11653 (SFD)r
Building
Address k9--21
Owner
Sheldon Diller
•01
��
A' f
P.O. BOX 1504 No. 1165+
78.105 CALLE ESTADO
Ira LA QUINTA, CALIFORNIA 92253
Mailing
Address '77025 Avenue Fernando
City Zip Tel.
La Quinta, 92253 564-1902
Contractor
Stephen Jones
Address
P.D. Drawer 4656
city . Zip
Pala Desert, Ca a 9
State Lic.
& Classif. B 518713'
Arch., Engr.,
Designer Totem, jakway
Address Tel.
7351 W. California 291-4956
City Zip State,
'an Dieacs, ` i� }92110 ` Lic. # C 10907
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of theAialm6ss.a�d!Pr fessions Code, and my license is in full force and
effect. `� `�--_ C n �s'! 4� �i �, . i 1V
Tel.:
City
Lic. # 2096
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's. 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 Tile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Cdde,'or that. he -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).
O I, 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, Buisness and
Professions Code: The Contractor's License. Law does not apply to an owner or property.who
builds or improves thereon and who does. such work himself or through his 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 did not build or Improve for.the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or Improves thereon, and who contracts for
such projects -with a contractor(s) licensed pursuant to the Contractor's License Law.) -
O I.am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -Insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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.
Date . �Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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
This is a building permit when properly filled out; signed and validated, and is subject'to
expiration if work thereunder is suspended for 180 days.
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 the above-.
mentioned property for inspection purposes.
Signature of applicant --Date-
Mailing
ateMailing Address
City, State, Zip
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description Lot 50, Tract 25237
Project Description Sinctle Family Dwell nq
Sq. Ft. No. No. Dw.
Size 5261 Stories 1 Units
Newer Add ❑ Alter ❑ Repair ❑ Demolitiori ❑
Permit includes block wall. Pool vermis
to be obtained seoaravely.
Estimated Valuation $419,480.00
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const:
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Eno.
Infrastructure
hrts in Public
TOTAL
2
10844.
AMOUNT
1201.31
1759,50
306.04
283.50
42.00
20.00
6000.00
798.70
REMARKS
A :..
ZONE: BY:
Minimum Setback Distances -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES ,
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
STORAGE TANK
FLOOR DRAIN
MECHANICAL FEES
DU T WORK l t 3
v `
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REINF. STEEL
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
FIRE ZONE ROOFING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SQ.FT.GAR @ V4c
HOUSE SEWER
LATHING 6— 3 Ly
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING//(5-/t3 tfl UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS Vy
SEWER OR SEPTIC TANK ROUGH WIRING.
DU T WORK l t 3
v `
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)l l —2 !3 3r, METER LOOP
fJ!
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE l 2 q3 lln
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
G RADI NG
/ecu. yd.
VV$ —plus x$ _$
LUMBER GR.
FINAL INSP. ,— U
FRAMING �� �} L'
J
FINAL INSP. 11-3
(
ROOFING
G
VENTILATION
/ f
rite Ptv-r ��r��..
1
��ld Q��l /�{Cn�
�—� •� 3 Lb P
�o &ea &V-A P - r -G P
✓�/��� 3 C/b
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL -16-960
LATHING 6— 3 Ly
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
REC�O�R[),RQ(REOUEBTIiD BY
AND NNEN N}'COQQiDtiArTN11"DIiD'. ;;"e.116-
NEtO1N •AIL AN NUTMEAT Te: .
Nam r Sheldon.
JDiller'.,
iaet 77021. Ave: Ferna17d0r. .F
city It La Quinta, Ca. 92253
else L
MAIL TAN STATEMENTS TO, I
Nems 4 - � US �/ 8
16 J
Street
Aoereu •'H ? j
- ! SAME AS ABOVEIll< _..
-• _ — -
city e j 1'
R-102003-35149 IR
TITLE WDlA N0. ENUM �.--. i__.••..— SPACE ABOVE THIS UNIT FOR RECONVER's WE
CORPORATION GRANT DEED .
THE UNDERSIGNED GRANTUR(S) DF,.CI.ARE(S)
DOCUMENTARY TRANSFER TAX is $- 616.00
® computed on full value of property conveyed, or
LJ computed on full value less value of liens or encumbrances remaining at time of sale.
M[� unincorporated area ' M city of ...... -- 7 A QIITNTA AND
t FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
..CITIZENS INVI:STMEN'�CORPORATION AN OHIO CORPORATION
a corporation organized under the laws of the State of
hereby (GRANTS to
Sheldon J. Dilliar, an
the following described real prope
County of RIVERSIDE
N
TM
in the
State of California:
I SEE ATTACHED EXHIBIT tAr
j
� h
i
t
MAIL TAX STATEMENTS AS DIRECTED ABOVE
In Witness Whereof, said corporation has caused its corporate name and seal to be affixed hereto and this in-
strument to be c '111cd by its.___. __.... ...- .•_President and.... Secretary
thereunto duly authorized. I CITIZENS= INVESTMENT CORPORATION, AN
Dated: July 5. 1991T111111 011-14 CI•TI1,11119
C ION
OHIO
x
.
STATF, or- ~_
11 �By
COUNTY OF StarkresidentUn
P
_.....t14!Y._5►.. �� —. t on: uta,.Utc_uuJcr-._
signed, a Notary Public in and for said State,personally appeereil — -
nue.] D. Paradeses! known
—President
to rile N he the _ I FMAINK, and
jack R. Gravo I _known to me to be
Treasurer ?Si41fXtj of the'Corpnration that executed the
withinlnarument, know to mean he the persons who exceulcd the
within instrument on behalf of the Corroratinn therein named, azul
ucknowledged to me shut such C:urpnratiop executed the within Instru• t 1 J
merit pgrsuant, to its by-laws or a resolution of Its hoard of directors. i�!.: •. • "
WITNRSS hand
piy and
l ;
Signature
DIANP M Y4afiFA ITLiT�Nw
N� g/TV�4,� ,,��``P,rintcd) aa' tddn.w J;C
In Aral f0I VIY'��BaVar-p+rq• . r• •,"M r4�Rt t)
�
MY comtTlie>itaT E.xptroe tat 'Ilk l9q3 �',, a• '
MAIL TAX STATEMENTS AS DIRECTED ABOVE
' u 231335
EXHIBIT "A"
phi 1, -
Irot SQ of Tract No. 25237,in the City of La Quinta, County of Riverside,
State of California, as per map recorded in Book 228, Pages 95 to 99, ino:lusive
of Maps—,try-mW 0A a Of the county taoor+d-eer of
RESFRViNG FROM, for the benefit of Grantor, its successors in interest and
others, nonexclusive easements;for access, ingress, egress, maintenance, repair,
drainage, and for other purposes, all as described in the Declaration refe red to
below.
FXRrdER RESERVING UNTp' i R, its successors and assigns,
right to grant:•and transfer all'or aTether with the
portion of the same:
A. All previously unreserved oil rights, mineral rights, natural gas
---- rts.and rights to all other hydrocarbons by whatever name known, to all
9 u n+rl heat and ' to all prod�icts derived from any . of the fo: egoing
(collectively, "subsurface Resources"), and
B. The perpetual right to drill, mine, explore and operate for and to
Produce, store and remove. -Subsurface Resources on or Prom said Lot
inej udit3g the right to' whips-tZany of tock ot: directionally -dri --�.
than said rot, wells,�tunnels and shafts into, through or across the suisurface
of said Lot, and to 'bottom such whipstocked or directionally drilled wells,
tunnels and shafts within
lor'•beyond the exterior limits of said Lot, and to
redrill, retunnel, eciuip,. maintain, repair,:deepen and operate any such wells or
mines ...but withoutthe.rigfi to drill, mine, explore, operate, s
produce, ore or
remove .any of the irface Resources through or' in the surface or the upper
five hundred feet (500,) of the subsurface of said iota
1
A. na =Flusi,v® easement .for ingress, !egress, over the `ooinmon area, as 'described
in the Declaration of Covenants, -'Conditions and Restrictions, and Reservation of
Easements recorded Manch .121, 1991 as Instrument No. 82168.
A nonexclusive easement for access, ingress and egress for pedestrian and
vehicular purposes over those private streets described as the °PUD Roads" and
"Venture property Roads,'! as described_in that certain Use Agreement and Grant of
Non-exclusive Easements ed on February 25, 1987 as Instrument No. 52339, in
Official Records of Riverside County, California ("Use Agreement").
1•' General and special real property taxes for the
supplemental assessments, iP any. current fiscal year•and
2. Covenants, coixiitions:-and, restrictions, easements, reservations, rights
and rights-of-way of re;=_d! easements,
Gzzantee,. by aCOptanc31 and recordation of this deed
coverk and agrees .to be bound expressly. zoceptB,,
provis1*QW and r �' atxl performance of all of the
requirements in the Use Agreement and -the Declaration of
Co"� Conditions sand Restrictions and Reservation Of'Easements ,or The
Fhclav 168, Iain Eshates. ("pe laxation") recorded on March 12, 1991 as Inst
No. 82168, in the Official`Recoids of Riverside
provisi and.reguirementslare'acknowl County, California.- which
are �ated herein wed to be reasonable, and all cf which
Upon
the �Y;this reference. ,his grant is expressly cor>ritioned
perform oP.such provisions to be performed
The use for which the Lot by Grantee the under.
L. intended is residential, and the restrict ioezeunns -on its
use are' -fully set fortjr.-harein.;and .in;the 'Declaration and the use Agreement, to
which this deed is expressly made subject.
i
K
veh`� V
1010 PEARL STREET, SUITE 5, LA JOLLA CA 92037 TEL (619) 455.5665
Thomas,Jakway A.I.A:
2151 W. California Street
San Diego CA 92110
Re: Diller Residence in LA QUINTA, Ca
Dear Tom;
July 13, 1993
Regarding our telephone conversation this morning, The
contractor can use Glue laminated beam DF/DF instead of sawn
lumber if the they are the same sizes.
Also Versalam Joists may be used :instead of 2X rafters, if they
are the same size
Since Y.
Meh.d Hemmati P.E.
fill
FA
J
�
_,
rC,: .l � t✓ .�.� An rfiy'u. _A .' �, A �
nLiA, .ti
31
of
Ilut to al�
-306
This Certificate issued pursuant to the requirements of Section of the Uniform Building!
Code certifying that at the time of issuance this structure was in compliance with the various
Ij
J;
;
ordinances of the City regulating building construction or use. For the following;I
k
a
BUILDING ADDRESS 49-215 Vista Ventura
�
j
I
i
I f
i
use Classification Single Family. Dwelling Bldg. Permit No. 11653
r
it
I�I
i I
il`�i'
Group R3 Type Construction VN Fre Zone "' Use Zone SR
j i
Sheldon Diller 77025 Avenue Fernando
Owner of Building Address
i
jI
I'I
i'
City JLa Quinta, :CA 92253 - Lonnie Da y
By
Dote: November: 3,' 1993
ISI
Building Official
POST IN A CON8PI000US PLACE
—
—
_
_
Ogg
•W _
r
REGISTERED INSPECTOR'S WEEKLY RFPART
JON-TANDY
3580 Conda l is Ave.
Yucca Valley, CA 92284
(619) 365-5045
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE . TRUCT... STEEL ASSEMBLY
❑ POST TENSIONED'CONCRETE-O ASPHALT
O REINFORCED MASONRY O FIRE PROOFING
O s H v
OTHER
JOBL CATION
psi' �e A
REPORT SEQUENCE NO.
TYPE OF STRUCTURE
PERMIT NO.
pA
DAY OF WEEK
MATE�y4L DE RIP ION /� _.�� .�.
ARCHITECT
I-N-SS'E-C-�T�OR
HRS. CHARGED
1 a
ENGINEER
ASSSTANTS
HRS. CHARGED
INSPECTION
DATE ..
GENERAL SUB
CONTRACTOR .+ ��N�� CONTRACTOR L.
W
5_v, c Ass Lo-el_0►N{G:- oa
��-13
A s'
(.c w n o J13. .
u �i�t .S F4 -a P U,)( --W N
_rv; y3
a it-
eLip . c.cJeL0 1NC47
_
• (D
j eC..o 1 w
-Lr0C 45 ;..laSr42 I &Akes d ()RetJ(A
Oc C 1'.S.l-vim e s N
C (4(C 6.ASC
wawa f_pt -c, ¢C, i0 `Tod „:�YUt�e:eS
i COPY SENT TO. CLIENT O
CONTINUED ON NEXT PAGE 0
PAGE OF
CERTIFICATION OF COMPLIANCE.
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE .BEST :OF -MY
KNOWLEDLE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE SIGNATURE OF REG6TERE SPECTOR
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED ��. (% _ 0
PLANS. SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
11
,9M
`Materials and weldments conform to plans and specificatio
Shipping Mark ns and AZSC, and AWS D1.1
305 SHEL Special 06P
P y Zttap. �
r l l tb C-2
�; o l Sb 4J 01, -(A v4 �Tv�
S3 FANUCATIM tt nffr
Begin Date:
Job HMO: - P�G1y�•.T(k Job No.
Fab. Stop _ wlrL
Lute:-1-�3
S
H
A
D
D
rcD
P
E
LM
Des'Camber
Heat
No.
ALTS.P.
101.
Pilots
A
T
H.P.
Filets
A
T
Full PEN
($ymbol)
NCE
Hate
S.Lzo
Date
(In) CK
(AOC)
E
(AOC)
E
(VIS)(Date)
(Date)
Reffirks
Co
S
►�3�
9
3g
CC
o
11
,9M
`Materials and weldments conform to plans and specificatio
Shipping Mark ns and AZSC, and AWS D1.1
305 SHEL Special 06P
P y Zttap. �
4- 1
Materials and weldments conform to plans and specificati
Shipping Mark ons and AISC, and AWS D1.1
05 SHEL Special Deputy Inap. �,C/
v �s �� ��v�
S3 FANUCATxN Mgr
Begin Oats:
Job Name: 1(ne F';� (Ig �,P LdS QL), TN Job No.
_ Falb. Stnp W TE:- SiE1 law Date:
2-1 -q3
S
A
D
D
P
E
ASM
DOSARNo.
(seat
AISC
101.
Size
Camber
S.P.
Filets
A
T
H.P.
Filets
A
T
Full fW
(Symbol)
NCE
Hart%"
Cate
(In) CK
(AOC)
E
(AOC)
E
(VIS)(Date)
(Date)
Renark3
IL
W9
J
,
�3
-3
r
f�3,63
-31
cC
/o
t
Q
LD
�X
(ACL
Lvs
�`
..
�
� 8k
•v
Cal
3 r
Acc
.y
�n1
3 (
AC
:3
�y
+s
A cc.
(�cc_ vis
G�
4- 1
Materials and weldments conform to plans and specificati
Shipping Mark ons and AISC, and AWS D1.1
05 SHEL Special Deputy Inap. �,C/
F1
f
-� - JON,TANDY
. 3580 Conda I is Ave.
Yucca Valley; CA 92284
(619) 365-5045,
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE TRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFINGl-IeL�
Q S
OTHER Ir,
JOB L CATIONt
C �A `o W_ A LA L) t l J
J V, Tn
REPORT SEQUENCE N0.
TYPE OF STRUCTURE
F.D
-
t 1 eta -,AtAo .
PERMIT NO.
D�
� /gib-'
DAY OF WEEK
.
- MATEB*L DETIP• ION _ �">>
ARCHITECT
INSPECTOR
115 ,j
HRS. CHARGED
- 1
//
( -r l E--2
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERALSUB
CONTRACTORs�-��jJ�� CONTRACTOR c
tP. S V'!5 otj
-a- 93
aenmsGo S A (TAA-t44_zn �g
yQt c &4 n o o) '
A -'i-13
• m
1D w.eL S J U e CT Ti.o bo
I.IJ 20.10 %,IQ
e,C.tD e. i2 $ ,` �eSr42� �oles -_T'iw 0 Ovee �J rA
QC C c S t Ue. (?eS71 N
4t<CoA-ST-TET-14
`
-r'743k
0 r��q
_
W o•e.�2 �t �(r to o,4 4 VIA,- 2S e__
S.P 9KK.► III, CevT�
COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE,0
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY SIGNATURE OF REaISTERE
KNOWLEDGE THE ABOVE REPORTED WORK UNLESS OTHERWISE _ f �SPECTOR � Q '
NOTED. I HAVEE FOUND THIS WORK TO COMPLY WITH THE APPROVED ;U� G.-
PLANS, SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS. DATE OF REPORT REGISTER NUMBER'.
'DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA - 92201
Document Cannot Be Duplicated (619) 347-8631
Date 1/4/93 Type of Permit La Quinta
No. 111941 Permit #
r
Log
Owner Name Sheldon J. Diller
No. 49215 street Vista Ventura
city La Quinta Zip 92253 Study Ajea 109
APN # Tract # 125237 Lot # 54 Square Footage 1,
Type of Development Single Family Residence Na of units 0
Comments Lot #50 formally Tract #14496 exemption approved by Marcia 1. Ewart, 5,265
square feet-
At the present time, the Desert Sands Unified School District does not collect fees on
garages/ carports, covered patios/ walkways, residential additions under 500 square feet,
detached accessory structures or replacement mobilehomes. , It has been determined
the above-named owner is exempt from paying school fees at this time due to the
following reason: r
Under Mitigation Agreement
EXEMPTION NOT APPLICABLE
S ,
This certifies that school facility fees imposed pursuant to Mitigation Agreement
in the amount,of 628.00 x 0 or_$ 628.00 have been paid to D.S.U.S.D, for
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued. -
Fees Paid By. Stephen Tones Telephone 346-3366
Name on the check ,
By lamps FAivellE
Assistant Superintendent, Business Services
- T• o- `=
Fee collected /exempted by Vickie J. Durrett
Payment Receive '
d , r '
Signature �C� .4c'u 2/ZQ ,�, _ - •� `�..
ciie�k _N�-M4195'
Collector: Attach a copy of county or city plan check application form to district cop; for all waivers.
Embossed Original- Building Dept./Applicant Copy -'Applicant/Receipt Copy - Accounting
- J