HomeMy WebLinkAbout347 WOODLAND PL - Building Permits�
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CITY OF COSTA MESA
BI/ILDIN6 p1VISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
BUILDING PERMIT
.lobnddress: 347 WOOD�AND PL
Suite:
Vicinity: TRI-PLEX
ParcelNunmber: 42623101 Zoning:
npp�icant: HULL, ROBERT L
Address: 347 WOODLAND PL . � " .
� � Phone: (949)646-7363
COSTA MESA, CA ,'� � Zip: 92627
Owner: HULL, ROBERT C
Address 347 WOODLAND PL
' Phone: (949)646-7363
�- -COSTA MESA, CA - '_ Zip: 92627
/
Cont{ador. �, . � -
-Address: � � -- �
' � � ,� � � Phone:
Zip: - License:
.,``
PERMIT NUMBER
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: OS/26/1999
Issued: OS126/1999
ISSUED BY: �q�,y�
Arch : � " ' ' Eng:
Address: � � � � Address:
- , � ' - ' Phone: Phone:
� Zip � � License: Zip: �License:
SCOPE OF PERMIT
, ;� REROOF - T/O, INSTALL NEW 7/16" OSB SHEATING, NEW FELT & 25 YEAR COMPOSITION SHINGLE ROOF.
FEE SUMMARY .
Plan Check: $0.00 _ _ , Caic Valuation:
Permit: . $112.25 Claim Valuation:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$0.59
$0.00
$0.00
$D.00
$112.84
SETBACKS
MAIN STRUCTURE Front 0-�0
\
ACCESSORY �-Front 0-0
PARKING Existina: o
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
:
PLANNING & ZONING
Left 0- 0
Lefl 0- 0
a�o osed: 0
a
Right 0-0
Right 0- 0
$s,eso.00
$5,850.00
NOTICE: The work aNhorized by this permit shall compty with all applicable handicap access requirements under Calitomia 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 penod of 180 days.
INSPECTIONS: In order for the work eulhorized under this pertnil to be considered legal, such work must comply with all applicable codes, and all
requlred Inepeetlona end flnal epproval must be obtained. Feilure to obtain inspections end final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545826
WORKERS'COMPENSAnON �ECLARAnON: . �
I hereby alfirtn under penalry oi perjury one oi Ihe lollowing tleclarations: � � .� , 1', . .,
❑ I have anA will maintain a cetlificate oi cronsent to setl-Insure for workers' compensation, es provided tor by section 3700 of the Lebor Code, for the pertortnance ot tha
wark for which this pertnit is issued. �
❑ I �ave antl will maintain workers' compensation insurance, as requiretl by sec[ion 3700 oi the Lebor Cotle, for the perfortnance of the work lor which Ihis permit is issued.
My workers' compensatlon Insurance carrier and policy number era:
Cerrier. Policy Numbar.
(This section neetl not be crompleteO illhe permiNs va/ued et one huntlretl dollars ($100) or less.) ' �'"
❑ I certify that in the peAortnance of the work for which ihis permil is issued, I shall not employ any person in any manner so es to become sub�ect to the workers'
compensetion laws of Califomia, antl agree that if I shoultl become subject to the workers' compensation provisians oi Section 3700 of the Labor Cotle, I shall forihwith
wmply with these provisions.
Applicent Signature: Dete:
WARNING: FAILURE TO SEGURE WORKER5 COMPENSATION COVERAGE IS UNLAWFUL PND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND dVIL FlNES UP TO QVE MUNORED
i/K)USANO OOLLARE (5100,000), IN AODITIQV TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEGTION 3706 OF THE LABOp CODE, IMEREST, AND ATTORNEYS FEES.
LICENSED CONTRAC70R5 DECLARATON:
I hereby aftirm that I am licensed under provislons of Chapter 9(commencing with Saction 7000) of Division 3 of the Business and Professions Code, end my license is in full
force antl ettect Lic. x Class N
Comractors SignaNre: Date:
CONSTRUCTION LENDING AGENCY:
I❑ I hereby aHirtn that Ihere Is a construction lending agency for the pertormance ol the work lor which Ihis permit is issuetl. (Sec. 3097, Civil Code).
�. Lendafs Name: Lendefs Address:
� SignaWre: Date:
OWNER-BUILDER DECLARATIONS:
I hereby attirm ihat untler penalry of perjury ihat I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Profeuions
Code: Any ciry or counry which requires a pertnit to consiruct, alter, improva, demolish, or repalr any sWcture, pnor �o its issuance, also requires Iha applicant for such permil
to Tile a signetl s�atement Ihat he or she is licer.sed pursuant to ihe pmvisions of Ihe Contractors Llcense Lew (Chflpter 9(commencing with Sectlon 7000) of Division 3 ot the
Business antl Professions Cotle) or Ihat he or she Is eaempt therefrom and Ihe basis for Ihe elleqed exemptlon. Any vloletion of Sectlon 7031.5 by any applicant for e permll
suDjects the applicant to a civil penalty ot not more lhan five huntlred tlollars (5500).):
❑ I, es owner of Ihe properry. or my employees with wages as their sole compensation, WILL DO THE WORK, and Ihe siructure is not intendetl or ottered for sele (Sec.
7044, Business antl Professions Code: Tha Gontrectors License Lew does not apply to an owner of praperty who builds or improves ihereon, end who does such work
himsetl or hereelt or through his or her own employees. providetl t�at such improvemenis ere not intanded or ottered for sale. If, �owever, the bulltling or improvement is
/ soltl within one year oi completion. ihe owneabuilder wlll heve the burden of proNng that he or she ditl not builtl or improve for puryose of sala.).
(� I, as owner of t�e properry, am EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Pmfesslons
Cotle: The croniractors License Lew does not apply to en owner of properry who builds or improves thereon, antl who contrects for such project with a contractor(s)
license pursuani Io Ihe Contractors License Lews.).
❑ lam
Signature:
Owner ID
drivefslicense. ❑ Ves ❑ No
Business antl Profeuions Code br Ihis reason:
Da 9: �-�s-
Orivers License No. Expires:
Verification of Ownership by (type ot tlocument, i.e. - properry tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PEHMR CER7IFICATION:
❑ I hereby certify that no excavation five (5) or mora teet in depth Into whlch a person is requiretl to tlescend, wlll be made in connactlon wi[h work euthorized by [his
permit, antl that no builtling sWcture, scaMoltlinq, lalsework, or demolition or dismantling I�ereot, will be more �han thirty-six (36) leet high. (Chap. 32, Grp 2, An 2, Sec.
341, Tltle 8, Califomia Atlministrative Code).
❑ Ps owner-builder, I will not employ anyrone to do work which would require e pertnit irom the Division of Industnal Sefery, as noted above, unless such person has a
pertnit to do such work from the division.
Signature: Date:
Division of Industrial Safey Pertnit Number:
CERTFICATE OF COMPLIANCE AND AUiHORVJITON OF ENTRV: I certi(y under penelty ot parjury ihat I heve reatl this application and state that the information given is
correct. I agree to comply with all s[ate laws antl ciry ordinances relating m building consiructlon, end authorize representatives of the Ciry of Costa Mesa lo enter upon the
above-tlescrib d property for insp ction urposes. I a9rea not to occuDY a� allow occupancy of any builtling authorized by Ihis permit untll finel inspection.
��,-C�.CJ �� S —�S- 1�%
Signawre Of Legal Owner(s) Date
AnNOr Authorized Applicent
CODE L INSPECTIONTYPE
1616 Fixetl System Pinal Fire Prevention
1266 Pool Spa Final
200 Final Ra-Roof
201 FInaI BIocWRetalning Wall
202 � Final Factory Fire Place
203 Final Sign
204 Final Demolition
2446-bfi
�
�
CO�E�' INSPECTIONTYPE
206 � � Final Mechanical
208 Final Plumbing
210 "' Final ElecMcal
212 Final Fira Preventlon
220 Final Plenning Approvel
222 Finel Site
250 Final Building/Occupency �
INTRIRLS
t
PP0.IECTP/ `�V'S5: 347 WOODLAND PL
U�JINEH'Jf�'dE: HULL ROBERT L
aounEss: 34 7 {JOODLAND PL
COSTA MESA,CA
AflCHIENGINEEB: �46—'7363
aoneess:
�N�T: L C
n
92627
flEG.NO.:
UNIT:
PEflMITTEE: CRANK BROTHERS ( 714 ) 54$-5569
noowEss: 126 COMMERCIAI, WAY
C.M. CA 9262�
LICENSED CONTNRCTON OECIABATION: I �ereby a��irm ��at 1 a licensetl unaer provisions ol Chapter 9lcommencing with Section
]000) of �ivision 3 0l ��e Business antl Prolessions COCe. and icense is in �ull lorce, a�ntl etf
cirvuc.: OU5993 STii'Eu°'`408677 �aSs: C3G<v .
jlate: ����_� � Signa�ure: ���`v�.,
WOXNEPS' COMPENSFTION DECU1Pp710N: I here6y at averF a cenificale ol consem m sell�insure or a certilicate ol Workers'
Compensation Insurance, ar a cenified copy ��erea� emi 3800, Lab. C).
POLICYNO.: � 85-91UNIT002 E%P.ORTE: OI IOS I J?
comenxv: S'PATE FUND
� Cenifiea copy is hereby fumishe0. � Cenifietl copY � �' tl w�th �he ly BuilOing Divisioa �
✓ �'7
�7ate: �_ �Ci �� Applicant���� �5�h�� /�"��`-�
EMEMPTIONFHOMWUflNEBS'LOMPENSATION�ECLAPpTION: �Thi55ecUonneeCiwlOecompletc-0i�Ueperrrvii5larone�uMreO(5100�orkss�.
I certily iha� in Ihe peAorman[e al Ihe work lor w�ich t�is permil is issuetl, I shall not employ any perwn in any manner 5o as to become
5u�1�� ro Ne WOrkers' Compen5aiion LawS ot Calilomia.
Oa�e: Signalure:
NO710E: If, al�er makinA ��is tleclaration, you sAould hecome su�l�� �a Ihe WOMefS' CAmpensation prpWsions af t�e LaOor
COd¢. yau mu5t IOtlhwil� tamply wiih 5uth pmvi5ion5 of Ihis permi� 5hall Oe �eemetl revoketl.
CONSTqUCTION LENOING RGENCY: I hereby affirm t�at there is a ronstmction lending agency for tAe pedarmance oi [he work lor
whicn Ihis permi� is issuea (Section 3097. Civ. CI.
IENDEfl:
AODNE55:
OWNEP BWL�Efl DELUHPTION: I hereby ailirm Iha� I am exempi Iwm the Contrac�ors' S�a�e License law br the follovnng reason
�Sec�ion 7031.5 Business antl Pmfessional CoOe: Any cily ol counry which requires a permit m conslmci, atler, imDmve, Oemolish. or
reoair any simcture, prior to its issuance. also requires ihe applicant for such permit to lile a signed statement ihat he/she is litensed
Dursuam io ��e O�ovisions ol the Contractors State License Law (Chapier 9(cammencing with Section 7000) of Division 3 af the Business
and Pm�essions Code� or Inal ne/she is exempt ��erelrom and Ihe basis �or t�e allegeG e�emption. Any viola�ion a� Section 7031.5 Cy
', any aDDlicani lor a permi� subjals Ihe applicani to a civil penalry of nol mare Ihan tive �unOreE dollar5 (8500�.
1, as owner ol t�e propeny or my employees witA waAes as 111eir sole compensation, vAll Ao the work, anE tAe
❑ svucWre is not intenCeC or olferetl lor sale (Section 70aa, Business and P�ofessional COAe: The Contracmrs State License Law
aoes not aoWY �o an owner of a o�opetlY w� Ouiltls or improves tnereon, ana wtro eoes such work himse�f/hersell or �nmuph
�is or �e� own employees, pmvi0etl lhal such imp�ovemen�s are not inlenUeO or olfere0 lor sale. tl, however Ihe Euiltling or
improvemen� is soltl wiihin one year al compleiion, �Ae awner vnll have Ihe burAen oi pmving he/she tliU not Guiltl ar impwve
lor tne ourpose oi 5ale�.
I. as owner ol I�e pmpeny, am exclusively coniracting with licensetl coniractors to consimct ihe pmlect (Section 7M4, Business
❑ and Profe55ion5 Catle: ihe fAnVactors' Sla�e License Law tloeS nol appry la an owner o� pmperiy w�o 6uilds or impmv¢51Aereon
antl w�o conlracts tor such pmlecis wi�� a conVactor�s�license Oursuanl Io t�e Conlraclors' State License Law�. I am aware
Ihal prool ol I�cir Wmker'S Compensalmn insurance shoWd be providetl lo me.
� I am exempt unGer Sec�ion: 8. 6 P. C.
lor Ihis reason:
Date: Ownec
I do �ereby cerlily Ihal I am awaie ol anU unUer5lanU t�e reQuiremenis ol Cali�omia Healih antl Safely Cqde Sec�ions 25505. 25533, antl
2553a and I�at lor anyfulute Ouilding acupanivnlVwillnotltircle one� nee0to comply wit� Saitl state coaes andiherequiremenisfora
permit for con5imc�ion or moUilicalion Imm Ihe Air Oualily Managemeni DiSiritl. flesiaenlial conslmciion apDlica�ions are exemp� Imm
ihese D�aviSions.
Oale: NPPiicanl'. —
I pereEy cetlity Ihal I �ave rtad Ihis aDP�italion and siale tl4
ordinances ana slale laws rela�ing to �uileing conslNc�ion antl
.propetly torins0ec�ion purpol¢S. ,
Oale'. / .7 Ci �
Oriver's License ar Sacial Secunly x: �
t641 u6 While—Bmltlmg'. Green—Cotle
—
: Canary—AOP��nI; PinM—Revenue: Goltlenrad—Assessor
CITY OF COSTA N,ESA — HUILDING PERMIT PERM NO; B 053119
PERMIT NO: H 053119 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTTON T'YPE: V—N PERMI7' TYPE; STR � PJRPOSE; ALT
JOH DESCRIPTION : REMOVE AND REPLACE ROOF W/4 PLY BIJILT UP SQ FT; 1,8'75
CLAIM VALUE; 1,875.00 CALC—VALUE: 1,875.00 GROUP OCC: R-1 /
COMMEN'TS: FLAT ROOF OVER GARAGE
x**�r*�x���*��***-x�x�*x*�e*�+�����*�r��x±��***�**�**�xx��*��������**������#�**�*��x*�
Z O N I N GS ERTEH�AUCIKRSE M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY H�LDING ---------
FRNT: rT IN REAR: FT IN FRNT: ^T IN REAR. FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN
PARRSNG REQ• FRG1V; PARCEL; 47.623101 ZNE: REF NO:
PLANNING Nf5'!'ES>
�. }
i6 if iF if iF jE i� �1t if iF jf if iE iE� ik 1f 3f iE �f ik � iF iE If i� ik iE iE iF iF iE iF iF iE if if k IE iE iE 3F iF IE !t if iE �E iE �lE if if 3f iEif iFif iE iE aF 1f iE iF jF i(� if ah if IS iF ji� if if iE t IE � ip iE
D E V�,'L O P M E N T S E R V I C E S R E Q U I R E M E N.T S
ZONING APPROVED BY DATE:
BUILDING APPRbVED BY : DATE:
,�
APPLICATION I�SUED BY• �L( DATE; �,jd•'�C
iE iF #c iE iF iE �e iE if iE iF 3E iF 'iF iP iE it i!� iE if if7F�FiF3Fif7F3F3F3e3e7F3F3F'iFiF'ir'iF ir�R�Fi[iFiF�F3F3i�iFif7F7i-iF fh # ih K� i� iF iF ir 3k if iE if
�F if 1ElF IE K 1E 1E iF IE iE 3Fje if if ie iE 3i� iF 3F IE iF jf if If if �f if iF if iF it 1f �F if if if #f if iF if jE aF iF k� iF iF if If if 3E 3f )F 3F iF �f IE If aE if 1F iE iF 3'r IE 3F ff # iF iP 3F 3f !c � iP Y.� if iE aE
LEGALIZATION:N F E E S U M M A R Y STRUCTJRAL SEGMENT;Y
HLDG FMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 43,00 _ .50�
SMIP/NCJN—RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID � DIJE
TOTALS----> 43,50 0.00 0,00 43,50 43,50 ,OU
REVENUE DIVISION TOTALS--> COLLECTED: 43.50 OVER/SHORT; ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIF/TOT GRADING PLAN—CHBCK
43.00 ,SO
if if 3F if iE iE if iElE iF iE if iE lE iFiE aE iE ff if iF if if iF # if iE iE 3b iE jE iE iF iE it iF iE 3E iF aE iF ii� iE iE 1E 3E R If iF 3e 3t � iF ie jt }�(- it iE 3E iF aE iE x-iE iF if �F aE iE 3E aE 3f le i'r 3F iF i� fE
I N D I V I D U A L F E E B R E A K D O W N
TYPE �TY D E S C R I P T I O N UNIT COSS TOTAL COST
SFR 1R75 REROOF BY VALUE RESIDENIAL NOZONE 1,OU • 1,R75.U0
END OF FEES "
�`•� ..
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� CONSTRUCTION ANDPLANNING
APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
�. Temporery Electrical Service or Pole � 52. Pool & Equipmeni Location
2. Soil Pipe-Undrgrnd. � , 53. Steel Reinforcement
3. Electrical Condui[ Utility-Undrgrnd. 54. Forms
4. E�ectrical Conduit-Undrgrnd. � 55. Electrical Bonding
5. Steel Reinforcement 56. Fough Plumbing & Pressure Test
6. Electrical UFER Grnd. � . 57. APPROVAL TO COVER�GUNITE
7. Footings � 58. Electrical Conduit�Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor System • 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection � 62. Backwash & Receptor•Final
12. Sewer Cap � ' 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing SYstem - Finat
14. Rough Plumbing " 65. Electrical-Final
15. Rough Electrical•Conduit ' 66. Solar SYstem-Final
16. Rough Electric Wiring 67. Fencing & Access ApP�oval
'�i7. Rough Wiring Sign _ 68. APPROVED fOR PLASTERING
18. Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace . � APPROVALS Permit #
21. Oucts, in Structure . . 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas OOiI
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing _ �73. Undergrnd.StorageTank OGas OOiI
25. Roof Sheathing , 74. Overhead Hydro
26. T-Bar Ceiling IStructural) & Monocoat 75. Dry Chemical •
27. Frame and Flashing 76. Dry $tandpipe .
28. Lathing & Sidinq . 77. FIXED SYSTEM FINAI
29. Insulation � 78. F�RE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster 8rown Coat . �� i 79. FINAL INSPECTION
32. Electrical Power Meter�Final I� � .80. FOOD CERTIFICATE ISSUED
33. Final Electric - i Notes: . '
34. Final Heating & R,ir Conditioning �
35. Finai Gas Pipe�Test ��
.
36. Hood or Canopy � -
37. Final Factory Fireplace .
38. Final Plumbing
39. Water Service�Final -
40. Gas Service-Final ; , � � �
41 . Solar pomesticFinal �
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation SYstem -
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING ,9,� �WJ/ ��J'„ q � ��`j„ ��
c r o�ir.
48. FINAL PLANNING . ��, /,
G
49. Electric Release to Edison _
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
City of Cosfa Mesa
Building Safefy DepaMment
P. O. Box 317
Cosfo Mera, California
CERTIFICATE OF OCCUPANCY I1I� ,Z�21 C
ae �,.,,t�
The Building located at 7�' '"'"'�-'' �eo��iLs k�
has been inspected and fo�nd fo comply with the provisions of all City of Costo Mesa Ordinonces app{icoble thereto
for a Group g& J Occupancy.
Use of Building "�'qDl�a tJ1Lh aL�O�i�a Fi�ttII8�6 �d i�l�
Legal Descripfion ��1�
(Soe mvene �ide for Mete� ond Bound�)
Building Permit No. '�� Electrical Permit No. �� Plumbing Permif No. �
Floor Load Signs have been installed as Room Capacity Signs have been instaled as
required und¢r $ec. 2308 lJ. B. C. . required under Soc. 3307 (7) U. B. C. —
17050. CERTIFIGATE OF OCCUPANCY. (o) No apartmenf ho�se, hotel, or lodging ho�se shall be used or occupied
until the owner or operator has been iss�ed a valid certifitate of occupancy by the enforcement agency.
(b) A new certificate of occupancy shall be obtained whenever there is a change in:
1) Occupancy classification of a building or portion thereof �
2) The number of apartme�ts or guest rooms
3) Ownership
If Gro�p H Occupancy, number of apartments and/or guest rooms as req�ired under Sec. 17050.1 (d), California
Adminisirative Code, Title 8, Chapter 9, Article 8.
Number of apartments_�— and/or guest rooms
ISSUED TO: Building Official �/
�14.� �►�i yY ,�DA.v�.A1Li(1 �� 1� �- �4.On.�-�l,f`� .
Date— �kStAbQL' %.6� :,� I
This Certificate of Occupancy SHALL BE posfed in a conspicuous place on the premises and SHALL NOT BE removed
except 6y the Building �cial of fhe City of Costa Mesa under Sec. 306 (e) U.B.C, ro,,,, ava��M—i�-a�,sa r
31718
� COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For App/icant to Fill in Completely
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CONTRACTOR R. SeW011
AODRESS above
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STATE �lBl�
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APPLICATION FOR BUILDING PERMIT
RECEIVED BV � DNE RECEIVED nerv icci�
BUILDING
ADDRESS
FIRE
ZONE
ED
VARDS APPROVED
MAIN BUILDING
FROM Gl STREET)
DISTANCE BET
VALVE
USE OF NE
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I �ereby acknowled8e thet I have reatl [his opplieo[io� antl stete '� —' — '� ^"�`�"�
that the abo�e informa[ion is correc[ a�tl oBree [o comply wI[h
afl faws ropulating builtling consxruttion, nntl I ahall noc employ
any pe�son in viola[ion Of the workman's compenseT�on lews ot
the S[a[e ot Calitomia. �� �
I hereby certlfy that I em proporly licensatl ez a contrector untler Sn•
Ne Ste[e of California Businass entl Profeuione Cotla, Dlvlsicn 3, THE AMOUNT SHOWN UNDER VA AT
Chapter 9, antl that such Iicansos ore in full forea antl affact, or I THE PURPOSE OF ESTABLISHING A PERMR
nm exampt t�om ihe provislons of the Staro of Celltornie Businass VALUATION
ontl ProteSsions Cotle Divlcion 3, Chaptef 9. -i
PERMIT FEE $ o�
SiB�etura oi //��J o
Pormittea � � � �-/�f ���A S � _ /`D -W PLAN CHECK 5 �
St < � ��
Au[�orizetl Apant Ja�� TOTAL FEE S�G
m
�
' O
ON IS FOR ^
=EE ONLY: �
¢
m
G, S �
�j m
b • 2/� E
!/ l. LL
1+
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