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HomeMy WebLinkAbout1919 SUVA CIR - Building Permits CITY OF COSTA MESA - • �w"�a BUILDING DIVISION )•• '��.�-qm�,l 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us �•i'a�. FOR INSPECTIONS CALL:(714)754-5626 `*'oenm PERMIT NUMBER: BX07-00062 PERMIT TYPE B_MISC STATUS: ISSUED DATE ISSUED: 08/22/2007 ISSUED BY: RMD JOB ADDRESS: 1919 SUVA CI CM Suite/Unit: Vicinity: SIDE YARDPrimary Occ: .,,const Type :?? SQ. FT: 40 Valuation: . $7,200.00 • SCOPE OF WORK: CONSTRUCT A.40•LN FT. OF 3 FT. HIGH MAXIMUM RETAINING AND 3FT. HIGH BLOCK WALL ON TOP ALONG BALEARIC DR. • 6 FT. HIGH MAX. ON LOWER SIDE OF GRADE (ALONG PUBLIC RIGHT-OF-WAY SIDE). HT OWNER: RIZZACASA, SANDY A TR Address:: 1919 SUVA CIR • Unit City/State: COSTA MESA, CA Zip Code: • 92626 Phone: 714-546-4225 APPLICANT: MADRID; EMMET Address: Unit: • City/State: Zip Code:- Phone: 714-775-0315 CONTRACTOR: EMMETT MADRID LANDSCAPE - -- License No. 303527 Address: 16533 MT TODD _ Unit: City/State: FOUNTAIN VALLEY, CA Zip Code: 92708 - , Phone 714-775-0315 Cell: ARCHITECT: License No.- Phone ENGINEER: BERNARD ADAMS License No. :10183 • Phone -FEE SUMMARY Building Plan Check: $99.61 Building Permit: $153:25 - Electrical Permit: $0.00 SMIP Residential $0.72 SMIP Commercial $0.00 $0.00TOTAL FEES $253.58 • 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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. CODE S. INSPECTION TYPE DATE INT111ALS CODES INSPECTION TYPE DATE INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof // a///�/ 210 Final Electrical g"7 201 Final Block/Retaining Wall Vn 7 V ry 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 r I WORKERS'COMPENSATION DECLARATION: • Owner ID verified by driver .se. ❑Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: ,Driver's License No. 'Expires: O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for.the performance of the work for'which this permit is issued, O 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: 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 CL amer.> S '�,�y0 or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This sector need rrorbee oajnplle�ie:�I ffy perm(is valued at one hundred dollars($100)aless.) 2,Ah 2, Sec.341,Title 8,California Administrative Code). PDlicy Number ©OO?.SJ Lr it? ) C ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workes' c pensation provisions of Section 3700 of Applicant'sSignature Date the tip Code, I shaltq�j�h c ply with these provisio s. the •/ //j , __ Division of Industrial Safety Permit Number: 'Appli nfs ignatur D e"' -� HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes ❑ No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑No Li_# ,�I (' ��/ C G�sCJ (/ /I Class# ( ,— 8" (Section 25533 of the California Health and Safety Code, with some le( y-'� exceptions, requires registration with the Costa Mesa Fire Department by yiy.LL?�%'- �� (/ �y each business which at any one time has on hand a quantity of acutely CLo_ntrador'ssgnaure rDate 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work fa which this permit is issued.(Sec.3097,CMI Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes 01No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Dale 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑ No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑ No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications fa non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes ❑ No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). Q I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No thereon,and who does such work himself or herself or through his or her own 8. (If"yes", attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for control ofscer 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 CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and Q I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec. 7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspectio urposes. I agree of to upy or allow occupancy of any building out ythisp rffinal' ection.dirt Signature o Legal Tsr� Date Signature Date e / • T � 1i305.)-dbl3/0]) VAnwor Autho, ppliran r—-o CITY OF COSTA MESA CALIFORNIA P. 0. BOX 1200 From the Office of the Planning Department Me. Vie Marton April 21, 1965 1491 Baker Street Costa Dleaa, California The City of Costa Mesa wishes to advise you that in revising street addresses, the numbers listed below were changed: Old Address New Address 1935 Balearic Derive 1919 Suva Circle (Lot 56 - Tract 4341) For your convenience we are listing the agencies below that we will notify of this change. In addition to those listed, you may desire to notify your correspondents of the change. Your cooperation in this matter is appreciated. Very truly yours, W. L. Dunn Director of Planning By: it esti Planning Technician rlb cc : Southern Calif. Edison Co. Southern Co. Gas Co. Costa Mesa Co. Water Dist. Pacific Telephone U. S. Post Office County Clerk (4) Public Works Dept. Engineering Dept. Bldg. Safety .✓ Street File Pacific Facility Test Center Bond Department CITY OF COSTA MESA PLANNING DEPARTMENT "Bfl -3-71vArtO:i 12& A. P. No. 139-431-31 Bldg. Permit No. 3_99873 PARK AND RECREATIONAL FEES - Apartment Developments Fee Payment Receipt Project Address 1919 SUVA CIRCLE, COSTA MESA, CALIFORNIA Owner's Name JAMES S. FERRIS Bachelor or 1 - Bedroom Units 1 @ $25.00 = $25.00 2 - Bedroom Units @ $40.00 = 3 - Bedroom Units @ $55.00 = • 4 - Bedroom Units @ $70.00 = 5 - or more Units @ $75.00 = $25.00 Total Fee Total number of Dwelling Units 1 Planning Department Approval Date 8-3-71 Par rea No. 12 By W.L.D. ag Applicant's Signature PAID AUG -3-71m-5700 126Ra****25.00 CITY OF COSTA MESA PLANNING DEPARTMENT A. P. No.1i Bldg. Permit No. 3 .3 V,Pia PARK AND RECREATIONAL FEES - Apartment Developments Fee Payment Receipt Project Address 1 :t: 'tvY3 C:(: L. , C' T", . , r;L . . :!' Owner's Name ' . Bachelor or 1 - Bedroom Units 1 @ $25.00 = 2 - Bedroom Units @ $40.00 = 3 - Bedroom Units @ $55.00 = 4 - Bedroom Units @ $70.00 = 5 - or more Units @ $75.00 = . .' Total Fee Total number of Dwelling Units 1 1 Planning Department Approval Date ? i PP k A ea No. 1;. By •L. '• c% Applicant's Signature .,C7' K1 OWNER FERRIS., James S. ( DATr 8-3-71 \NisiiJOB ADDRESS 1919 Suva Circle BUIL-AG PERMIT NO. 33483 .GENERAL CONTRACTOR Owner-Bldr. DESCRIPTION of WORK Encl.porch for room 4APNo139-431-31 LOT TRACT FIRE ZONE VALUE $3,375.00 INSPECTIONS Signature Date GROUP J. TYPE V ZONE R-1 SOIL SUBCONTRACTOR PERMITS ISSUED GAS Date Number Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE❑ HOUSE CON. 0 SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER 0 /�pjc' r n ROUGH WIRING �` y - /I Heating and Vent. TRENCHES 0 FORMS 0 STEEL REINF. ❑ FLOOR SYSTEM BOND SHEATHING FRAME AND FLASHING LATHING — IN n OUT 7 - PLASTER, BROWN COAT STRUCTURAL, FINAL Ele tri C (�/7�j//J• /, �/� HEATING, VENT., REFRIG. AND A.C., FINAL e /,�`-'_ g ?,2-,/ t' ito-.. PLUMBING, FINAL AND GAS TEST 7 � J ELECTRIC, FINAL /<jf '227.7/ • 33483 1UC -3-71�e5°OO 127:1 ****392C COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely �s� /� /� RECEIVED,,,B'i DATEp� RECEIV DATE ISSUED ADBUILDING DRESS rC, I q SOWI /tel i (ri If— O 5/-3 -7/ OWNER �// MES 1 , /�F-PP A.P. NO"/39— S/3/-3/ P , �P BUILDING /� j� ,/- - /�"IO ADDRESS SAN ADDRESS (.(/rR LN'CiCX/ MAIL Z M '— y3Y/ zSd W W / TRACT LO BLOCK Z- U CITY Co S7"f) /''I C SA NO. 3�9i' NEW ADD ALTER REPAIR MOVING OFMOI ISH Z < CONSTRUCTION O 1- LENDER ,/ am V 3 J7 BRANCH `V,'fl.w ,/� ..� ' J CO OWNER -t[( Q W ADDRESS _ e \ 1 r�. m J /Jr4 //'�`..s"'sss"'JTTT/"'/"`^^^"/_ VALUE OS 7� J m ARCHITECT TEL. USE »1-. $ OR ENGINEER NO U(in FIRE W Z ADDRESS ZONE TYPE GROUP 1 12- LLl APPROVED . I ��/i �j / --I O CONTRACTOR n(MA r 4->2 BY D 70LDATE a I �/ CO Z J cc ADDRESS W W TEL. ZONE NO.OF USE OF NEW O= CITY NO. _ / PLANS BUILDING ZI- O STATE CITY YARDS APPROVED YARDS APPROVED LU to CC LIC.NO. LIC.NO. MAIN BUIL INC ACCESSORY BUILDING 00 (F'NO.OF BLOCS. � ide- OF LOT_ „OA/ o23J,.L22 NOW ON LOT : L E 1' Ji SIZE FT. USE OF EXISTING BLDG. 2 2 GO`Si N � -�JcFT. I— SIZE OF NO.OF Wr Z NEW BLDG. ROOMS STORIES / L.SI FT. UEXTERIOR WALL ROOF _ COVERING COVERING _ REAR .01,...5 FT. FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 1 CL MAIN BLOCS. ACCESS.BLOCS. DATE a0 CL.OS� 0,-.1 Po 12C)4 l-02 cU.P# APPROVED I- APPROVED / mil , e-3-7/ z ALL I�iJ l� AQ S Poo Nr AY / DATE 0 0P I hereby acknowledge that I have read this application and state D that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ I— any person in violation of the workman's compensation laws of N the State of California. ce S '9 Z I hereby certify that I am properly licensed as a contractor under ----SQ. FT. o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR i Chapter 9, and that such licenses aro In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 9 cc am exempt from the provisions of the State of California Business and Professions Code,Division 3,Chapter 9. VALUATION / -- a) PERMIT FEE $ (� N to Signature/dr ] Permittee —id' `f,/$ .Z 7S PLAN CHECK $ /3 -- E Authors -d A1:• 39�. u. TOTAL FEE $ 19820 FEE RECEIVEC COSTA MESA BUILDING-SAFETY DEPARTMENT OW 1 d 1Q8$ • P.O.BOX 317 COSTA MESA,CALIFORNIA FINANCE DEPT. For Applicant to Fill In Completely Ciff ib tr F RERMIT Tr. 4341 TYPE OR PRINT Lot 56 B ILDING BUILDING a For Office Use Only ADDRESS . ,J •17C To 7 ' \ 1 RECEIPT NO. PERMIT NO. Vt COSTA MESA, CALIFORNI /� a 19820 Lu(Jr RECEIyDDOT PATE RECEIVED DATE ISSUED OWNER Grove Park Construction,Inc., -�.t�f14 b --/-/—b,.. JUN 1 9 1963 _ 11 ADDRESS 1653 Minorca Drive ADDRESS°9 ""��.I�r__� "/.il_ __� CITY Costa Mesa Na' KI-90398 ZONE Mel�(9�TYPEGROUP C /% ARCHITECT C 772 TEL. BYPROVEO DATE OR ENGINEER E•G•Kaltenbach NO. -336 ADDRESS 9772 Katella Ave.,Anaheim ZONING NO.OF USE OF NEVr'(-T {1A�',( Mesa Verde Development Co. ( I PLANS L BUILDING Ri C"fes �1 CONTRACTOR P R K/�yl l LEGAL ADDRESS 1653 Minorca Drive DEBGRIPTION �g C�1 .S 6 f? ��y I CITY Costa Mesa - A.P.NO. � . NOTE: NO EAVE OVERHANG SHALL BE LESS THAN SIC. TATE 181322 To. KI-90395 SO"TO SIDE&REAR P.L. No EAVES SIZE 85 x 102' I NO.OF SLOGS.°' ALLOWED (U.B.C.REQUIREMENT) OF LOT NOW ON LOT YARDS APPROVED YARDS APPROVED USE OF --- MAIN BUILDING .ACCESSORY BUILDING EXISTING BLDG. (FROM C//L�STTREET)�J /arc C/Z y4-3 SETBACK LINE CENTER OF STREET 50 REAR YARD 32pFRONT ;^ry FT. /�J o //,�{�/Y�' L FT. SIDE YARD LEFT 20 I RIGHT 8 R.SIDE .FT. ( "'� `/�F"r• `f DESCRIPTION OF WORK L.SIDE 20 FT. FT. NEW X ALTERATION _ ADDITION REAR ---FT. FT. DISTANCE BET. BET.MAIN& MAIN BLDGS. ACCESS.BLDGS. REPAIR MOVING DEMOLISH BUILDING NO.OF VAR.# • DATE SIZE 2243 s.'f. ROOMS 8 STORIES 2 C.U.P. APPROVED EXTERIOR WALL WOOd Q$t ROOF shake APPROV [ -Q l COVERING Stucco I COVERING S"Ingle - BY .0DATE O'.%�6.-3 USE OF BUILDING AND WORK TO BE PERFORMSD single family residence and attached garages Plan 5 A / /4/624&1 -i 77 i A‘tickt '11? I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UND R VALUA N IS FOR THE AND STATE THAT• E ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. Y � y.IIyy O PLY WITH ALL yyyyy���.�.��yyy�...Il����y.yyy�•ROMANCES AND STATE LAWS REGULATING VALUATION �� m BUILDING CON" •N. -A F SIGNATURE O' PERMIT FEE $ 6 PERMITTEE n /y�� G $ (`2� Gj�L°T� PLAN CHECK $ j 0 AUTHORIZED AGENT pl //�/_�/ � I` 6:. TOTAL FEE 24 I 79 COSTA MESA BUILDING-SAFETY DEPARTMENT 1965 ' P.O.BOX 917 COSTA MESA,CALIFORNIA MAY 18 1 For Applicant to Fill In Com•let= t - - APPI►�j��A�TI RMIT TYPE OR PRINT - ,r. - - I�n � BUILDING •• /f —Far-Office {/Se *Jnly ADDRESS- • [-'` rte{ 1i //g�j 9�J RECEIPT NO. PERMIT NO. // // /// T E ' LI..=4A • a ? 7 OWNER / / L.c7 L,y.i 11 I RECHI;e��j _0,,,,.rOE� a TE/5 E'p{D/w/ MAILESS / / // ✓ EA4/� BUILDING,1 7/(]�N ADDRSS / / 7G(/ (/ �I/ N! i CITY COSf14 /14A ThS NO.ELS.—.S. FIRE ZONE TYPE GROUP APPROVED ARCHITECT TEL. BY / /DATE i OR ENGINEER NO. ZONING ADDRESS /� Z / I NO.OP4.1,../I UEHOPNEW CONTRACTOR �,/ N�5 /14 AS dA' 'C i PLANE BDILDIND J 7l4/ �O N ccccRIPTION Ln-t-- sG p(-R t3 Li j ADDRESS D ,_y/ h ( ] CITY 0R/ p, �/h 1..- A.P.NO. [ ✓ 7- (43/— .73 / -1 `(/� p O . NO. i 5T 53 NOTE: NO HAVE OVERHANG SHALL BE LESS THAN STATE /J TEL. [Lg SO" TO SIDE&REAR P.L. LIC.NO.II�� p J71I -q PT �/ 7 / SIZE o G [ /� (o 1lT / J. EAVES +/'y I �1 �6 q `� I NO.OF EILDOB. ALLOWED (U.B.C.REQUIREMENT) OF LOT ye ✓. NOW ON LOT USE OF (O 1•'j YARDS APPROVED YARDS APPROVED EXISTING BLDG. MAIN BUILDING ACCESSORY BUILDING (FROM C/L STREET) 4 %� SETBACK LINE FROM FRONT FT. (/ F r. CENTER OF STREET REAR YARD SIDE YARD I LEFT I RIGHT _ — R.SIDE FT. 6 FT. DESCRIPTION OF WORK L.SIDE FT. FT. NEWT ALTERATION ADDITION _REAR FT. /If DISTANCE BET. BET.MAIN 9 MAIN BLDGS. ACCESS.BLDGS. REPAIR • MOVING DEMOLISH BUILDING ,— NO.OF VAR.# DATE SIZE ROOMS STORIES _ C.U.P.# p APPROVED 7 COVERING EXTERIOR WALL I COVVEF RING APPROVEDDI I III j> USE OF BUILDING AND' Or WORK TO BE PERFORMED ED /fr �(/(lI d !O AP 11171- ' L,nio n . !N /ASC/ SG.Pt I HER BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE i • AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY [ORANGES AND STATE LAWWW((('ITTiEGULATING BUILDING RE U N. e VALUATION �, O SIGNATURE OF (..all • PERMIT FEE $ PERMITTEF ��vj tQ O $ 5 PLAN CHECK $ C AUTHORIZED AGENT Cd H TOTAL FEE $ J