HomeMy WebLinkAbout3370 WISTERIA CIR - Building PermitsAppiican[ to fi11 in all sDaces within heavy boraer lines anO sign al1 appropriate Oeclarations.
CITY OF COSTA MESA PERMITyy� TRACT NO. LOT NO. �BLDG. NO.
CONSTRUCTION PERMIT f � //�/S
Address
Address
LICENSED CONTRACTOR OECLARATION
1 hereby atfirm that I am Iicensetl untlet Provislon
mencing with section ]000) oT DIvi4�on 3 of
Prot¢55i005 Cotle, a�tl. myy IicenSe IS In full
S.�L_ $ignature
dPEN5AT10N DECLARATION �
that I hdve a<¢/tifltat6 Ot COnS¢Ot to selt-insu�e ov a
orkers' Compensation �nsurance, or a certifietl copy
3807 Op,Lp�C.Company ���� ' "' � T �
LC
�.�"adrtltietl aOpy is h¢rBby furnishetl.
-��rtifiea <opy is Tiletl with the city BU�Itling Division.
EMVTION FROM WORKERS' COMPENSATION DECLARATION
(This settion neetl not De completetl if the permit is tor one huntlred
SE100) or less). �
certify that in the p¢rformdnce of the wo�k fOr which this permit is
issuetl, I shall not employ any perzon in any manner so as co become
subject to the Worker5' Compensation l.a�✓5 of California.
Date Si9nature �
NOTICE: If after making this tleclaration, you should become subject
to Ihe Workers' Compensation provision5 of tne Labor Cotle, you must
torthwith comply with such provisions nr this permit shall be tleemetl
revoketl.
CONSTRUCTION LENDING AGENGV
I hereby affirm that there is a constructlon lentling agencySor the per-
formance of the work for whi<h this permit is iszued {Section 3�9]
a�. a�. _. m L til
Lender's Name
Lentler's Atltlress
OWNER BUILDER �ECLARATION
I hereby aftirm that I.am exempt from.the Contractor's License Law for
t�e (ollowing reason (Section 7031.5 B�siness antl Protessions Cotle:
Any city o� county which requires a pe�mit to ConStruct, alter,
improve, tlemolish or repair any structure, prior [o its issuance, also re-
quires fhe applicant for such permit to file a si9�etl ztatement that he
is licensetl pursuant to the provi5ions ot the Contractav's LiCense Law
(Chapter 9(mmmencing with Section �000} of Division 3 of the.
Bu5ine55 antl PrWessions Cotle) or that he is ezempt therefrom antl th¢
basis tor tne allegetl exemption. Any. violation of.5ection 7031.5 by
a pplicant /o� a pe�mit subjects th¢ applicant to a civil penalty
< more than .five huntlretl tlollars ($500). -
C, as owner o( the pro0e�ty, or my Bmployee5 with wages as their
sole compensatlon, will tlo the work, and the structure is not intendetl
or offeretl'(or sale. (Section ]044, Business antl Professions Cotle: The
Cont�acto�'S License Law tloes not applY�to�an,owner of a p�ope�ty
wh0 builtl5 0� improves theieon, antl who tloe5 SucH wo�k him5eltb�
throu9h his own emplbyees, provitled thdt suth improvemenls.are not
intentletl or oftered tor sale. If, however, the buildin9 or improvement
is Soltl within one y¢ar Of <ompletion, tHe owne� will M1ave tM1e bu�tlen
o/ p�oving he tlitl� not' bUiltl or impro�e tor the purpose of sale).
❑ I, as owner o( the property, am exclusivery `contiacting with
IicenSetl cont�acto�s to.construCt the projec( (Section ]044, Business
antl Professions CoOe: The Contractor'S License L3w tloes noi apply to
an owner of property who builtls or imProves thereon, antl who COn-
t�acts from 5uth projects with a cont�dcto�(s) licesnetl pu�suant to
the Contractor•s License Law). ` .
❑ I am exempt untler Section B. & P. C. for this
reason �
TVPE OF CONSTRUCTION
�NEW ❑ ADD. ❑ ALTERATION
❑ REPliIR ❑ CONVERSION ❑DEMOLISH
❑ OTHER
DESCRIPTION OF�WORK
• 7769 !I/03/81
� �
Z
A.P. �
_ ZONE PLNG�. REF. �
TYPE OF PERMIT
❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL'�PLUMBING ❑MECHAI
❑ OTHER
PROJECT DESCRIPTI�N '
SQ. FT. 8 7
OCCUPANCV_CONSTRVCTION TVPE
VALUATION ZONE �
GRADING CV. VDS. ACRES
PLUMBING
BATHTUBS
TOILETS
LAVATORIES
KIT. SINKS
SERVICESINKS
FLOOR SINKS
DRINKING FOVNTAINS
INTERCEPTORS
SWIMMING POOL
WATER SERV ICE
PLANCHECK
SHOWERS
URINALS
OOUBLE LAVS
DISHWASHERS
SUMPS
FLOOR DRAINS
CLARIFIERS
PTRAP
Al_TERATION
GASSERVICE OUTLETS
WATER HEATERS BTU OUTPUT
SEWERCONNECTIONS
'SOIAR TANK
SOLAR PIPING !
, ISSUEFEE^,.
MECHANICAL
COLLECTORS
PLAN CHECK
- HEATING SYSTEM -0-300,000 BTV
�'ANDDUCTING' 100,000+gTU
REFRIGERATION 0-100,000 BTU
SVSTEM
300,000 + gTU
BOILERS BTU
Date Owner SVSTEMREPAIR,ALTERATION
I h¢vEby certifythat I have reatl this appliGation antl state that the above EXHAUST SVSTEM MULTIPLE
information is correct. I agree to comply with all city antl county
ortlinances antl state laws relating to const�uttion, antl hereby authorize
representatives [his city t enter u on the above mentionetl
property for ' ecti purp e. � �
Signature Oatd ISSVEFEE
Driverz' License or 55 �
CMF 0865-46 White-Builtlinq; Canary-APPlicant; Pink-Accounting; Goltlenrod-Assessor
REAR VARD (TO P/L) -
PKG. SPACE REQ. PROV IDED
STREET WIDTH PARK FEE
'LUNING qPpROVED BV I �
SPECIAL CONDITIONS:
ELECTRICAL PLAN CHECK
5O. FT_ SQ_ FT.
.GENERATOR p.l KW_1-10 KW _
TRANSFORMER
AGPLIANCE 30-50 KW_50 + KW _
MOTORS 0-1 HP 1-30 HP _
(INC.SOLAR) 10-SOHP 50+HP_
FIXTURES OUTLETS SWITCHES
GAS TUBE SIGNS
POLE LIGHTS '
POLES METERED SUB
PANELS MAIN. - SUB
'SERVICE AMP
'APPLICATION APPROVED BV
SUMMARV OF FEES
BUILDING
PERMIT $
PLAN GHECK- $
PLUMBING $�
PLAN CHECK $
ELECTRICAL $��
PLAN CHECK $
MECHANICAL $
PLAN CHECK $
SMIP '
PERMIT
ISSUANCE
GRADING
. 15.50 TLi'
�ATE
$
S �
$ ♦\
�+�
$ �
MICROFILIN $ �
TOTAL FEE $ '_
LE55 AD- �
VANCEPC $
� SJd
FINALFEE $�
�� � CONSTRUCTION�AND'PLANNING � t ' � POOL & SPA ,
APPROVALS Permit # Date Inspector qppROVALS Permit #� Date Inspector
1. Temporary Electrical Service or Pole - 43. Pool & Equipment Location ' ��
2 �Soil. ipe-Undrgm . � � - - 44. Steel Reinforcement ' � ���
3. Electr,ical Conduit Utility-Undrgm ` - • � 45. Forms' � � � ' � ` `�
4. Electrical Conduit-Undrgrn " "' � - ' � � " � 46. Electrical Bonding - � �
. tee ein orce�, � ' - � - - 47. Rough.Plumbin & Pressure Test � � -
6. �Electrical UFER Grn " - � � • � 48. APPROVALTO COVER-GUNITE
7. Footings � - ' � � -• � 49. Electrical Conduit-Undr m ' ' '
B: Foundation . - " �- -- - � - - 50. Gas Pipe, ❑ Undr rn, Test "
�9. Water Plpe-Undrgrn - � 51. Backwa`sh Cines P-Tra - 0 Undr m�'
' -i0�'" Structural Floor System" - `� - 52.' �APPROVALTO�DECK � �
, �it. � Propert �Sewer Line & House Connection. � !' ' � - � 53. Backwash & Rece forFinal ' � �
�" 1'2. Stieet Sewer-Connection '�- �� - - � � 54. Heater & Vent-Final '
13. Rough Plum6ing" �� ' - ' - ' ' ' '
�"�14�. Rough'ElectricConduit � ' - �56. Electrical-Final '
-�15. Rough �Iectrio-Wiring. . 57. Solar Sysiem-Final ao -
i 6... Rough Heating & Air Conditioning • Fencing & Access qpproval � .
' 17. Ducts, in Structure .� - ,,.. ' 9. APPROVED FOR PLASTERING --' '
18. Ducts, Ventilating' � � �� �� . � � � � �n . � ' �
- 19. Gas Pipe-Rough &Test ' � � 60. POOL/SPA SYSTEMS FINAL . - � .�� -
20. Roof Framing • � � � � �
• 21. Roof Sheathin ' - � ' .
22. Frameand Flashin ' � NOTES: ��� gy (.;��T[�2D L�� .
23, Insulation -� � � -
24. Lathing & Siding � � '
- 25. Drywall Nailing � � • � � �
26. Plaster grown Coat - �- ' - �
27. Electrical Power MeterFinal � � - � � � - •
28: Final Electric ' ' � � � '
29. Final Heating & Air Conditioning - � � ' ' ' ' -
30. Final Gas Pipe-Test - � - �
31. Final Plumbing � � � �
32. Water Service-Final � � / / � - % -
33. GHs-SerGice-�inal ' • � 1 / i �/' � `� ./ /f
34./Solar pomesticFinal �. . �� / V � � � -
35. Landsc� eeS r.inklin'S stem ' ` - � � � - � �7
� 36. Sound Attenuation � ' r i i
37. Handicap Regulations � - -" �" - ' � / '
38. FINALSTRUCTURE&BUILDING - � � �
39. Special Requirements Completed � � � � �
40. Electric Release to Edison. � �� ���
41 . Gas Release to Southern California Gas Co. - '" ' � ' ' "-
42. CERTIFICATEOFOCCUPANCY � � -
No _ Date �
� ~ SOLAR FEASIBI L�T�
tta:� ��-1� --+-?� �'; ,S�
AAU.R..�"'�S ���G �1/i STf;� �A C.��:2
CT'�"I �U 57��9 /f%f's �;� ZIP CODe. �/.- ?C�
_ ��� PHD:i:. �5 %o � %� s �/
TX�'� �' CO?]TP.OI. C" 3 d
S�oaac� Ta�� szz: 4o C�� L
SiOP,AGr^. Tl�ii'ii FLACc^. '�-"�'�T�� !? .: i� (.- P
HOT WAT� T.tiT�C SI� L/e ,;� � L.
HtlT TdAT:.R T4i�:c� ?W 4C :�'�;T �o �ji� L
HOT :iAi� ^1.�."id J.;C:�:' "�'
DZST. TO �.?.CTF�t'.AL C.;��
P�3 : Jh I..�."�i�GT:.' t�,. /6F .�7�
Y
S�Z: CONC.�?. SI„�3 /YU
OL�^_'St�.S ST_OZ4G� Sr..�"D�. ��C�
OYr' OH 'r�0 STGfiY �i/.�'�'
Peranii ,#�l_�_s'
THIS NUMBER MUST ACCOMPANY '
ALLINSPECTION REQUESTS �
S�UD'"� DN�I
na� � ��; ��; �'/
�. ��,z �-� •Y
MA2 F�:l /� - 7
BUS�iE55 °&DiTc.'
S?�II' Y"?.S� � a � ,�0
___�' �
cor�,�c:oas z �?:�u�/�
aooF xs�� . ���.i: L_
ROOF CO.;DITION �'�/
u
RCOF SLOP� :� c%
c.�3^ r��� N �
aac� (-taT �t;,F.ac�) �D
a�c �cc:ss „y-� S
P� ccr��z %'i-' �
P�L.-'I'EOD Gr^ ?A�•L;T �
� ,
; ��
Ap'��6y�
�������
�� �� c�srA �o9�sa
P.1acl:anical Division
6ui3ding G�partmerT
Approved���f'�"""'�._.... Datel�l .��../..��..
a
0
f?4UNi/N� Bl�NK 1
�'�" L A G i3 0 L 1' _
�
t�fiK11�1UM �,,
RAET�R ._ -
T..RU55_ES @ �'l IN %
��.'�..:-.;�,.:;_,:_ `�coi�L�.c.TqR :::
SDLAf�_�.b�.:L.�CTOR:�f_90unJT1NG.-D�T�►G
_. ._... _..._ ,-:::.,__------
„ - SEcT-iaN /� -1� __ ._ ...
9 ° c� �
��:��
l N. J� � . r • 1
�
�o �� � � �..A. rr��
r
z x4 �� G.F..
,A�fED GR�nSOTE
:Ao- To -- __
RAFTERS :.
-.-SILIGONE S�A�.ING
� •4-. SHINGLE
'a- Roo F
�,/a.!'�i1.L �fm:'TPK 5 2116
_ ; , .
. _ ._ _ _
� STAND�RD Pl..AN SOL.4:� WA� H� �iNC SYS�1
_ CAL-S � . �.E BUILDF335 . . c�°�" � �e.s�zsae
�
rtc-te _
a�'�3 � .
' • . _ - � �IR V�1.T : . .
. �,–� "'�
�fJ i OL! i
. " �
.. . .'�.:: .. �.
V: L'� =
tt .
L�
_ 't .
1�
�Q��� II
s � cP.�c � . �
T�NK � � ; �:M� �
tc
t� .
ti �
iy _..
I 1 .
♦ • O CF.^1{V }ili�
. �'C c'-t r�:= 4`. .
• �� Z
•4 � =4,`�� I � I � .`
�
,`2�.� , �oti
I
TESTING
Twininq Laboratories ��f =��,«t�==,� �=��f�=,=��, �>>_�.
°.O- BOk <� ..'�D Ai670Fi W.SY . LOUG BEACH CAIIE 9CEOI . �2i3� '1oJi» .'213� 636�2386 .(1�4� B2B�6432
=enNc� n�F�ces.
� �su.poa�:��n.pe.s�,e,.� ..., Ho-ue��,.-o.�re����y
s:.'.;�
s,..�t.e c,���..ra�rm E _A, zassaado,a�n.e.P-o ea..r
Pi��Eli2!a. ��� wyo+cnCeif.9Cp01�1p1e]01)EO
1���.
,�N.
August 19, 1974
exam��a�io�: sC74-4383
COMPRESSION TESTS oNGUNITE CYIINDERS
Mr. James L. Moor
5°�0 Maverick
Riverside, Lalifornia 92509
PROJECT Swimming Pool for DAVtD JONES
ADDRESS 3370 Wisterie Rve., Costa Mesa
SAMPLE FROM Shallow End, Deep End E Bond Beam
♦PCHI1f:1
Blue Haven Poois
fNGINEEv
- Same -
MIX 4—��Z [O �
DATE CAST $'�Z—�4
DATE TESTED 8-19-74
CYIINDER NO. A
CONINAQOP
DLue Have Pools
SUBCONIRRQOR
Enterprise Gunite
SPECIFIED
STRENGTH
CYLINDER SIZE
8-19-74
B
COMPRESSION % D�yS 7 Days �
rorn� IOAD, LBS. ]4,000 82,500
POUNDS PFR SQ. IN. 2�$5Q j��L�O
slzE: 5-3/4" x 12-1/2" 5-7/8" x 12-1/2"
GO MPIIANCE 7 Day test complies with speelifications.
CYIINDERS
Mnoe er
Enterprise Gunite
ois.aieuriow
James Moo� - 2
Blue Have Pools
Costa A1esa 61dg. Dept.
oEiivEAEo er
Dave
2,000 psi
8-19-74
C D "HOLD"
E ��HOLD"
7 Days F "HOID"
77,000
2,965
5-3/4" x 12-i/2"
0.ECE�VEO ON
8-13-74
---- - /.
�� .
�
�' �'�- ��� .
, �..���4.�._
��:.�,..- -
,
. �.. � _ . , , .� ,. .. _. .. ,� ..�.. �. . . _ . ._ . _ �� � .� . ,,. � a�v atv o ._.�„o�, aa F.
o. s .� � _ .. .. ..�� . .�. .,.. . � ._ � ..�. .. ... �_._.. �o:E�. ,� ,��«,F�.S � E_
o�e��c •�o o.=sc_.�es.
f
` CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT N0. �j�l ��'� DATE � li;
IpT N0, � � rj
ADDRESS �`3r► P �l..,t��. L,2n�.e�
The developer of the above entitled tract desires to sell the above set
forth 1ot prior to the t3me that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledgea that
(he-she-they) � (was or were) ��I�;�QtiQ advised that this tLact has
not been given fin nspection nor has it been accepted by the City of Costa Mesa
as having complied with the conditions of approval which were impoaed by the City
at the time the final tract map was approved.
The City assumes no liability fot the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The underaigned agrees to indemnify and hold the City harmleas from
any claim reaulting in damage or peraonal injury to the undersigned by teason
of the aforementioned uncompleted condition. �
i
BY / i_
Purchaser
BY
��a^� ��
Developer and/or authorized .
representaeive
BY � E�h:� �( Gec�o-rr
Lender
OWNER JONFS� DAVID
.;t JOB ADDRESS
GENERRL CONzRACTOR
�` � �].C��r-
� Pool Location -
� Forms
Main Drain
Steel ReinfUrce
Elec. Bond
Approval to Cover
Underground Electric _
Gas Piping Test
Filtering System Lines _
Backwash Lines and Recep.
Electrical Final
He-'—• and Vent Final _
Fi� 3ystem Final
Backwash and Recep. Final
DATE 7-22-74
BUILDING PERMIT D
DESCRIPTION of WORK Pvt.Swim Pool
FIRE ZONE VALUE $ �3�
GROUP TYPE
SUBCONTRACTOR P
Date
Electric
� a�
r /
Plumbing
�
}•'y � � P�i.. i:i:�.}
v, y � 22-7��-�. onzia.•: 3�.5C
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
PP IC ION FOR BUILDING PERMIT
For Applicani to Fill in Completely
RE e D�E yE�i E ��
ADDRESS � Q S ' C�✓/(� �< <�
/�/J MIT NO
�WNER ["' A.P. NO. — `D� �7
MAIL BUILDING 3'%Q ��f�t A .a
ADDRESS �/aDDRESS /
Z . �/'
dU CITV �� NOL TRAGT�/ T BLOCK
ZZ W A P
Q CON5TRUCTION
O N LENDER
am
J � BRANCH ' �
J N OWNER
m J ADDRESS � VALU$ ZZ ..�.
m ARCHI7EC TEL. f%����
J a OR ENGINEE N
V Q FIRE
W Q ADDRESS ZONE TVPE GF UP
aw APPROVED � ��-�J
w Z CONTRAG �-pP�/ BY DATE � �
J �
m Z
J � ADDRE55 ,'�
W w 20NE vn NO.OF �% USE OF W�
�= CITV NO�'�� ,�/ /\/ P��Q BUILDI
Z�
w O STATE CITV VARDS APPROVED VAFOS APPROVED
�� LI0. NO, y ��C. NO. MAIN BUILDING ACCESSOFY BUILDING
_� SIZE NO.OFBLOGS. (fROMC/ISTREET)
OF LOT NOW ON LOT ROM' FT. FT.
USE OF
EXISfING BLDG. FT
H SIZE OF DO NO.OF
Z NEWBLOG. ROOMS STORIES L.SIDE b FT. FT.
�% COVE ROINGALL COV�ERING REAR SFT. FT.
J USE OF BUILDING ANO WORK TO BE PE:�FORMEO p�'ANLE BET. BET. MAIN &
d MAIN BlOGS. A�ESS. BLDCS.
a
Q VAR. � DATE
O C.V.P.�b APPROVED
yAPPROVED � •�
� a�'
UI hereby ecknowletlBa that I have reatl thia application antl stata
� that ihe abova information is correct antl aBrae to comply with
� ett fews reyulaNnO buttding coostmcHon, end 1 shall not employ
F any person In vlolation of t�e workmen's compensatio� lews of (�`
y [he S[ete of Calitomia. �
zI hareby certity thet I am properly Iicenzetl as e contractor untlar S�. FT. o
[he Stata of Calitornia Businesz antl Proteszions Cotle, DlvisiGn 3, THE AMOVNTSHOWN VNDER VALUATION IS FOF
Chapter 9, antl that Fh Iicenses ere in tull force antl aftect, or I THE PVRP06E OF ESTABIISHING A PERMIT FEE ONLV: ¢
em azempt irom tJr��rovistonsof the5tate e fornia Business VALVATION '�
antl Professions 6, Divisio 3, Chaptar . m
PERMfT FEE 5 �
SIB�oture of ���� /) �q( 7
Permitt //T'T=>� $ �✓�O� PL.ANCHECK$ � E
��'�� q .� °
Authorizetl Agen[ LL
TOTAL FEE $
2 .
a cWj
Z
Za
O v~i
d pj
J �
J N
Q w
0] J
m
J Q
UN
Z a
W �
aW
J Q
m Z
J �
W w
0
z�
W �
��
�o
�5 �
vn�o
AUG 15-72�a�.001065+� **t� 142.E�
COSTA MESA BUILDING-SAFETY DEPARTMENT "
SOLBRP•O. BOX 1200 COSTA MESA, CALIfORNIA 92626
PL CATION FOR BUILDING PERMIT
For Applrcant to Fill in Completety �
RE EIV V DATE RECEIVED D E ISS D
BUILDING .iZ/.�7 /� �7
ADDRESS 3 70 Wisteria (�ilTC1E � i
- PERMIT NO.
OWNEF Larwin Southern Calif. , IRC, A�P� NO. '� �
BUILDING � '
nooRess 16255 VentuY'a BlVd, nooaess ��� �(/�K,
CITV Encino, Calif. No.`'986-889 TPACT /�� LOT BLOCK
conisraucrion,Larwin SoutheY'n Calif. Ew noo A� E P
LENDER
BRANCH 16255 Ventura Blvd. � n
OWNER �K��� C
ADDRESS EnCino, Calif. -
W/ VAWE `-�
ARCHITECT TEL SE «D
OR ENGINEER N
FIRE � �
ADDRESS 9100 Wilshire,Beverl H11�.S ZONE TVPE GROUP �
APPR
CONTRACTOR LaY�niin SOutheYn Cd�.lf. B�'� DATE7"2/—%
nooRess 16255 Ventura Blvd.
TEL. ZONE p NO.OF USE OF NEW S/N
c�T� En i No. /�I P�anis a eui�owc �,p T C
STATE CITY �'AROSAPPFOVED YARDSAPPROVE�
uc.No. 191311 LIC.NO.B-1 MAINBUILDING ACCESSORVBUILDING
SIZE NO.OP BLDGS. iFROM C/L STREET)
OF LOT 6O X LOO NOW ON LOT Q FRONT . FT. FT.
VSE OF
EXISTING BLOG. R SIDE FT. FT.
SIZE OF NO.OF
NEWBLDG.1%�FO FOOMS STORIES 1 L.SIDE FT. FT.
EXTERIOR WALL ROOF ^/
COVERING St.0 OVERING REAR ib T. FT.
USE OF BUILDING AND WOFK TO BE PERFORMED OISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS. BLOGS.
Construct sin le £amil dwellin c�P# avPRoveo �J
APPROVED '� �Y(' E 7Z
I hereby acknowledge mat I have reatl mis aoolication antl stare �pI,p FOR SPECIAL REQU � N1'S
that the above information is correct and a8�ee to comply wiih
all laws regulating buildin8 construction, and I shall not employ
any person in violation of the workman's compensation laws ot
�
the tate o ali omia. �
I hereby certity that I am properly licensed as a contractor untler � SQ. FT. O
the Stata of Calitornia Business and Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR �
Chapter 9, and that such licenses are in full force antl etfect, or I THE PURPpSE OF ESTABLISHING A PERMIT FEE ONLV: ¢
am exampt trom the provisions ot the State of Celifornia Business VALUATION
antl Professions Cotle, Division 3, Chapter 9. � N
/� PERMIT FEE $ �
Si natura o{// /�� ^ � 0'V m
Permittee ��J ///'�//�/J- %1�✓�� D. Downs $ / � �� p�qN CHECK $ �— E
�.c4s � G`r��L C� V �
Authorizatl Agent / �� LL
TOTAL FEE $
� V
6P