03-0814_BLANK, CLIFFORD_Surety ReceiptU
CITY OF
9
Plan Check Application No.
Permit No.
SAN JUAN CAPISTRANO
MISCELLANEOUS RECEIPT
Project Name
Project Addre
Applicant
Address
L60 e!; L Glc,
Building Plan Check ...........................
Grading Plan Check ............................
On -Site Plan Check ............................
Special Inspection/Re-Inspection ..................
OCFA Plan Check .............................
Geotechnical/Soils Plan Review ..................
( )
Copies @ 20¢/each ......................
Other l�v.C�?.�..
TOTAL ...................
$
(01-4411)
$
(01-4413)
$
(01-4413)
$
(01-4412)
$
(19-2334)
$
(01-4419)
$
(01-4521)
$
NOTE: APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS
FOLLOWING THE DATE OF APPLICATION/DEPOSIT SHALL EXPIRE BY
LIMITATION AND BECOME NULL AND VOID. UNIFORM BUILDING CODE
SECTION 304 (d)
Prepared By 4OqGV4
Department of Engineerin & Building