11080181 (2)COVERSHEET
11080181-D
10271 JOHNSON AVE
Ir
DATE
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DATE: Z ',;Z5 -1.2�
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PHONE: 331:911 - FAX:
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DATE:
DATE I""- , TMAL FEES ---I � Z- L -f - -J-
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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10271 JOHNSON AVE
CONTRACTOR: CHANG WOO
PERMIT NO: 11080181
CONSTRUCTION
OWNER'S NAME: JASON PARK
3204 ARCHWOOD RD
DATE ISSUED: 11/10/2011
OWNER'S PHONE: 6507939727
SACRAMENTO, CA 95821
PHONE NO: (916) 607-8420
11 LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL El =MERCIAL11
License Class Lic. 4 7
CONSTRUCT NEW ATTACHED 2 CAR GARAGE 461 SQ FT
Contractor f/�
I A Date W11-19A"�
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area;
Valuation: $16000
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
APN Number: 37518030.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITBW*4 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
Issued by,--���� Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature_ (---�A Date /,'/�V /.:P -D
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
k,'� Loo
installed without first obtaining an inspection, I agree to temove all new materials for
inspection.
OWNER -BUILDER DECLARATION
Signature of Applicant: Date:*
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, as owner of the property, or my employees with wages as their sole comfensation,
will do the work, aid the structure is not intended or offered for sale (See.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505,25533, and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and wil I maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for whichthis permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: 4 Date:
permit is issued.
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 Worker's
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shal I be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with a] I city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with a] I non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
S ignature Date
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10271 JOHNSON AVE
CONTRAcTOR: CHANG WOO
PERMITNO: 11080181
CONSTRUCTION
OWNER'S NAME: JASON PARK
3204 ARCHWOOD RD
DATE ISSUED: 11/10/2011
OWNER'S PHONE: 6507939727
SACRAMENTO, CA 95821
PHONE NO: (916) 607-8420
LICENSED CONTRACTOR'S DECLARATION
F– F–
12-6o_('-7
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lie. #
F_ r– F_
Contractor M/,J r) 1,0,0 0 Date 7--2-r— -1,
MECH RESIDENTIAL COMMERCIAL
I hereby affirm that' �am licensed under the provisions of Chapter 9
JOB DESCRIPTION: CONSTRUCT NEW ATTACHED 2 CAR GARAGE 461 SQ FT
(commencing with Section 7000) of Division 3 of the Business & Professions
REVISION #I- REMOVE KITCHEN ISLAND AND ELECTRICAL
Code and that my license is in full force and effect.
Revision 41- remove kitchen island and electrical , install kitchen peninsula
I hereby affirm under penalty of perjury one of the following two declarations:
with I GFCi tamper outlet
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $16000
performance of the work for which this permit is issued.
1 have and wil I maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
APN Number: 37518030.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes, (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
ZE
granting of this permit. Additionally, the applicant understands and will comply
Is Date:
sued by:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date 7-2-f —D-01 -
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. Ifa roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, 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 & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read (he hazardous materials requirements under Chapter 6.95 of (he
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
I hereby affirm under penalty of perjury one of (he following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with (he Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
(he Health & Safety Code, Se ' 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
/72
permit is issued.
Owner or authorized agent-
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 Worker's
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
4
CUPERTINO
CONsTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 REVISIONc-B
(408) 777-3228 - FAX (408) 777-3333 - buildingacupertino.org
[:1 NEW CONSTRUCTION 0 ADDITION El ALTERATION / TI X REVISION / DEFERRED ORIGINAL PER -MIT #
I
PROJECT ADDRESS 0
1 APN#
OWNERNAME
U>p
ONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
F
11 OWNER 0 OWNER-BuILDER OWNER AGENT CONTRACTOR 11 C ONTRACTOR AGENT ARCHITECT ENGINEER DEVELOPER TENANT
CONTRACTOR 4AME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NOE
111,
FAX
STREET ADDRESS
CITY, STATE, ZIP
PJJONE
ARCHITECTIENGI[NEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
NJ 6 vtocr le -4 e CUrT L��-T)
yj_Tmz_� 191ATL_,r__T Ct�,_Llo
EXISTING USE
PROPOSED USE CONSTR.
TYPE
#STORIES
�
USE
T YPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
I NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PCIRCH
GARAGE AREA: LJ DETACH
____F_1SA
'
OATTACH
# DWELLING UNITS:
S–ECOND UNIT 0 YES
SECONDSTORY 0 YES
BE�G ADDED? ONO
ADDMON? ONO
PRE -APPLICATION El YES IF YES, PROVIDE COPY OF
IS THE BLDG AN 0 YES
TOTAL VALUATION:
PLANNINGAPPL# MNO PLANNING APPROVAL LETTER
EICHLER HOME? [:] NO
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf I have read this
application and the information I av5,0��ided is correct. I have read the Description ofWork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatmgl�to ui ing construction. I authorize representatives ofCupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agen Date: 7—
SUPPLEMENTAL INFORMATION REQUIRED
New SFD or Multifamily dwellings: Apply for demolition permit for
-0
existing building(s). Demolition permit is required prior to issuance ofbuilding
W7
permit for new building.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
.. ........
... .......
To—rm if any Hazardous Materials are being used as part of this project.
n
Copy of Planning Approval Letter or Meeting with Planning prior to
submittal ofBuilding Permit application.
BldgApp.2011.doc revised 06121111
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildinqCcDcupertino.orq
[:1 NEW CONSTRUC-1710N Dd ADDITION
Q ALTERATION/T1 [:] REVISION/DEFFRRED ORIGINALPFRMIT It 111)LF010
PROJECT ADDRESS _7
16-271 J09A1_<-0A1 AV
AP N 9
3
OWNER NA1,E JA,�O/,J _p
PHONE��
F -MAIL
- 272 71
cem
STREE7 ADDRESS 2
_SNAV &Ulf AV *3
,,5qlV1
.�3
CITY, STATE� ZIP
3
FAX
CONTACT NAME
z�441��
PHONE
91K__)0X33 _Asly
E-MAIL
Ae 1
STREET ADDRESS ,
_b6o_ Aka6k�5� AW.
CITY, STATF_ ZIP
FAX
El OWNER El OWNER -BUILDER OWNER AGENT CONTRACTOR 1-1 CONTRACTOR AGENT 13 ApcHmc-r C1 ENGINEER 11 DEVELOPER TENANT
CONTRACTOR NAME aMA)�O
LICENSE NUMBER 7 LICENSE TYPE /3
BUS. LIC #
COWANY NAME
A,k ti,10,0
E-MAIL
_7,
FAX
STREET ADDRESS 3a64 4reAitixW
CITY, STATF_ ZIP
--A 'LIJ-1
PIJONE
—:574C e
Zo7-24w
ARCH]TECTIENGINEER NAME A:��V/ A/
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAJL
FAX
STREET ADDRESS
CITY. STATF_ ZIP
I HONE
-60 A
JZ6 - - 7 R Z6
DESCRIPTION OF WORK
IV _r__ W �2, C,4,e C7��
EXISTING USE
PROPOSED USE CONSTR-TYPE
STORIES
&AZI445- I
6_14k. 1 9 C� I
USE
k,
TYPE
OCC.
SQ.F7.
VALUATION (S)
EXLSTG
AREA
NEW FLOOR
AR.
DEMO
AREA
TOTAL
NET AREA
ui 1�_*_
BATHROOM
KITCHEN
OTHER
REMODELARFA
REMODEL AREA
REMODEL AREA
ion
PORCH AREA
DECK AREA
TOTAL DECKRORCH AREA
GAFLAGEARE& ODETACH
� 061 I�YATTACH
# DWELLING UNITS:
IS A SECOND UNIT L1 YES
SECONDSTORY C] YES
BEING ADDED? E]NO
ADDITION7 1:]NO
PRE -APPLICATION [I YES IF YES, PROVIDE COPY OF
IS THE BLDG AN E] YES
RECEIVED BY-
TOTAL VALUATION:
PLANNINGAPPLA []140 PLANNING APPROVAL LETTER
EICHLER HOME? [] 140
; 17 1 L
4 \
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pr�perty owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives ofCupertino to enter the above-idenfified property for inspection purposes.
Signa=e of Applicant/Agentsx,::�� Date:
SUPPLEMENTAL rNFORMATIOVEQUIRED
PLAN CHECK TYPE
ROUTING SLIP
El OVER-THE-COUNTER
UMDING PLAN REVIEW
New SFD orMultifarnily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance ofbuilding
permit for new building.
C1 EXPRESS
'PLANNING PLAN REVMW
__ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
�STINDARD
PUBLIC WORKS
Torm if any Hazardous Materials are being used as part of this project.
11 LARGE
9-16iiDEPT
copy Of Planning Approval Letter or Meeting with Planning prior to
MAJOR
11 SANITARY SEWER DISTRICT
submittal ofBuilding Permit application.
ENVMONMENTAL REA I TH
BldgApp.2011.doc revised06121111
W
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: AALC"- , Ay.
PERMIT # 416B LQ /,6 /
OWNER'SNAME: PACK JASnAl
PHONE# q,16— g -3a -a6-61
GENERAL CONTRA&OR: "6
BUSfNESS LICENSE #
ADDRESS: -12041 "ChIA)WD AD
CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
—Si�n—ature Date
Please check applicable subcontractors and complete the following information:
j/
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date
CITY OF CUPERTINO
RM -7. FEE ESTIMATOR — BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 10271 Johnson Ave
QTY/FEE
DATE: 07/25/2012
REVIEWED BY: Sean
BP FEES
APN:
I BP#:
*VALUATION: j$1,000
*PERMIT TYPE: Electrical Permit
1
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1REAP10
PERMIT TYPE:
WORK R vision #1: Remove kitchen island and electrical and install kitchen peninsula with (1) GF I tamper
SCOPE �reesistant outlet.
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
FElec. Pennit Fee: 1EPERMT
Recep/Switch/Outlets
1BREMRECEP
Other Elec. Insp.
1
#
$45
Suppl. hisp - CIC
PME Unit Fee:
$45.00
PME Permit Fee:
$45.00
Corwruction Tax.
Administrative Fee: 1ADMN
$42.00
Work Without Permit? 0 Yes E) No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
$45-oO
Strong- Motion Fee: IBSEISAffCR
..........
FEE
QTY/FEE
Elec. Plan Check hrs
10.0 1 $0.00
Ft -h. 11"!rmlf Fec'.
[P111117— Permil F'q:.
FElec. Pennit Fee: 1EPERMT
�NIIJ77. 9— -
f I I � 1. ec"
0/ho'.P.."'Oph Insp
Other Elec. Insp.
Plumb. Insp. 1.ee"
Insp. FCC -
NOTE: This estimate does not includefees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the Preliminary information available and are on1v an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711111)
FEE
QTY/FEE
MISC ITEMS
Plan (-'hcck Fee:
�NIIJ77. 9— -
f I I � 1. ec"
PME Plan Check:
$0.00
Suppl. hisp - CIC
PME Unit Fee:
$45.00
PME Permit Fee:
$45.00
Corwruction Tax.
Administrative Fee: 1ADMN
$42.00
Work Without Permit? 0 Yes E) No
$0.00
. lvonccd Plannin- Fees:
& I
Travel Documentation Fee: ITRAVDOC
$45.00
Strong- Motion Fee: IBSEISAffCR
$0.50
Select an Administrative Item
Bldg- Stds Commission Fee: IBCBSC
$1.00
. ...... ... 4R A.'s'A.;
........ -------------Or 'A%
$17 8.501
"�"` L.�' . ' "Iff.
$0.061"
$178.50
Revised: 07/01/2012
CITY OF CUPERTINO
Fm -ft FEE ESTIMATOR — BUILDING DIVISION
19
ADDRESS: 10721 JOHNSON AVE
DATE: 08/24/2011
REVIEWED BY: SUIEW.B.$
PC FEE ID
APN: 37518 030
BP#: 11080181
*VALUATION: $16,000
'PERMITTYPE: Building Permit
PLAN HECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
2nd Unit? 0 Yes G No
OTC? 0 Yes (E) No
PENTAMATION 1R3SFDADD
PERMIT TYPE:
WORK �
ADD NEW 2 CAR ATTACHED GARAGE
SCOPE�
OCCUPANCY TYPE:
TYPE OF
CONSTR._
FLR AREA
(s.f.)
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom) i
11-B,111-B,1V,V-B
461
$1,482.00
IADDPLCK
$1,205.00
IADDINSP
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,205.00
Suppl. Insp. Fee<D Reg.
0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
TOTALS:
461
$1,482.00
77,;:
i 1,205.00
-
40
MECH, HOU
y.
Yes N PLUMIB HO e$
RLY
0 UR
NOTE: These fees are based on the Drelitninary information available and are oniv an estimate. Contact the DeDt for addn'l info.
FEE ITEMS (I-ee Resollifion 11-053 Elf 711,11
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,482.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: G Reg. 0 OT
070T
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,205.00
Suppl. Insp. Fee<D Reg.
0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Acoustical Fee:
0 Yes E) No
$0.00
0
G
Work Without Permit? 0 Yes E) No
$0.00
Plana��
PLLONGRNGR
$59.93
Select a Non -Residential
Building or Structure
G
0
Stronp, Motion Fee:
IBSEISMICR
$1.60
Select an Administrative Item
Bldp- Stds CoMmissio n Fee: IBCBSC
$1.00.1
..9TJ-BTGT-At-&'1!'
��,749.53
$0.00
.......... A6'
... . ................
$2,749.531
Revised: 071d411?S1'fP
-� k& �, 51-3