31� COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN �g,i ��-p. COSTA MESA. CALIFORNIA _ .� OWNER �EJ. U. MAIL , AODRE55 CITV "/y.�)�_� ARC .,T OR Ei...iNEER ADORE55 LEGAL DESCRIPTION A.P. NO. SIZE ... ..- �i OFLOT /oJ��JO USE OF EXISTING 6LDG. SET6PCN LINE iPOM CENTEP OF $TPEET SIOE YARD FEE RECEIVED tAAY 2 1 }957 �?f,Q fINANCE DEPT. CITY OF COSTA ME3A APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY PECEIPT ND. PF$�1fi1iQ ��, �� « TNO-y�?��IJ� AOOREI LIC. NO. ��r� ��. �7 NO. o ai ..5 � r ow�orv , o.� CJ / ftIGHT �D LEFT DESCRIPTION OF WORK NEW � ALTERATION I ADOITION REPAIR MOVING DEMOL�SH SIZEDING /� LIC� NO.OF (Q ROOMS STORIES E%TERIOR WALL�/ �J(��, ROOF GOVERING /t/�//+�(� COVERING �C—� use oF New U� /1 �Z, '/� r\ .:i .� COSTA MESA. CALIFORNIA APPROVEO BV OPTE CORRECTIONS �: I HEREBV PCNNOWLEOGE THRT I HAVE READ THIS APPLICATION ANO STPTE THwT TNE ABOVE IS COflRECT arvO FGFEE i0 COMPLT WITH wtL CITY ORDINFNCES PND STl�TE Lh�NS REGUL�ITING Bl11LOING CONSTRUC- riorv. /I (� / VALUATI ON SIGNATURE OF /' ,� p__' ,� / PERMIT FEE S � �� PERMITTEE " �YUY 5 y �D /! PLAN CHECK $ /y � $ �� / AUTHORIZED AGENT // TOTAL FEE 5 ��o � vM� �h