HomeMy WebLinkAbout3482 WINDSOR CT - Building Permits(714) 754-5273 • Fan (714) 754-4856 • wv+w.ci.costa-mesa�.��ILDING PERMIT �� FAIR DRNE, GOSTA MtSA, GA 926'16
JobAddress: 3482 WINDSORCT
Suite:
Vicinity:
Parcel Number: 41204247
Applicant: BASS, WAYNE
Address:
Owner: KENNICOTI", BARBARA L
Address 3482 WINDSOR CT
COSTA MESA, CA
Contractor: WEB ROOFING
Address: 27722 BAHAMONDE
MISSION VIEJO, CA
Zip: 92692
Arch :
Address:
Phone:
zoning: R1 R1
Phone: 949�290-7210
Zip:
Phone:
Zip: 92626
Phone: (949) 227-7864
License: 746354
Eng:
Address:
Status: ISSUED
Applied: 11114/2000
Issued: 11/14/2000
ISSUED BY: �
Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF, RE-SHEATH WITH il2" OSB, TWO LAYERS 30L8 FELT. COVER WITH MONIER TILE, LESS THAN 6 LBS.
PER SQUARE.
Plan Check: $0.00
Permit: $167.25
SMIP Res: $0.90
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $168.15
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existinq: o
NOTES:
Rear 0-0
Rear 0- 0
Re uired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Pro osed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
ss,000.00
as,000.00
NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspeetions and finel epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626 ,
zaaws laroo)
WORKERS'LOMPENSAnON DECLARAnON: � '
I hereby eMirm under penalry of perjury one ot the tWlowing tledaretions:
❑ I heve end will mflintain a certificata of consent to Self�ln5ure tor warkers' compen5aiion, es provitletl lor by section 3700 ot the LeDor Cade, for the pertortnance of the
work tor which IhiS permii is issued. �
❑ I have and will mainWin workers' compensation insurence, as required by section 3700 ot I�e Lebor Code, tw the pertortnance of the wwk ta whi IhiSpertnit is issued.
My workers' compensation Insurence rarrier arM pdiq number are: �
Cartier. Policy Number.
(This section need nat be com /efe0 i! fhe pemtit is ve/ued et one hundretl tlollars (5100) or /ess.)
❑ I cehily �het in Ihe peAo man ol the work tor w iyh this pertnit Is luued, I shall not employ any person In any manner so as to becane s ject to Ine workers'
compensation laws ot alifo a, end egree thet � I houltl bewmo suD�ect to the workers' compensation provisions oi Sectlon 3700 of the Lebor Cotle, I shell forthvrit�
compry.wim��neae� o� io /
'App wIi nt Signet=_re: � « Date: I � / � � /Fi�
WARNING: FPILURE TO SEWRE WORKER$' ENSATION WVEPAGE IS UNLAWRIL M1D SW1LL SUBJECf AN EMPLOVER TO CRIMINAL P TIES M!0 VIL FlNES UP TOONE HUNDRED
THOUSnND DplARE (5100,000). IN AODfTION TO TNE CQ6i OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SECTION 3]080F TME LABOR CODE.IMEREST, AND ATTORNEVS FEES.
LICENSED CONTRACTORS DECLARATON:
I hereby ellirm Ihat I am license unqrer provislons al Ch�i/tu� r 9(wmmencinp with Sectlon 7000) of Divislon 3 0l the Business antl Prolessions Cotle, ana my licensa Is in lull
force and enect. uc. a 1 II ! •� Class a
GmitrectoYS'SlgnaWre:—�• bin+ �--%�� Date: / _ _ .
CONS7RUCT10N LENDING AGENCV:
❑ I hereby aflirm ihat Ihere is e tOnStructi0n Iending epency lor Ihe peAOrmance of Ihe work lor w�ich IhiS permit 15 issuad. (Sac. 3097, Civil Code).
Lenders Name: Lendefs Aatlreu:
Signature:
OWNER-BUILDER DECLARATIONS:
Date:
1 hereby eHirtn that under penelry at perjury Ihet I am EXEMPT FROM TME CON7RAGTORS LICENSE lAW tor Ihe lollowing reason (Sec. 7031.5, Business end Professions
Code: Any ciry or wunry whic� requires e permit to construct, alter, improve, tlemdish, or repair any sirucWre, prior to its Issuance, elso requires Ne appliwnt for such pertnit
to file a signed stetement that he or she is licensed pursuent to the proNsions ol iha Contrectors License Lew (C�epter 9(commencing with Section 7000) of DiNsion 3 ot the
Business and Pmfessions Cotle) or that he or she is exempt therefrom enC the Oasis for the ellegetl exemption. Any violatian ol Section 7031.5 by any applicanl for e pertnit
suhjects tha applicant lo a civil penalty of not mora t�an live �untlretl tlollers (5500�.):
❑ I, as owner of Ihe propeny, or my employees with wages es Iheir sole compensation, WILL DO THE WORK, antl the structure is not Intentled or offered for sale (Sac.
7044, Business and Prolessions Code: The Contractors License Law tloes not apply lo an owner o� property who builds or improves Ihereon, and who does such work
himsell or herself or Ihrough his or her own employees, provided that such impmvemenis are not imended or oHeretl lor sale. Ii, hawever, the builtling or impmvement is
sold within one year of completioq tne owneo-builtler will heve Ihe �urden of proving that he or she did not build or improve tor purpose of sale.).
❑ I, as owner ot the property, am EXCLUSIVELV CONTRACTING WITM UCENSED CON7RACTORS to constmct the pmjea (Sec. 7044. Business antl Professions
Code: The crontracwrs License Lew does not appty to an owner ol property w�o bulitls or Improves Ihereon, and who conirects tor suc� project with e crontractor(s)
license pursuant b the Cantractors License Lews.).
❑ I am exempt under sec. Business and Prolessions Cotle br this roeson:
Signature: Data:
Owner ID verifie0 hy tlrivafs license. ❑ Ves ❑ No Drivofs Licanso No. Expires:
Venfiwtion of Ownership �y (type of Cocumen�, i.e. � pro0erry tax bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATON:
❑ I hereby certify ihat no excave�ion �Ive (5) or more leet in tlepth into which e porson Is required to descend, will be made in connection wi�h work euthorized by Ihis
permit, antl �hat no huilding structure, scafloltling, lelsework, or tlemolition or tlismantling lhereol, will be more ihan Ihiny-six (36) feet higR (Chap. 32, Gry 2, Art 2, Sec.
341, Title B, Calilarnia Atlminisiretive Cade).
❑ As ownerDuilder, I will not employ enyone to tla work w�ich woultl require e permit irom Ihe Division ol Intlustrial Safety, es notetl ebove, unless such person hes a
pertnit ta do such work irom ihe tlivision.
Signature: Date:
Division of Intlustrial Salety Permit Number:
CER'f1flCA7E OF COMPLIANCE /WD AIJfHORIZA710N OF ENTRY: I certify untler penalty ol perjury that I have reatl this applica�ion and state that �he information given is
correa. I egree to compry with all state laws anO dry ortlinances relating to building consuuction, antl authorize representatives of Ihe Ciry of GosW Mesa to enter upon Ne
above-describetl propeny lor inspectionyurposas. I egree not to oaupy or ellor, occupanry ol eny building authonzed by Uis permit un�il tinel inspection.
GOUE I, INSPECTqNTYPE
1616 Fixetl System Final Fire Preventlon
1266 Pool Spa Final
200 Final Ro�Root
201 FInnI BIocWRetaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition �
PAIE IIII�SL9
'.i r• ��
COUE� INSGECTIONTYPE
206 Finel Mechanicel
208 Final Plumbing
2�0 Finel Eloctrical
212 Finel Flre Prevention
220 Final Plenning Approval
222 Final Si�e
250 Final Builtling/Oaupanty
r:�
PdIE 4i�EL5
November 14, 2000
Mr. & Mrs. Kennicott
3482 Windsor Court
Costa Mesa, CA 92626
_� �
`1�'m�ledon`l��lla e
8
RE: WIM[3LEDON VILLAGE ASSOCIATION
Request f'or Architectural Change Approval
Dear Mr. & Mrs. Kennicott,
As management agent for the Wimbledon Village Association, I have been instructed by the
ArchiTectural Committee to contact you regarding the approval of your architectural application
to re-roofing of your home.
Please be advised that the Architectural Committee has approved the application as submitted.
If you have any questions, or if I can be of assistance to you in any other matter, please do not
hesitate to contaCt the undersigned at (949) 450-1515, extension 246. Thank you.
Sincerely,
VILLAGEWAY fANAGGMENT, INC.
� w�v._
�o e, Property Manager
the Dir tion ofthe Board of Directors
P.O. BOX 4708, tRVI�VE, CALIFORPIIA 92676 (944) 450-1515
\\Yllageway0l�pmjec[s\Wimble�pi 018V�rthittttual & CCRWU Correspontlence\34fi7 Windsor.da
)
CZTY OF C�'i'A
RD�fJFST FUR OCQJPANCY
TRACP N0. �D�7"/ A�TE: � _
�e develq�er of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been conpleted and its streets
accepted b�+ the City of Costa Mesa.
By executing this agrcement, the undersigned acknv.rledges that he/she/they
�ras/were advised that this tract has not been given final i.nspection rar has
it been accepted b� the City of Costa Mesa as having cotrplied with the conditions
of approval which were inposed b� the City at the time the Final Tract Map was
approved. •
The City ass�nnes no liability for the enforcement of the conditions necessary
for approval other than th�e conditions protected b� surety bond.
The undersigned agrees to indemnify and hold the City harmless fnxn any claun
resulting in dam3ge or personal ,injury to The undersigned b,� rnason of the
aforementioned unoortl�leted condition(s). �
BY�C�i��ii��� i�`WL/� brL'��t'e%��
(Signature of Purchaser)
BY _ � S � .
(Signature of Developer and or
authorized represe tative
BY (
(Signature of Le er) I
HOI� SAVINGS F, LOAN ASSOC ATION
4n9
2� Zs .
�2zW"'� FlOZ Iwininq Laboratories �,f s�u�f=,= ����f��,=�, �,�.
� 33t0 a�.i,�r. wav � n�ad��,q ai:m.ss P 0 fto. 17 / lony Bcacn. Ca 90A01 � i2i 31 nZb�3355 � i? � 3i G36 2386 i 17ia� 8'e-6�32
TESTING 9A�::C�� Of�ICE 1511�D NOr'b ��erOe� S:reri � Sen�n dnn C� AlJOi 41�I SJ� 10�5
February 24, 1981
Ex�mination: SC81-975
COMPRESSION TESTS ON GUNITE CYLI1uDERS
Max Sitter
Post Office Box 3�54
Fullerton, CA 92637
PROJECT SPA
noDaE55 3482 Windsor Court, Costa Mesa
SAMPIE FROM Main Drain
IUtCXItlC! CONTII�Ci011
Berge Pool Berge Pool
fNO�NEEII fU�COHl�ACfO�
Aerna^d C. Admas S& A Gunite
SPECIFIED
M!X 4,2-1 STRENGTM
DATE CAST 2/11/81
DA7E TESTEO 2/21/81
SPECIMEN NO. 1
COMPRESSION 10-Day
TOTAL LOAD, 185. 3'] � 000
POUNDS PER SQ. IN. 1,;;10
COMPLIANCE
w�w �r
SPECIMENS Jeff
DltttlWflON:
Max Sitter - 3
sta Mesa Bldg. Dept.
SLUMP SIZE
DEUVFlEO �Y
Max Sitter
2,Q00 psi
6" x 12"
IECfIviD OM
2J12/61
�-iu�.:'::x'�'LLJ
��'�, p 2 1981
Neale Zuidema
•�� 4c�o4*s •nt saewirrco •s i�c cow.mc+*�•i 000.r..�. or �u�..y .urwo•�r.+io� .on ooeuc.iion or ooa aenoars. co�c�mio.a o+ �
r�•crs �.ow o= aec•+wYc r�i� is .Es�wro •evo�Ye ouA wei**[� .nowov.� .s �.urw� Pao.rcno.. *o cue»n. •�i .vrt�c ..+o ov��e�v�s
330 i3
�
W���2 Zq� , .S��.rf�„Z i:,f� ot,Z�,, J,u.
Fo2 Twininq Laboratories �f - ' f
3310 Funnr, Wa�. � Sta���ng 4dnrrss P O Bo� a]� �on� 6cacn CG 90n0� 1713� npg-�355 ' I� 131 636-7386 / 17141 828-6332
TESTING 5an�:c�� orncc :s�� o rn��•n •�..>P. s�.��; s���a e�. c- e�-o.� �,��,r �o�s
March 3, 1981
Examin�fion: SCE1-975
COMPRESSION TESTS ON CUNITE CYLINDERS
Max Sitter
Post Office Box 3U54
Fullerton, CA 92b37
PROJECT SPA
noDRE55 3482 Wi_ndsor Court, Costa Mesa
SnMPIE FROM Ptain Drain
MCMIfFCT COM[�CiO�
Berge Pool Berge Pool
FNOINfF� fU�CONT��[t0�
Bernard C. Ad[oas S& A Gunite
SPECIfIED
MIX 4,2_� STRENGTH
DATE CAST 2�>>�8� SLUMP 512E
DATE TESTED 7_/21/S1 3/03/81
SPECIMEN NO. 1 2
COMPRESSION 10-Day 20-Day�
TOTAL IOAD, 1B5. j%,000 106�000
POUNDS PER SQ. IN. i��10 3�4SS
01-
�rz-
2,000 Dsl
6" :t 72"
6�" x 12}"
COMPLIANCE Zp-Day test complies with specifications.
w.0 �r OELIVGFO �r ■iCfWfO ON
SPECIMENS Jeff hiax Sitter 2:12/81
Olti�l\UTION:
Max Sitter - 3
, Costa Mesa Bldg. Dept.
YGIL:iiuli �TZ',.Pl
�' �� 09 1981
Neale Zuidema
�� o rt`o15 ��l Sul��Il10 �5 Iw( CON�iDlti:i�L ✓+ Ini� Of CLi[Ni5 ♦ViNOYiI�:iON iOn nu[ i OM O� 01/R PfPORiS COwC�VSIOMb O�1 [�
i��C15 �sr�y pe ulG�np�YG �r�fu �S nl5toi[O IfYf - Ve WeITI[Y �✓nqp✓�t �5 � �Utt1�L VPOiI w �O Cll[M1• THL nJfIIC �MO Ol1Y�[LV[S
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�g� ��- -- ---- ---- --� -- -. . ..
CITY OF COSTA MESA
3y$� Ut,nin5oa G7. Building DEPARTMENT
Address OF
1� . ,, BUILDING SAFETY
�C2NNi��nii Owner
p,}Cp �-�y�L. i�AI1tT8ctoi
'i�"'�j S, (1�qfN t A, Address
Permit Date
S'�� Il Number r/�,�, Isaued
Registered Deputy Building Inspector
Certiflcate of Compliance
� h,� ��
Date of s`Certificate
�. /r, /g �
To the Director of Building Safety:
I hereby certify that the following portions of work on the buildings
at the above address which required continuous inspection and which I was
employed to inspect, were inspected by me and comply with the provisions
of the Building Code applicable thereto.
1) Concrete 3) Welding 5) Spectal Cases
2) Masonry � 4) Reinforced Gypeum
Swimming Pool Size 5pq rj,�tt Gunite �� Rar,3 Pack
Sacks Cementy��—� Tons of Sand �b
Approximate % of water in aggregate 5��h
This report covers work completed during week ending��Q �
REMARKS:
SrFEL� �0�� �ZN�JI S�FeL �/ \:�. �
C.Le�aH+�-cQ,J �vi:�lu+�q^.�Si��p 0.1t, ggGISTERED PU BU3L-B1�0(� ZNSPECTOR
�ovo�•�l� L�L,.�oP2 pawll"S
Name /�A�( S�a
nddress no• �ic �t�l�4 1�v�lra�o�..
Laboratory ��v•�.�..v Telephone LJ�% 1— 5�'� )
Form BU 6
]L2i:C�YVEiD
r--� � 7 ��81 tti.
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� COSTA MESA BUILDING-SAFETV DEPARTMENT
� P.O. BOX 1200 COS7A MESA, CAL�FORNIA 92626
/
For Applicant to Fill in Comple[ely - Use Ink Only
BUILDING
AODRESS Tract 1�2%8 iAt 41
OWNER OR
TENANT McLain D0V2 O T t. CO
ADDREss 1470 Jamboree Rd.
arv Newport Beach No�'640-6800
CONSTRUCTION
BRANCN
ADDRESS
ARCHITECT r...-1.;../v�...�F...; TEL.
ADDFE55 Jbbl spruce SL. � lV0Wj�0I'L tlCR.
CONTRACTOR MCLain Development Co.
ADDRESS 1470 Jamboree Rd.
TE�.
CITV Newport Beach No. 690-6800
LIC.No. 273675 LICYNO.LHH%3
SI2E NO.OF 8LDG5.
OF l0T NOW ON LOT
USE OF
Separa[e permils are required for
elecViq plumbing and heating work.
UILDING AND WORK TO BE PERPOFiMED
I heraby acknowletlge thet I �eve reatl ihts application antl state
that the abova Intormation is correct antl aprea to comply wlth
all taws rBBulatinp builtlinp cOnrtrucNon, antl 1 shell noi amploy
eny permn In violatlon of Me workman'a compensation laws ot
the State of Ceiifornle.
I hereby eertify that I am proparly IlcanseE as a contraetor undar
the Stata of Celifornia Business antl Profeuiona Cotla, Division 3,
Chapter 9, antl that sueh licenses ere In fuli force antl afieci, or I
am exompt from t�a provisions of t�e S[ete ot Cellfornia Businen
und Profes5iona C e, Divislon 3, Chapte/rg
SiB^ntura of �E C // £N„�t�
Permlt[ae ���
or
Authorizotl A t Date
hh7G II/IwIl7 �uo�qu il
APPL[CATION FOR STRUCTURAL PERMIT g`'
RECEIVEDBV PEfjf�J'[�.�*i� �^ •
A.P. NO. �'I� (i
BUILDING ���'
ADDRESS p
UNIT OR
SPACE NO.
TR.NCJ,��� LOT �
� CJ
NEW ADD AITER I
v
USE
ROVED
APPROVEDSETBACKS
(FROM C/L STREET)
PLANNING ACTION
THE AMO
THE PUR%
VALUATION
S /��/�/
f .� i
�
VALUE
E
DATE
APPROVED
.,eT� 10
'ABLISHING A PERA
PERMIT FEE S
PLAN CHECK E
---I
TAX E
TOTALPAID y
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. COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICAT[O�FEO'R��I'RlIC1FZ�11Y.1�L PERMIT 48.50
Y.U.tlVAI[UU GVSIAMtJA,GALIYU!(NIX9[b[b -
RECEIVED PERMIT y A /
For Applicant to Fill in Comple[ely — Use Ink Only `-� J
Aooa°es"s 3482 iVINDSOR CT. A�P� N�' �— O 2— y�
OWNER OR ADORE55
TENANT KENNICOTT
MAILING SPACE NO.
HDD0.E55 3482 iYINDSOR CT.
�ONO.� � � LOT �' BLK.
TEL. �
CITV NO. _
NEW ADD ALTER REPAIR MOVING DEMOLISH
CONSTRURION
LENDEFi
BRANCH
OWNER
AODRESS VALUE
ARCNITECT TEL. USE S]i8 E SOOO.O
ORENGINE aB.C. ADAA9S 636-029
ADDFESS 12%rj3 Brookhurst G.G. 20NE — T GROUP
CONTRACTOR BERGE POOLS INC. ByPROV DATE / d
ADDRESS 4].31g S. Main .ST.
cirv SANTA ANA N�79-5616
APPROVE�SETBACKS
uc No. 280953 C 53 uc�No.
SIZE NO.OF BLDGS (FROM C/LSTREET) ��
OF lOT NOW ON LOT OfYT FT.
EXIS'fINGBLDG. SFD �
Separate permits are required for L. SIDE 2 FT.
electric, plumbing and heating work:
REAR T.
USE OF BUILDING AND WORK TO BE PERFORMED PLAIVfVING ACTION
DATE
APPROVED
APPROVE �/,% /��/1���
o.�u� ! w
I hereby ecknowletlpa tha[ I havo reatl thls eppllcatiOn antl stat0
thet the ebove InformeNon is eorrect antl aprea to comply wlth
all lews reB�leting buildlnp conrtructlon, and I ahell not employ
any parson in violatlon of Me workman's eompensation laws oi
the Stata of Celifornia.
I hereby cartify that I am proparly Ilcansatl os a eontreetor untlar SQ. FT.
the State of Callfornia Businese antl Professions Cotle, Dlvlsion 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, entl thet sueh Iieenses��full torca enA affect, or I THE PURPO6E OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from tha �viAonrof the S te o( Celifornia Busineca �p�LUATION PERMIT FEE 3 �
and Professions Co �/Divialon 3, Chaptar 9.
� VLAN CHECK S ��
SlBnatur �/ /�
Pa�mitte � / �(/D TAX S
or 9_81 �y �
Authorized ABent e TOTAL PAID �
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COSTA MESA BUILDINGSAFETY DEPARTMENT APPLICAT[ON FOR STRUCTURAL PERMIT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 *
RECEIVE V �,��3 s�9�ei.51q41 • •5Q
For Applicant to Fill in Completely — Use Ink Only -
ADOflESS ��I L 4s �f/ i/Il1� /J� �� A.P. NO. 2"' �"
BUILDING � ` �
T�ENANT�R��r,+�,e' ��✓.' /�C: '���') r�( RT ADDRE55 3 �IN� SO� C
UNIT OR
MAILING �� � SPACENO.
AD�RE55 i i' 4y �� �I: I�I'I; (%� v�
TR.NO. � LOT BLK.
TEL. D
CITY P/%'�i�C ��L�t NO.
NEW AD� ALTER REPAIR MOVING DEMOLISH
CONSiRUCT10N
LENDER
BRANCH `� CMM 1
OWNER � �O
ADDRESS /f VALUE
ARCHITECT �/C'//, rJ �yr',q TEL. � •n�
USE � a+I � C.OIh}�s E,SOC±
ORENGINEER F /':IL''>� /,.��.� /-� �.
ADDRESS fL� i��P / ILA S i i v'1'� �C�l ZONE YP�^NGROUP
/ J ' APPROVED n
CONTRACTOR (�)j` /� {�h/y(/j`(� �,� %��'(. 9V DATE J�7'^
ADDRESS �' h'� � �/�
��%C r;,?/,c�i � 04':�('
i � C' TE%,^ �f'/_: r
��T� iJ i��<l ,��: � No.:�vJ,.���
APPROVEDSF�TBACKS
LIC.NO. � � �4�! � LICVNO.L3%� �` � �� ��
SI2E NO.OF BLDGS. (FROM l TFEET)
OF LOT NOW ON LOT FRONT
USE OF A Q� D��
EXISfING BLIX'i. T Lv
r '
Separate permits are required (or L. SIOE �. �
electric, plumbing and heating work: �
FEAR fT.
USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
� DATE
APPROVED
APPROVE � 6�
� C�
I hereby acknowledge thet I have reatl ihis epplication end rtete �
that the above information is cOr�ect antl agree to comply wlth �
ell laws ragulating builtling construction, antl I shall not employ �
any person in violation of the workman's compensation laws of m
the State of California. m
I hereby certify that I am propelly licensetl as a contractor untler SQ. FT. � O � N
the State of Californie Business antl Protessions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, antl that such licenses are in full force antl effect, or 1 THE PUFPOSE OF ESTABLISHING A PERMIT FEE ONLV: �
am exempt from the pr visions of the Staie of Calitornia Businass a
antl Professions Co ision 3, Chapter 9
VALUATION PERMITFEE $ �— '
I "�
/ PLAN CHECK $ �— "�
Signature o 0 �
Permittee S �� TAX $ �. F
O� � � U
Authorizetl Agent Date TOTAL PAID $
. J