The URL can be used to link to this page

Home My WebLink About341 WOODLAND PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Viciniry: Parcel Nunmber: Applicant: Address: Owner: Address 341 WOODLAND PL 42622136 VOLLMER, KENT ORR, JOHN P 1115 HIGHLAND DR NEWPORT BEACH, CA Contractor: VOLLMER ELECTRIC Address: 230 SOUTH EMPIRE ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 7000a Service over 1000a Motors to 1 hp Motors to tOhp Motors to 50hp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole ANAHEIM, CA Phone: 714-533-76t4 Zip: Phone: 949{50-7668 Zip: 92660 Phone: 714-533-7614 Zip: 92804 License: 463159 SCOPE OF PERMIT ADD HOUSE METER FOR LAUNDRY ROOM AND OUTSIDE LIGHTING. $23.50 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $30.50 $0.00 $0.00 $0.00 $0.00 Quantiry 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Buswaylt00ft Standing Section Misc Electrical Equipment Transtormers up to 1 kva/kw ................up to 10 kva/kw .................up,to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System I Ckt Misa Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand fireworks Stand Other Electriral Fee Investigation Fee Plan Check Fee Reinspection Fee status: ISSUED Applied: 06/27/2001 Issued: 06/27/2001 ISSUEDBY: rG1 Quantiry $0.00 0 $0.00 0 50.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES E54.00 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all appticable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period ot 180 days. INSPECTIONS: In order for ihe work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requirad inspections and finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2448-06(N00) WORKEPS' COMPENSATION DECLARA710N: ` I here6y attirm untler penalty of perjury one of the following declarations:� ❑ 1 heve entl will meintain a certificete of wnsent ro self-Insure for workers' compensetion, es provided for by section 3700 of the Labor Code, for tha pertormance of the work tor which ihis permii is issuetl. ❑ I have antl will maintain workers' wmpensation insurance, as requiretl by section 3700 of the Labor Cotle, tor the pertormance oi the woAc iw which this pertnit is Issued. My workers' cqmp�rrs:yion Insurence c�rriar end policy number are: Cerner. lThis section one or less.) Policy iJum�er. � I certily that in the peRo�� cebf tl work) r ich this pertnit is issueQ I shall not employ eny person in any manner so as to become subject to ihe workers' compensation laws of C lii �a, nd ag elt t i I shoultl become sub�ect ro the workers' compensetion provlsions oi Section 3700 of the Labor Code, I shall forthwith comply with Ihese pr ' on I / Applican� Signalure: Da�e: b' ��' � � WAHNING FAIWRE TO SECURE WORI RS' dJMPENSATIdJ COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVEF TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND WLURE (510p,000), IN ADDITION TO THE CQST OF COMPENSATION, DPMAGES AS PROVIDED FOR IN SECTION 31O80F THE tABOq CODE, IIJrEREST, MID ATTORNEI^S FEES. LICENSEDCONTRACTORS I hereby aflirm ihat I am licen; force end effect. Lic. k_ Contractor's Signature: _ 9(commencing with Section 7000) ot Division 3 of the 8usiness end Professi �j°� d my license is in full Clessa C'l� �J/� � Date: 6`27• O CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirtn that there is a construction lending agency for the pertortnance of �he work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lendar's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eflirm Ihat under penalry o� per�ury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Profe55lons Cotle: Any ciry or counry which requires e permit to constmct, elter, improve, demolish, or repair any siructure, pnor to its issuance, also requires the applicant for such permit to file e signed statement lhat he or she is licensed pursuent to ihe provisions of ihe Contrectors License Law (Chapter 9(commencing with Section 7000) oi Division 3 of t�e Business antl Pmfessions Cotle) or that he Ot she is exempt tharefrom antl tha �a5is for the allegad eaemption. Any violetion oi Seclion 7031.5 6y any epplicant tor a pertnit subjects tha epplicent to a civil penairy of not more ihan five hundred dollers ($500).): ❑ I, as owner oi ihe properry, or my employees with wages as Iheir sole compensation, WILL DO THE WORK, antl the structure Is not intentletl or offered for sale (Sec. 7044, Business antl Pmfessions Cotle: The Contracmrs License Law tloes not apply to an owner of propeny who builds o� improves thereon, and who tloes such work himsell or herself or through his or her own employees, provided ihat such improvements are not intendetl or oHered for sale. If, however, the building or improvement is sold within one year of complation, ihe owner-builder will hava t�e burtlen ot proving tha� he or she did not build or improve for Ourpose ol sale.). ❑ I, as owner of the properry, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct the prolect (SecJ044, Business antl Professions Cotle: The contractors License Lew does not apply to an owner of pmperty who bulids or Improves ihereon, antl who contracis for such project with a contractor(s) license pursuant to the Contracmrs License Lews.). ❑ I am exempt untler sec. Business and Protessions Coda for Ihis reason: Signature: Date: Owner ID verified by dnver's licen5a. ❑ Ves ❑ No Driver's License No. Expires: Venfice�ion oi Ownership Dy (type ot tlxument, i.e. - property tax bill or tleetl): DIVISION OP INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certity Ihet no eacavetion tive (5) or more feet in depth into which a person is required to descend, wiil be made in connaction with work authorized by this permit and ihat no building simcture, scattolding, falsework, or demolition or dismantiing Ihereof, will be more than ihiny-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle 8, Califomia Administretive Code). � ❑ As ownervbuiltler, I wili not employ anyone to do work which would require a permit irom ihe Division of Intlusirial Safery, as noted above, unless such person has a permit to do such work from the tlivision. Signature: Date: Division of Intlustnal Safety Permit Number: CERTFlCA7E OF COMPLIANCE AND AUTHORIZATON OF EMAY: I certity under penalry of perjury that I heve read Ihis application and stale that the infortnation given is correct. I agree to comply wu all state laws end ciry ordinances relating to building consimction, and authorize representatives of the Ciry of Costa Mesa to en�er upon ihe above-descnbed property tor�nspec�ion purpQs§6� I egree not to occupy or allow occupancy of any building au�horizetl by ihis parmil until final inspection. CODE N, INSPECTIONTYPE 1616 Fixed System Final Fire Preven�ion 1266 Pool Spa Final 200 Final R8-Roof 201 Final BIocWReteining Well 202 Final Fectory Fire Place 203 204 Finel Sign Final Demolition p�L INTRIALS CODE I INSPECTION TYPE 206 Final Mechanical 208 Finel Plumbing 210 Final Electdcal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy �E N71 RIRLS � 1'�'J.!J�Y � y�� :.:..::: ; ; �; (�ia) �sa-sz�a • Fa,c (�ia� �sa-aess CITY OF COSTA MESA BUILpING DIYISION DEVELOPMENT SERVICES DEPARTMENT PERMIT BUILDING PERMIT JobAddress: 341 WOODLANDPL Suite: Vicini[y: ATTACHED UNITS A, B, C INCL GARAGES. ParcelNunmber: 42622136 . Applicant: ORR, JOHN P Address: 1115 HIGHLAND pR NEWPORT BEACH, CA Owner: ORR, JOHN P Address 1175 HIGHLAND pR Contrector: Address: Zip: Arth : Address: NEWPORT BEACH, CA Phone: Zoning: �Phone: 949-650-7668 � � � Zip: 92660 ' Phone: 949-650-7668 Zip: 92660 Phone: License: Eng: -- Address: . 'L � • PERMIT NUMBER "' 699-0061'I 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 05/04/1999 Issued: 05/04/1999 Phone: Zip License: Zip: License: SCOPE OF PERMIT REROOF: T/O; RE�EATH 2 LAYERS OF 15tt FELT; REROOF WITH 25 YR COMP SHINGLES; BACK PORTION Of STRUCTURE BUR. SMOKE DETECTORS REQUIRED. � � Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $0.00 $11225 $0.55 $0.00 $0.00 $0.00 $112.80 SETBACKS MAIN STRUCTURE Fronl 0- 0 ACCESSORY Frant 0- 0 PARKING Ezistinq: o NOTES: Rear 0- 0 Rear 0- 0 Re uired: 0 FEE SUMMARY _- �" � PLANNING 8 ZONING LeR 0. 0 Left 0- 0 Pr000sed: 0 , - �'r�" � Calc Valuation: ss,soo.00 Claim Valuation: ss,soo.00 Right 0-0 Right 0. 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 7, 72-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180�days, or if work is suspended or abandoned for a period of 180 deys. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, antl all requlred Inepeetlone end�flnal approval must be obtained. Feilure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSATON DECLARAnON: — 1 hereby ettlrm under penalry ot per�ury one of the tollowing tleGarations: ' ❑ I heve and will maintein a certiflcate of cnnsen� to selbinsure tor workers' compensetlon, es provided for by sectlon 3700 of Ihe Lebor COCe, for the pertortnence ol the work for which this permlt is issuetl. ❑ I have and wlll mainteln workers' compensation insurance, as requiretl by section 3700 of Ne Lebor Coda, tor ihe peAortnance of Ne work lor which Ihis permit Is issued. My workers' compensatlon Insurance carrier end policy number ere: Cerner. Policy Number. (7his sectlon need not be complefed!l the Oermif Is valued et ane hundred dWlers ($100) or Iess.) ❑ 1 cenlly thet In the peAortnance of the work tor which this pertnit is issued, I shell not employ eny person in any menner so es to become sub�ect to the workers' compensatlon lews of Californla, end agree t�at If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shell forthwith camply wit� these pmvisions. Applicant Signature: Date: WARNINO: FAILURE TO SECURE WORKERS' CAMPENSATION COVERAOE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FMES UP TO ONE HUNDRED THOUSAND DOLLAFE (5100.000�, IN ADOIT1pJ TO THE COST OF COMPENSATION, OAMACaES AS PROVIOE� FOR IN SECTION 3]OB OF iHE LABOR WOE, INfERE$T, AND ATTORNE`fS FEES. LICENSED CONTRACTORS DECLARA710N: I hereby affirtn thet I em Ilcensetl untler provlsions ot Chapter 9(commencing with Section 7000) of Divislon 3 of the Business and Professions Code, antl my Iicense is In tull force end ettect. Lic. x Class # Contrectols SigneWre: Dete: CONSTRUCTION LENDING AGENCY: ❑ I hereby ettirm ihat there Is a consiruction lending flqency for the peAormence of the work tor w�ich Ihis pertnit is issued. (Sec. 3097, Civil Code). Lentler's Neme: Lendefs Address: Signature: Date: OWNER-BUILDER DECLAFiAT10NS: I hereby aHirm thet under penelry ot perJury that I em EXEMPT FROM THE CONTflACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professions Cotle: Any ciry ar counry which requires e pertnit Io construct, alter, improve, demolish, or repelr eny siructure, prior to As issuance, also requires the epplicant for such pertnit to file a signed stetement that he or she is licensed pursuant to the provisions ot the Contrectors License Lew (Chapter 9(commencing with Seqlon 7000) of DiNslon 3 ot the Business entl Protessions Gode) or Ihet he or she is exempt therefrom end the besis tor the alleged eaemptlon. Any violation ot Sectlon 7031.5 by eny epplicant tor e pertnit subjecls Ihe eppllcent to e civil penally of not more then five huntlretl Collars ($500).): ❑ I, as owner of the properry, or my employees with wages es thelr sola compensetlon, WILL DO 7HE WORK, antl the structure is not IntenAed or oHered lor sale (Sac. 7044, Business entl Pratessions Code: The Conirectors License Lew doea not apply to an owner ol property who builtls or improves ihereon, end wha does such work himself or herself or through hls or her own employees, provided that such Improvemenis ere not iniended or oHered tor sale. If, however, Ihe building or Improvement is soltl within one yeer of completion, ihe owner-builder will heve the burtlen af proving thet he or she tlitl not bulltl or Improve for purpose ot sele.). irl I, as owner of the property, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the pro�ect (Sec. 7044, Business antl Professions 7� Cade: The c rectore License Lew does not eppty to en owner ot propeny who 6ulltls or Improves ihereon, end who conirects for such pro�ect wlth e contractor(s) license pur o Contrectors license Lews.). ❑ am exem t tle c. Business entl Professions CoGe for this reason: .� I. �� Si ature: Date: ner ID verifie by tlrivels Ilcensa. ❑ Ves ❑ No Drivefs License No. Expires: by (type ot tlocument, i.e. - properiy tax 6111 or deed): DIVISION OF INDUSTRIAL SAFETV PEHMIT CERTIFICA710N: ❑ I hereby certlty ihat no e:cave�ion five (5) or more teet in depth Imo which a person Is required to descend, will be made in connection with work authodzetl by Ihis pertn0. end thet no building structure, scaftoltling, falsework, or tlemolltion or dismentling thereof, wlll be more than thirty-slx (36) feet high. (Chap. 3.2, Gry 2, Art 2, Sec. 347, Title 8, Celitomla Atlminlsiretive Code). ❑ As owner-builder, I will not employ enyone to do work which would require e pertnli trom the Divislon ot Industnal Safery, as noted above, unlass such person has a pertnil to do such work iram the tlivisian. Signature: Division ollnduSMel Safety Permit Number. Date: CODE �. INSGEC710NTYVE 1816 Fixed Systam Final Fire Prevention 1266 Pool Spa Finel 200 Final Re-Roof 201 Final Block/Retalning Well 202 Final Fectary Fire Place 203 Finel Sign 204 Final Demolition 2maas �L��CIIIII� CODE� INSPECTIONTYGE 206 Finel Mechanical 20B Final Plumbing 210 Final Electncal 212 Final Fire Prevention 220 Finel Planning Approvel 222 Final Slte 250 Finel Building/Occupancy Q� INTRULS City of Costa Mesa Building Safefy Department P. O. Box 317 Co�to Mesa, California CERTIFICATE OF OCCUPANCY N� 2720 C The Building located at ��' ��'- �p uSl�t'9 Q'C has been inspected and fo�nd fo comply wifh the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group � & � Occupancy. Use of Building �'i�'� �� BLLQ�d g$�'g�Q� p� ],� Legal Description ��_�� ($ea rever�a side for Metts ond Bou�dt) Buildinq Permit No. `�'�7 Eledrica4 Permit No.—�3 Plumbing Permit No.��X+� Floor Load Signs have been installed as Room Capacity Signs have been instaled as required under Sec. 2308 U. B. C. . required under Sec. 3301 (1) U. B. C. � 17050. CERTIFICATE OF OCCUPANCY. (a) No apariment hovse, hotel, or lodging house shall be used or occupied untii ihe owner or operator has been issued a valid certificate of occ�pancy by ihe enforcement agency. (b) A new certificate of occupancy shall be obtained whenever there is a change in: 7) Occupancy classificotion of a building or portion thereof 2) The number of aparfinents or guest rooms 3) Ownership If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California Administrative Code, Title 8, Chapter 9, Article 8. Number of apartments_ 3 and/or guest rooms ISSUED TO: Buifdirtg Official IilY.'i�,' &Eti�?� bY��.� 2_�' � � ��% p� DaTe ik.'f'+a'�6x' 16� 29i� This Cerfificate of Occupancy SHALL BE posted in a conspicuous place on �fhe premises and SHALL NOT BE removed excepl by the Buiiding Official of ihe City of Costa Mesa under Sec. 306 ie) U.B.C. For,�, sva�--im—ii-w--s�s r OWNER BUTLER� Michael R JOB ADDRESS �41 Woodlnn i o.11t3-1 Ih..�ECTIONS SOIL GAS W ATER ROUGH PLUMBING PROP. SWR. LINE SPRINKLING SVST MISCELLANEOUS ROUGH HEATING 0 TEMPORARV SERb UNDERGROUNO � ROUGH WIRING TRENCHES �I F LATHING — IN Pi 'TER, BROW TURAL, F FINAL -4"( LOT HOUSE CON. � AIR CONOITIONING OR POLE POWER � AS f� STEEL ftEINF. �'� DATE �-3a-7o BUILDING PERMIT N( JUP 1 TYPE SUBCONTRACTOR ; � " 32598 COSTA MESA BUILDING-SAFETV DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 2 . w w a U F Z 2 � ON am J � J N Q W O] J . Cfl J Q U N Z a W � aw W2 J Q m z J Q w w O= Z F- W � N � 70 �"' z Q U J a a Q � F' � Z 0 F U � � � � Z For Applicant to Fill in B V I lDl OWNER CITv ( �A-S rg^ CONSTiiUCTION � LENDER eaaNCN ^ ADDRE55 � ARCHITECT �� TEL. CONTRACTOR � , /y, �(;iJAT/{taUS ADORESS �. %GD M�A1U' O�LA� //I�. TEI. CITV � �L/'� NO.S'!�� STATE CIT V LIC. NO. JS"3 � 7` 7 LIC. NO. S I2 E i NO. OF BLDCS. OF LOT S�� X) y0 NOW ON LOT USE OF EXIS(ING BLDG. 3 pW4 L!./,Vt$ ��/ �dQ.O SIZE OF I � NO. OF NEW BLDG. /.7i x�ti ROOMS STORIE'. EXTERIOR WALL ROOF COVERING ST44C-O COVERING ROC%< USE OF BUIIDING AND WORK TO BE PERFOFMED I he�eby acknowl¢tlge thot I hava �eatl this applicotion antl state that the above information is correct end agrea to comply with ell laws regulatinB builtling construction, entl 1 shall no� amploy any pe�son in viola[ion ot tha workmon's tompen5stion lews Ot the State o� Californla. I heteby carHty tho[ I am proparly Ilcenso0 as a ton[racro� untl¢i the S[ate o1 California Businass ontl Protessions Codo, Divisicn 3, Chapter 9, antl that such licanses nre in futl force ontl effoct, or I um onompc t.om tho prov(sions of the Smte of Colltornia eusiness entl Professions Cotle, Divisian 3, Chapter 9/.J SlBnatureo( `ti/ ✓/�/, y/-l?�9�_/�-�L� Permittoa b� �� L� Au[ho�ixetl Agant nFr, so-�o"7000 092 34.50 f,XSA � ***� APPLICATION FOR BUILDING PERMIT FECEIV�O BV DATE RECEIVED DATE ISSUI Z-'� 2-�J- A.P. NO.II O�/�I— y, P IT ADDRESS 3 /� N�C��i �(�CG�'�C- /' FIRE APPROVED �E Y PLANSd VARDS APPROVED MAIN BUILDING � DISfANCE nnnw a�o- VAR. qW C.U.P.q� VALVE BET. MAIN & ACCESS. BLD DATE APPROVED � Z � SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPO6E OF ESTABLISHING A PERMIT FEE ONLV: VALUATION pp PERMITFEE $ 23•OO $ J/ DOO •—' P�.p,N CHECK $ �/� S O TOTAL FEE $ � �i r7 D m 0 � ¢ ] E LL s —' ;a� % ��% COSTA MESA BUILDING-SAFETY DEPARTMENT % P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completety �BU�LDING, �^'�? DORESS ��//, �.r,,,.a` .. A Dl n..e APR 2h-7GPA10O01506'+ �*++204.75 uisr APPLICATION FOR BUILDING PERMtT E�T:1X'7—C3/I�ED //T�SJUI H OWNER w.r. rv�. .- � �7 BUILDING Z qDDRESS 3 Z F+• 11 th St'• ADORESS �� a� ciTv COsta Mes& oio'�42-490 TRAC ZQ CpNSTRUCTION W �+ O N L NDEF am J � BP�+NCH J N pWNER m J ApDRE55 J m qpCHITECT TEL. S a OR ENGWEER N . UN FIFE w � qpDRESS 20NE a� W Z .4PPA�VED J O CONTRACTOR BV m Z J � ADDRESS above VALUE DATE w w TEL. ZO NO.OF USE OF � �= CIYV NO. y P�� BUILDING Z � w � ST.4TE {� CITV �'ARDS APPROVED YARD j O LIG. NO. 2 V1 IIC. NO. 1 8 MAIN BUILOING ACCES: SIXE NO.OF BLDGS. (FPOM GL STREETI OF LOT NOW ON LOT q f.�7' �OFT, VSE OF i EX�n�NG BLDG. F SIZE OF NO. OF Z NEH'BLOG. ROOMS ].6 STORIES L.SIDE SFT. U EXTERIOR Wq�t ROOF hingle COVERING .7LUCCO COVERING REAR FT. J USE OF BVILDING AND WORK TO BE PERFORMED DISTANCE BET. a C MAIN BLDGS. a ogarage. cu �w -- a N APPR D .(�! t tx- z d3�� u 0 U� �areby acknowletlBe thet I hevo reatl thia applicallon antl sto[e NOLD FOR Sl � Mai ihe abave info�metlon is rorrect antl agree m comply with � ell laws requlatinp building conanuction, end I shall not amploy F eny Per:on in violaQon at the workman'x compenmtion tawa ot y t�e State ot Calitomia. -� � zI hereby certlfy [hat I em properly Iicensetl as a conttanor untler SQ. F the State of California Business antl Professions Cotle, Dlvisicn 3, THE AMOUNT SH Ch@Pter 9, entl thm sueh licensas ara In (ull force antl eflocq or I THE PURPOSE OF I am exempt from the provlsions o( ihe State ot Celi(Ornie Businass VALUATION antl P�ofessions C/o�tle, Divizion 3, Chaptar 9. Signature of /H, _ /� �G ///p �� Permittee 9wG-h-- L/"� 5 � ' .�33So, � Authorizetl ABent f BET. MAIN & , A m NO `° 0 ER VAIV ON IS FOR ^ VG A PERMIT FEE ONU': Q 6 S� m FEE $ � 7 P m iECK 5 �+ •� E 0 D % LL =EE