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Home My WebLink About2606 DAVIS AVE; ; CB940272; Permit03/31/94 13-09 BUILDING PERMIT Parcel No --- - Valuation: «, Construction Type: VN Reference*. Occupancy Group_ Ml DETACHED GARAGEDescription: ADD 202 xt iu Suite Lot# Permit No- CB940272 Project No- A9400392 Development No: 619 438-^0470 Status- ISSUED Applied 03/15/94 Apr/issue. 03/31/94 Entered By. DC zyDo ri*»t/ j.--'^'" CARLSBAD, CA 92008 »** Fees Required^^***^'**.*Fees Collected &. Credo.ts^*** ^ _,Fees- Adjustments.. - Total Fees: 125.00 .. -00 125.00 Fee description Building Permit Plan Check Strong Motion Fee T^sue Fee ^Enter "Y" tor fj.u.nujj."y j.s=>w-= >• Enter "Y" for Electric Issue Fee > Enter "Y" for Remodel * ELECTRICAL TOTAL . Enter 'Y' for Mechanical Issue tee/ Total Credits. Total Payments: Balance Due: Units Fee/Unit .00 41.00 84 00 Ext fee Data 63 00 41.00 1.00 105 00 N 10 00 Y 10 00 Y 20 00 N CITY OF CARLSBA! 2075 Las Palmas Dr , Carlsbad, CA 92009 (619) 438-1161 \TION City of Carlsbad Building Department 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 IPliKMIT A - LJ Commercial LJ New Building LJ Tenant Improvement B - D Industrial Q New Building D Tenant Improvement C-.H^esidential D Apartment DCondo D Single Family Dwelling J9*Addmon/Alteration D Duplex D Demolition D Relocation D Mobile Home D Electrical D Plumbing D Mechanical D Pool D Spa D Retaining Wall D Solar Q Other 2. PROJECT INFORMATION Building or Suite No PLAN CHECK NO. EST VAL PLAN CK DEPOSIT, VALID BY DATE >.^f T FOR OFFICE USE ONLY Address IMXo Nearest Cross Street LEGAL DESCRIPTION SulxJivision Name/Number Unit No Phase No CHECK BELOW It SUBMI1 1LU D 2 Energy Calcs d 2 Structural Calcs D 2 Soils Report D 1 Addressed Envelope ASSESSOR'S PARCEL EXISTING USE PROPOSED USE_ DESCRIPTION OF WORK SQ FT »'*>£• *>& # OF STORIES/ 3 UUNiAiJTrtKJ>L)N lit Qitterent trom applicant; NAME ADDRESS CITY STATE ZIP CODE DAY TELEPHONE 4 APPLICANT )Q CON IRAC TOR LJAGhNI rOR CON 1HALIUK LJUWNhH LJAGhNI rOR OWNbK ADDRESS 2963 ' ' ' " CITY STATE £4^ ZIP CODE DAY TELEPHONE 5 PROPERTY UWNhK CITY STATE ADDRESS ZIP CODE DAY TELEPHONE / o CONTRACIURNAME CITY STATE STATE UC # ADDRESS 43>£~S> ZIP CODE LICENSE CLASS AlJUKkSS DAY TELEPHONE CITY BUSINESS LIC # CITY STATE ZIP CODE DAY TELEPHONE STATE LIC # 7 WORKERS' COMPENSATION workers Compensation Declaration Thereby an irm that I have a certificate or consent to sell-insure issued by the Director ol Industrial Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, Lab C) INSURANCE COMPANY POLICY NO EXPIRATION DATE Certificate ol txemplion 1 ceruly that in the pcrlormance 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 Workers' Compensation Laws of California SIGNATURE 8 UWNEH-BU1IJ3E Owner-Builder Declaration I hereby affirm that I am exempt from the Contractor's License Law lor the following reason D 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, Business and Professions Code The Contractor's License Law does not apply to an owner of 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 ) D D SIGNATURE I, as owner of the property, am exclusively contracting with licensed contractors to construct 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 contracts for such projects with contracror(s) licensed pursuant to the Contractor's License Law) I am exempt under Section Business and Professions Code for this 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 file 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 Code) 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]) DATE COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? D YES D NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? D YES D NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? D YES D NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED AFTER JULY 1, 1989 UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT 5 UJNSTKIKJHUN LJiNlJLNG ACiENiry I hereby allirm that there is a construction lending agency tor the perlormance ot the work tor which this permit is issued (Sec 3097(0 Civil Code) LENDER'S NAME LENDER'S ADDRESS lO^APPUCANT CERTIFICATION I certify that 1 have read (he application and state that the above intormation is correct I agree to comply with all City ordinances and State laws relating to building construction I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property for inspection purposes I ALSO AGREE TO SAVE INDEMNIFY AND KEEP IIARMIJvSS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT OSTIA An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stones in height Expiration Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 365 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 303(d) Uniform Building Code) WHITE- File YELLOW. Applicant PINK: Finance I CITY OF CARLSBAD INSPECTION REQUEST PERMIT* CB940272 FOR 05/13/94 DESCRIPTION: ADD 202 SF TO DETACHED GARAGE TYPE: RAD JOB ADDRESS: APPLICANT: CONTRACTOR: OWNER: 2606 DAVIS AV IDEAL CONSTRUCTION PHONE: PHONE: PHONE: INSPECTOR AREA PY PLANCK* CB940272 OCC GRP Ml CONSTR. TYPE VN STE: LOT: 619 438-0470 REMARKS: MH/RAY/438-0470 SPECIAL INSTRUCT: PM PLEASE TOTAL TIME: INSPECTOR CD LVL DESCRIPTION 19 29 39 49 ACT COMMENTS ST Final PL Final EL Final ME Final Structural / Plumbing J Electrical ]L Mechanical t\ M 1 ***** INSPECTION HISTORY ***** DATE DESCRIPTION 042894 Exterior Lath/Drywall 042694 Exterior Lath/Drywall 042594 Exterior Lath/Drywall 041494 Frame/Steel/Bolting/Welding 041494 Rough Electric 041194 Roof/Reroof 040694 Ftg/Foundation/Piers 040194 Ftg/Foundation/Piers ACT AP CO CO AP AP AP AP INSP PY PY PY PY PY PY PY COMMENTS SEE LIST 4/25 SEE NOTES SEE CORECTIONS OK TO POUR CO PY CORRECTION NOTICE ADDRESS: D APPROVED PLANS SHALL BE ON JOB SITE BUILDING D FOUNDATION D REINFORCING STEEL D MASONRY D GROUT-GUNITE D FLOOR AND CEILING FRAME D SHEATHING D FRAME D EXTERIOR LATH D INSULATION D INTERIOR LATH OR DRYWALL PLUMBING D UNDERGROUND PLUMBING D UNDERGROUND WATER D ROUGH PLUMBING D TOP OUT PLUMBING D SEWER AND PL/CO D TUB OR SHOWER PAN D GAS TEST 0 WATER HEATER ELECTRICAL TEMPORARY SERVICE ELECTRIC UNDERGROUND ROUGH ELECTRIC D POOL BONDING ELECTRIC SERVICE UFER GROUND GFI SMOKE DETECTOR MISCELLANEOUS PLENUM AND DUCTS COMBUSTION AIR CONDITIONED AIR SYSTEMS SOLAR GRADING POOL PATIO D SIGN D OTHER D D D D D D D CITY OF CARLSBAp BUILDING INSPECTION DEPARTMENT PHONE - 438-3550 Note Final InSfssntlonjRequlred CORRECTION NOTICE ADDRESS: - Z D APPROVED PLANS SHALL BE ON JOB SITE BUILDING D FOUNDATION D REINFORCING STEEL D MASONRY D GROUT-GUNITE D FLOOR AND CEILING FRAME D SHEATHING D FRAME D EXTERIOR LATH D INSULATION D INTERIOR LATH OR DRYWALL PLUMBING D UNDERGROUND PLUMBING a UNDERGROUND WATER G ROUGH PLUMBING D TOP OUT PLUMBING D SEWER AND PL/CO D TUB OR SHOWER PAN D GAS TEST d WATER HEATER ELECTRICAL D TEMPORARY SERVICE Q ELECTRIC UNDERGROUND D ROUGH ELECTRIC 0 POOL BONDING D ELECTRIC SERVICE G UFER GROUND a GFI a SMOKE DETECTOR MISCELLANEOUS C PLENUM AND DUCTS LJ COMBUSTION AIR [71 CONDITIONED AIR SYSTEMS D SOLAR D GRADING D POOL D PATIO C SIGN G OTHER TIME . DATE INSPECTOR CITY OF CARLSBAD BUILDING INSPECTION DEPARTMENT PHONE 438-3§5Q ^.J Note ^mal Inspection Required CORRECTION NOTICE ADDRESS: D APPROVED PLANS SHALL BE ON JOB SITE BUILDING D FOUNDATION D REINFORCING STEEL D MASONRY D GROUT-GUNITE D FLOOR AND CEILING FRAME D SHEATHING D FRAME D EXTERIOR LATH D INSULATION D INTERIOR LATH OR DRYWALL PLUMBING U UNDERGROUND PLUMBING D UNDERGROUND WATER D ROUGH PLUMBING LI TOP OUT PLUMBING D SEWER AND PL/CO D TUB OR SHOWER PAN a GAS TEST D WATER HEATER 'tfa~s\ f ^ ELECTRICAL D TEMPORARY SERVICE D ELECTRIC UNDERGROUND D ROUGH ELECTRIC D POOL BONDING D ELECTRIC SERVICE Q UFER GROUND a G FI a SMOKE DETECTOR MISCELLANEOUS D PLENUM AND DUCTS H COMBUSTION AIR D CONDITIONED AIR SYSTEMS D SOLAR D GRADING D POOL C PATIO D SIGN [J OTHER CITY OF CARLSBAD INSPECTION DEPARTMENT r'^ONE - 438-3550 Note Final Inspection Required PLAN CBECE : °JL(~ JURISDICnaK: TO: ENCLOSURES: PROJECT ADDRESS: FLOOR AREA: STORIES:. HEIGHT: REMARKS: PLAH CORRECTK E FA Plan check is limited to technical requirements contained in the Uniform Building Code, Uniform Plumbing Code, Uniform Mechanical Code, National Electrical Code and state laws regulating energy conservation, noise attenuation and access for the handicapped. The plan check is based on regulations enforced by the Building Inspection Department. You may have other corrections based on laws and ordinances by the Planning Department, Engineering Department or other departments. Present California law mandates that residential construction comply with Title 2k and the following model codes. 1991 UBC (eff. 8/1W92) 1991 UPC (eff 8/1V92) 1990 NEC (eff. 7/1/91) 1991 UMC (eff 8/14/92) The above regulations apply to residential construction, regardless of the code editions adopted by ordinance. The circled items listed need clarification, modification or change. All items have to be satisfied before the plans will be in conformance with the cited codes and regulations. Per Sec 303(c), 1991 Uniform Building Code, the approval of the plans does not permit the violation of any state, county or city law. To speed up the recheck process, note on this list (or a copy) where each correction item has been addressed i e.. plan sheet, specification, etc Be sure to enclose the ma'rked UP list when you submit the revised plans. Date plans received by jurisdiction: Date initial plan check completed: By: Applicant contact person: Telephone: NOTE: PACK NUMBERS ARE NOT IN SHJUKHCK AS PAGES HAVING NO ITEMS REEDING CORRECTIONS MERE DELETED. List No. 2, Carlsbad Single Family Dwelling and Duplex With All Supplements. (1991 UBC) 185.Show on the Title Sheet on the plans, the information required by the attached Developmental Services Sheet 112383. 'All new residential buildings, including additions, require a soils report. Please submit two copies. Exception: If a room addition is limited to one story and 1000 sq ft. in area, then a soils report is not required Esgil Corporation will advise the City to place their soils notice stamp on theplans. 187 Heavy timber framing, minimum 6" x 10" beams and minimum 8" x 8" post, for the structural beam and column supporting the fire separation between the garage and living area above, is acceptable if shown on the plans (city policy) 188 All structures require a Class B roof covering, except room additions. If a room addition covers all of the existing building (2nd story addition), then the above exception doesn't apply 189. City Ordinance 9792 requires two parking spaces/unit with clear area of 20'x20" i.e. no washing machines, etc. Show compliance. 190 Only tank-type water closets that use an average of 1 6 gallons of water per flush or less, and urinals and associated flushometer valves, that use an average of 1 gallon of water per flush or less shall be installed in new construction. These provisions shall apply to existing buildings only when toilets are being replaced in existing bathrooms or installed in new bathrooms. 191. Please see additional corrections, or remarks, on the following page. 192 To speed up the recheck process, note on this list (or a copy) where each correction item has been addressed, i.e., plan sheet, note or detail number, calculation page, etc. 193. Please indicate here if any changes nave been made to the plans that are not a result of corrections from this list. If there are other changes, please briefly describe them and where they are located in the plans. Have changes been made to the plans not resulting from this correction list? Please check. Yes No C l If you have any questions regarding these plan check items, please contact If you have any questions regarding City Building permit procedures, please contact Carter Darnell at the City of Carlsbad, 2075 Las Palmas Dr , telephone 619/438-1161 Thank you Enclosures 1 fT) 8/11/92 13 f li ,! 1,| 1 Datei Jurisdiction CARLSBAD prepared by i VALUATION AND PLAN PLAN CHECK NO. 3.H-WL, 3UILDING ADDRESS ?<&06 /M UK, APPLICANT/CONTACT BUILDING OCCUPANCY n-i TYPE 0? CONSTRUCTION "&M BUILDING PORTION '&4M«i f •— <j Air Conditioning Commercial Residential Res. or Comm. Fire Sprinklers Total Value BUILDING AREA ^ I -ZA2*<6 ~~- CHECK ^EE Q Bldg. Dept. D Esgil PHONE NO. DESIGNER PHONE CONTRACTOR PHONE VALUATION 'ULTIPLIER /9r •i! I; r ] ; ," le i? @ VALUE SfltS^ sasa f Building Permit fee $ $ Plan Check Fee $ $ C 0 H ME NTS- SHEET OF 12/87 City of Carlsbad Engineering Department DATE BUILDING PLANCHECK CHECKLIST PLANCHECK NO BUILDING ADDRESS PROJECT DESCRIPTION a C ASSESSOR'S PARCEL NUMBER.EST VALUE ENGINEERING DEPARTMENT APPROVAL The item you have submitted for review has been approved The approval is based on plans, information and/or specifications provided in your submrttal, therefore any changes to these items after this date, including field modifications, must be reviewed by this office to insure continued conformance with applicable codes Please review carefully all comments attached, as failure to comply with instructions in this report can result in suspensior^of/permrt, to jrfuild 1st CHECK Date: 2nd CHECK By.Date 3rd CHECK By.Date DENIAL Please see the attached report of deficiencies marked with 3). Make necessary corrections to plans or specifications for compliance with applicable codes and standards Submit corrected plans and/or specifications to this office for review By.Date- By Date By Date , FOR QFFICAL USE ONLY ^10N TO ISSUE BUIlDiNO PERMIT: CONTACT PERSON Dedication Application D Dedication Checklist G Improvement Application CH Improvement Checklist D Future Improvement Agreement CD Grading Permit Application D Right of Way Permit Application D Sewer Fee Information Sheet NAME. ADDRESS. PHONE. A-4 P \DOCS\CHKLST\BP0001.FRM REV 12/17/93 2O75 Las Palmas Dr • Carlsbad, CA 92009-1576 - (619) 438-1161 • FAX (619) 438-O894 BUILDING PLANCHECK CHECKLIST SITE PLAN Provide a fully dimensioned site plan drawn to scale. Show North Arrow D Property Lines Easements Existing & Proposed Structures E Easements Existing Street Improvements F Right-of-Way Width & Adjacent Streets D 2 Show on site plan Drainage Patterns C Existing Topography Existing & Proposed Slopes 3 Show on a section drawing or include a note stating that there is a minimum of 6" difference between the finished floor and the finished grade elevation adjacent to the structure 4 Include note "Surface water to be directed away from the building foundation at a 2% gradient for no less than 5' or 2/3 the distance to the property line (whichever is less)" [Per1985UBC2907(d)5] On graded sites, the top of any exterior foundation shall extend above the elevation of the street gutter at point of discharge or the inlet of an approved drainage device a minimum of 12 inches plus two percent" (per 1990 UBC 2907(d)5) D 5 Include on title sheet Site address Assessor's Parcel Number Legal Description For commercial/industrial buildings and tenant improvement projects, include Total building square footage with the square footage for each different use, existing sewer permits showing square footage of different uses (manufacturing, warehouse, office, etc) previously approved. EXISTING PERMIT NUMBER DESCRIPTION P \DOCS\CHKLST\BP0001 FRM Page 1 Of 4 REV 12/17/93 BUILDING PLANCHECK CHECKLIST DISCRETIONARY APPROVAL COMPLIANCE D 6 Project does not comply with the following Engineering Conditions of approval for Project No _ Conditions were complied with by. _ Date: _ DEDICATION REQUIREMENTS D 7 Dedication for all street Rights-of-Way adjacent to the building site and any storm drain or utility easements on the building site is required for all new buildings and for remodels with a value at or exceeding $ /o irV-t) -pursuant to Code Section 1840030 ' ' Dedication required as follows Attached please find an application form and submittal checklist for the dedication process Provide the completed application form and the requirements on the checklist at the time of resubmittal. Dedication completed by Date: IMPROVEMENT REQUIREMENTS 8a All needed public improvements upon and adjacent to the building site must be constructed at time of building construction whenever the value of the construction exceeds $ ST> cj^4> _ -pursuant to Code Section 18 40 040. Public improvements required as follows Please have a registered Civil Engineer prepare appropriate improvement plans and submit them together with the requirements on the attached checklist for a separate plancheck process through the Engineering Department Improvement plans must be approved, appropriate securities posted and fees paid prior to issuance of permit Attached please find an application form and submittal checklist for the public improvements requirements Provide the completed application form and the requirements on the checklist at the time of resubmittal. Improvement Plans signed by Date- P \DOCS\CHKLST\BP0001 FRM Page 2 Of 4 REV 12/17/93 BUILDING PLANCHECK CHECKLIST 1stV 2nd^ 3rdv/ D D D 8b Construction of the public improvements may be deferred pursuant to code Section 1840 Please submit a recent property title report or current grant deed on the property and processing fee of $ so we may prepare the necessary Future Improvement Agreement This agreement must be signed, notarized and approved by the City prior to issuance of a Building Permit Future public improvements required as follows: Improvement Plans signed by Date.. D D D 8c Enclosed please find your Future Improvement Agreement Please return signed and notarized Agreement to the Engineering Department. Future Improvement Agreement completed by Date D D D 8d No Public Improvements required SPECIAL NOTE Damaged or defective improvements found adiacent to building site must be repaired to the satisfaction of the City Inspector prior to occupancy GRADING PERMIT REQUIREMENTS The conditions that invoke the need for a grading permit are found in Section 11 06 030 of the Municipal Code G D D 9a. Inadequate information available on Site Plan to make a determination on grading requirements. Include accurate grading quantities (cut, fill import, export) D D D 9b Grading Permit required. A separate grading plan prepared by a registered Civil Engineer must be Submitted together with the completed application form attached NOTE The Grading Permit must be issued and rough grading approval obtained prior to issuance of a Building Permit. Grading Inspector sign off by Date1 D 9c No Grading Permit required BUILDING PLANCHECK CHECKLIST P \DOCS\CHKLST\BP0001 FRM Page 3 Of 4 REV 12/17/93 MISCELLANEOUS PERMITS 2ndv/ 3rd>/ D D 10 A RIGHT-OF-WAY PERMIT is required to do work in City Right-of-Wav and/or private work adjacent to the public Right-of-Way Types of work include, but are not limited to street improvements, trees, driveways A separate Right-of-Way permit issued by the Engineering Department is required for the following Please complete attached Right-of-Way application form and return to the Engineering Department together with the requirements on the attached Right-of-Way checklist, at the time of resubmittal. D D 11 A SEWER PERMIT is required concurrent with the building permit issuance The fee is noted in the fees section on the following page D D 12 INDUSTRIAL WASTE PERMIT is required Applicant must complete Industrial Waste Permit Application Form and submit for City approval prior to issuance of a Permit Industrial waste permit accepted by Date- P \DOCS\CHKLST\BP0001 .FRM Page 4 Of 4 REV 12/17/93 Plan Check No Planner DAVID RICK PLANNING CHECKLIST Address ^^4 "DdvUA /W Phone 438-1161 ext J328 APN- (Name) a 1 11 tl V ana a Type of Project and Use Zone \K-| Facilities Management Zone CFD (in/out) # circle (It property in, complete SPECIAL TAX CALCULATION WORKSHEET provided by Building Department) Legend 8 .* Iug Item Complete Item Incomplete - Needs your action 1,2,3 Number in circle indicates plancheck number where deficiency was identified Environmental Review Required: YES NO _jXTYPE DATE OF COMPLETION: Compliance with conditions of approval? If not, state conditions which require action. Conditions of Approval Discretionary Action Required: YES NO */ TYPE DATE:APPROVAL/RESO. NO. PROJECT NO OTHER RELATED CASES: Compliance with conditions of approval? If not, state conditions which require action. Conditions of Approval QTI California Coastal Commission Permit Required: YES DATE OF APPROVAL: __ NO^X San Diego Coast District, 3111 Camino Del Rio North, Suite 200, San Diego, CA. 92108-1725 (619) 521-8036 Compliance with conditions of approval? If not, state conditions which require action. Conditions of Approval 0 D CD 0/0 D D Q^D an n nan Inclusionaiy Housing Fee required. YES _ NO (Effective date of Inclusionary Housing Ordinance - May 21, 1993 ) Site Plan: Zoning* Provide a fully dimensioned site plan drawn to scale. Show North arrow, property lines, easements, existing and proposed structures, streets, existing street improvements, right-of-way width, dimensioned setbacks and existing topographical lines. Provide legal description of property, and assessor's parcel number Setbacks: Front: Int. Side- Street Side: Rear: 2. Lot coverage: 3. Height: 4. Parking: Additional Comments Required Required Required Required Required Required Spaces Required Guest Spaces Required *5/~~) ^ 7 f> 1 •> /'«KC/ Shown t-o 5 -5' $ Shown 8 2. ' ID' Shown lQ> l/'ff Shown 11' ! " ^4^ Shown 4/y« J^. 0i~^& shown / 2. fur i^f<^ Shown «5 tw &«•"-%' 0 u Shown ^ OK TO ISSUE AND ENTERED APPROVAL INTO COMPUTER DATE PLNCK.FRM