HomeMy WebLinkAbout3146 YELLOWSTONE DR - Building Permits I
Afined a estnnng a aboratories, Inc.
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1' gro MOBILE LAB. • SOIL • CONCRETE • STEEL • WELDING
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GENERAL OFFICE 1309 EAST FIRST STREET • SANTA ANA, CALIFORNIA • TELEPHONE Kimberly 7.8287
September 7, 1962
Job No . 62-255
REPORT ON GUNITE TESTS
Job Name: Clyde Gillam
Job Location : 3146 Yellowstone Drive
Costa Mesa , California
Contractor: Clyde Johnston
Architect: Scherrer & Bauman
Inspector: Jos . M. Henley Jos . M. Henley
Lab . No . : 3146 3146
Location in Shallow end center same
Structure : 2 ' above base
Designated stn.): 2000 psi -
Date of Pour: 7/28/62 8/7/62
Date tested : $/3/62 9/4/62
Diameter: 6. 125 x 12 6 .01 x 12
Area , Sq. in: 29 .46 28. 37
Max . Strength: 60200 68550
Compressive
Strength: 2122 2416
Age at Test : 6 days 28 days
Respectfully submitted,
ALLIED TESTING LAB. , INC.
7 ^/l ",6 By:
4— /74
Charles E. yde
President
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cc : City of Costa Mesa 19I -j,
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Clyde Johnston Pools Arle
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TESTING TO A. S T. M., A. A, S. H. O. AND STATE HIGHWAY SPECIFICATIONS
• Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. n,
CITY OF COSTA MESA (ICON CONSTRUCTION PERMIT -I PERMIT NO.I�. TRACT NO. LOT NO. UNIT NO. U a I
Project Address VVL Y£LGp7V- --e7-71.7t ✓ 1
Applicant's Mailing,AAfddress 69&/ N ELt17V& �. G,a• TYPE OF CONSTRUCTION E NEW Li ADD U ALTERATION aREPAI R f
Owner's Name 'dam R Cc. AfnCONCY , 97f cO 3l ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone
31% E2c�v. 7t Cer'.°'/2626. DESCR I PT IO Ni,0 F'WO SE OF BLD KEOF el)e2 ¢Q f/f�}(�
Address t" �i(Jy'f s-/- 6C .3_ Iw 1ry 5 9L 31 S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT . GRADING ❑ FOUNDATION III STRUCTURAL E Front o
Address . ' c ❑ TENANT ❑ EL(F��lT, AL ❑ PLUMBING ❑ MECHANICAL • B N
0C-SSA/ /2OOF/),46 to ,,}} 7 ❑ OTHER Pi- A Rear I
Contractor's Name Pho e[Ta� O C Right N
`� / p.,>�• PROJECT DESCRIPTION SQ. FT. 3Yco OCCUPA Y
Address(mailing) �S�A/'rtfJ7`Oi(/ if✓Z-+ La qO� K ' G
CONSTRUCTION TYPE VALUATION$ �./ 7•�V $ Left
City License No. 033 9O(� ZONE GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
0
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full for%.,,, effect. T
License CI. s '•'- Aiices - ri0 S
Date '� y/ • Signature t( . L '• _sr L PLUMBING FEES
WORKERS' COMPENSATION DECLARATION
Bar Sink Showers ELECTRICAL FEES
hereby affirm that I have a certificate of consent to self-insure or a certificate
Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
..800, Lab. C,i/•� '•�.. Automatic Washer Transformer 0 15.50 KW
Policy No. '/fir//� Com any 5ir�`/Ci Backflow Irrigation
❑ Certified copy is hereby furnished. /. g Sewer Cap Construction Pole Sub. 0 50+KW
CerlyfirA Is filed with the city �ls4rfg?li . rl[a/ /iy� Bathtubs Sewer Connection
v"--"CT ea` {y. L••• 1[ij/((rV'GCIIF``��� Cooking Unit Meter ❑up to 100 amps
DateApplicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers - Solar Collectors Dishwasher Meter Dover 100 amps
• (This section need not be completed if the permit is for one hundred ($100) or
less). Dishwasher Solar Piping Dryers OGas ❑Electric Sub Panel
I certify that in the performance 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 Drinking Fountains Solar Tank Fan Motors Oat HP 01''/ -8
Workers' Compensation Laws of California. --
Date
Date Signature Floor Drains Swimming Pool w/Spa F.A.U.
NOTICE:If,after making this declaration, you should become subject to the Inc.Solar 09-15 HP 016-15+
Workers' Compensation provisions of the Labor Code,you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet
1 hereby affirm that there is a construction lending agency for the performance Device Boxes Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.)
Interceptors Water Heater Outlets
-1 Lender's Name Range
`fiLender's Address Kitchen Sink 9
Water Service Switches Sign
lr
1 OWNER BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or 9 P Standing Sections
countywhich requires a permit to construct,alter,improve,demolish or repair TraysGenerator 00-5 KW 05-15 KW
r P P-Trap Laundry
oy a signed
igre, prior to its hat he/, also requires the applicant forrsuch i permitTrash Compactor
to file a statement he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt
herefrom 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).
Ll I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure is not intended or offered - ' Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES -
License Law does not apply to an owner of a property who builds or improves _ _ __
thereon, and who does such work himself/herself or through his or her own • _ DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for ZoningApproved
sale. If, however, the building or improvement is sold within ono year of com- pP By Date
pletion, the owner will have the burden of proving he/she did not build or imDuct-Uncle,'Ground-
prove for the purpose of sale). Building Approved By Date
0 I, as owner of the property, am exclusively contracting with licensed con- • al Refrigeration System Application Issued By Date`LJ..--O(p
— 81
tractors to construct the project (Section 7044,Business and Professions Code:
The Corkactor's License Law does not apply to an owner of property who • ■I 11 111 : 0109,000 : SUMMARY OF FEES
builds ort mproves thereon, and who contracts for such projects with a con- _ •� ^�O
tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple ❑ BUILDING PERMIT $ 72.00 $MIP $ S
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBG# II Fire Dampers
PLUMBING $ ISSUANCE $
Date Owner Heating System& Ducting RegistersPLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above uI. is. ARlIiliiaiuu
GRADING $
Information is rect. I agree to comply with all city and county ordinances ELECTRICAL $
and state law rating to bu•ging onstruct n and hereby authorize repre- MICROFILM $
sentatives of is cQ,.... , E• /,lgpon th bove-mentioned propert y�Jor PLAN CHECK 50% $ _ 4-� q �J
inspection .yl 'C5 . / t!.i //J/ Date MECHANICAL $ TOTAL FEE $ ( L
e SS [ `'-*i(iReinspection Fee $15 . Issue Fee $ 3 PLAN CHECK 25% SD
Drivers' 'cense or - $ r'a
CMF 086 -46,rev. 10/84 White - Building; Can. y -Applicant; Pink -Accounting; Goldenrod - Assessor !'. J46:.'t2 LLWLCL•r•f t >_v a -r:UL
DATE "7l6.37"V "I'VE: :4:51
' CONSTRUCTION AND PLANNING POOL&SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1..Temporary Electrical Service or Pole 52. Pool & Equipment Location
•2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
B. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 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 - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. 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. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush '
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
•
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79: FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System •
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 2�•! ` il
420 /"s48. Special Requirements Completed7 �"
49: Electric RW:ease to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
• I ,
Lot•
6 Tr. 35nn FEE RECEIVED
r, ' 14465 I MAY 17 T9&I
C1STA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT,
P. o. BOX 917 COSTA MESA. CALIFORNIA CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT
BUILDING
BUILDING
ADDRESS 3146 Yellowstone Drive
COSTA MESA. CALIFORNIA For Office Use Only
rr RECEIPT NO, PERMIT NO.
OWNER X W K Construction en , Tnr I _1 &466
MAIL RECEIVED BY D TE Rs�jEIV D/ -DATE IB u /
ADDRESS 1555 PI A r ENT I A AV r ✓li I //— 4( I ,-� -II./
TEL. / BUILDING
CITY NEWPORT RFACH NOA
MI -372, ADDRESS _
ARF -ECT TEL. COSTA MESA. CALIFORNIA
OR INEER NO.
FIRE '/ oI
ADDRESS ZONEIRTYPE (� GROUP I..(
CONTRACTOR K W Km I BPPROVED DATE
ADDRESS 1555 PIArFNTIe AVF ZONING Cingi ram_
CITYNEWPORT BEACH ZONE R-1
I NO.OP
P 2 I BUI ofLDING NEw/
`J att 8�.
LANE BUI
STATE TEL.
LEGAL
LIC.NO. $ 61195 NO. M A- DESCRIPION Int 6, Tract 3500
OF LOT •5Q77/' / //I</VNNOO.WOoFNBLDLOGTS. 0
A.P.NO. none
USE OF YARDS EVES
EXISTING BLDG. STIIrCn APPROVED ALLOWED
SETBACK LINO FROM / / ICENTER LINE ET.) _P-,
CENTER OF STREET .SO REAR YARD �t3 FRONT ,S OFT. IN.
610E YARD LEFT 5RIGHT FL(p R.SIDE g FT. ( IN.
DESCRIPTION OF WORK
L.SIDE ,c FT. IN.
N I XII ALTERATION I II ADDITION I REAR _2-3 FT. IN.
-1
REPAIR IVMOVING I I DEMOLISH I APPROVED W. L. D. DATE 5-1,C 61
BUILDING, NO. OF rib
SIZE ,5098Q.rt. ROOMS '7 STORIES ;
EXTERIOR WALL 'ROOF Wood shingle /
COVERING STIlren I COVERING
USE OF BUILDING AND WORK TO BE PERFORMED . / )7cb
SINGIF FAMILY RFSIOFNCF ANn i- fn1bW /
ATTATCHED GARAGE .. S00 °
Plan Wo 4-D U
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONS UCTION. VALUATION
SIGNATURE OP /4 /`� , rJ / J rr� - PERMIT FEE $ 35— N
PERMITTEE T 1 _6—` -C\ ✓f. //�� _a
$ /7 PLAN CHECK $ 1 50W
9
AUTHORIZED AGENT r^I 5O E
N, 1 TOTAL FEE $ 1/43;205 of a
•
16339 FLEE RECEIVED
CESTA MESA BUIL COSTA MESA. DEPARTMENT Fi1�1�V� 1$� T.
P. O. BOX 917 COSTA MESA. CALIFORNIA
For Applicant to FBI In Completely APPLICATION IAS' PRIMSTA MESA
TYPE OR PRINT n BUILDING
ADDRENG J/1 / YellO�SIDuQ nYI /�+C
ADDREss(/�, COSTAOMESA. CALIFORNIA For Office Use Only
OWNER , " t 1 l(.[1 `�I [(Q ..4 (� I RECEIPT NO. /916P 1h14-:
MAIL 3 i 4 VAIL) StdR C3 RECEIVEDI y T53/ c I I orin,n,.,.
ADDRESS /_
/� TEL. ,L� BUILDING
CITY `' Ail NO. i 90- ADDRESS
AR' -ECT - TEL. COSTA MESA. CALIFORNIA
OF (NEER NO. •,
ADDRESS FIRE
ZONE TYPE /1-/- GROUP
APPROVED /
BY DATE j
ADDRESS ZONING (
( NO.OP USE OF NEW/f
CITYT \ I PLANS )/ I BUILDING
STATE TEL. LEGAL
DESCRIPTION ���fi� >6 (/1 0 O
OF LOT NOW ON LOTA.P.NO. ' r y vI
C YARDS EVES
EXISTING BLDG APPROVED ALLOWED
SETBACK LINE FROM • (CENTER LINE ST.) ��
CENTER OF STREET REAR YARD FRONT FT. IN.
SIDE YARD I LEFT I RIGHT R.SIDE r -ti. - IN.
L.SIDE FT. (7IN. J
-`
REAR r IN.
_1iU
BYPROVED BP C DATE / 3 /ALLROOF
COVERING
LDING AND WORK TO BE PERFORMED
I. f.ewC.e ^8/0c k.Walt
it,X2s'Jody a". •GXeX4'h( sat
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY RDINANCES AND STATE LAWS LAYING
BUILDING CONK • VALUATION 224,1-00,. e�
SIGNATURE'O ` ��/I/.1/I PERMIT FEE $ ��--
PERMITTE b���� /� pK7 e_
$ / PLAN CHECK $
AUTHORIZED AG T , *co E
TOTAL FEE 0
1
-.. : 17581 FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT _ JUL 1 b 196?
P. O. BOX 317 COSTA MESA. CALIFORNIA !• FINANCE DEPT.
For Applicant to Fill In Completely APPLICATIONUiehtekr 1ITA MESA
TYPE OR PRINT - BUILDING
BUILDING 3146 Yellowstone Dr.
ADDRESS
COSTA MESA. CALIFORNIA For Office Use Only
OWNER Cl 'de Gillam I RECEIPT NO. I I '. . IT
MAIL RECEE• BY •ATE CEI ED DATE SrADDRESS 3146 Yellowstone Dr. ��/.'G -- ,� I , , 60.E
TEL
CITY Costa Mesa NoKI • aDDREsG `'/4 / /. ,
IL: 4 COSTA -A. CALIFORNIA
ADDRESS 1224 BAF "EDT 01 :MEER - • • FIRE
• ZONE PE -1C-GROUP.-/U
. • a • • Poole APPROVED '/`^� / J /-{/lG/.
BY DATE /Q/p 7
ADDRESS1735 N.Old. Tustin Ave. ZONING
Sant?. IONF NO.OF USE OF NEW
CITY Sant Aria if-/ I PLANS a. I BUILDING PC/17
u�5,c�3Rs�1a,A1.730 .
STATE ALkBnt-78011 No: KI 7-6581 LEGAL LC,'6... Ti? 3s"�
DESCRIPTION
SIZE NO. OP SLDGS.
OF LOT NOW ON LOT A.P.NO. /if — 31 — / 17
USE OF YARDS EVES •
EXISTING BLDG Residence & Gara .e APPROVED ALLOWED
SETBACK LINE FROM (CENTER LINE ST.) I
CENTER op STREET REAR YARD FRONT /S l` FT. b-014.•P-IA. IN.
SIDE YARD I LEFT I RIGHT R.SIDE G ( FT. a:7;( IN.
DESCRIPTION OF WORK L.SIDE '3 FT. '-- N.
III9
P I X ALTERATION I II ADDITION I REAR 17 FT. / IN. J
REPAIR _ I I MOVING II DEMOLISH I BBYPROVED /s���/y/�L
BUILDING • • O. OF �4/i �/
SIZE 1 • 1 •II ROOMS - STORIES - HOLD FOR SPECIAL, RFQUIRE?....dJ.
EXTERIOR WALL - ROOF - . - �/ �QJ /
COVERING COVERING /'a?,,t7 D W.„ /ot/ .0 r'ECE /_e/
USE OF BUILDING AND WORK TO BE PERFORMED ^'•i
'
onstruction of swimmin. •ool-•v; eu 677rycc w
•
mesr1?' S
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION OF AMOUNT - .WN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMA
'URPOBH OF -ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCESpQQQQQAND STATE LAWS OU 'TING
GACONFTILUC�t k1 7 VALUATION n `
SIGNATURE OFLsd I!J aL �} K0� PERMIT FEE 5 l✓ '
PERMITTEE VVV 1 n .. . .5O n
$ 9 (J PLAN CHEEK $ w
AUTHORIZED AGENT 0o
TOTAL FEE $ O` E
3V49(.9• Al
IAI) 15-75Tf;�.00 441* ***=39.50
t- COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
For Applicant to Fill in Completely APPLICATION FOR BUILDING PERMIT
RECEI(V/F�/g/�Y DATE RECEIVED DATE ISSUED
BUILDING �J I `' �/')t�� r�J ¢1 1-15-7 I tS_]r
ADDRESS a\v\tp - Q\\O'43 S�ON'2 1:A/'. / �(iCyyy/fff C�JJ C/
A.P.NO./�/-��I �i7 V x 1! /
OWNER �. \(�(�Q\�C't\�Q
MAIL (�� ADDRESSBUILDIEG C 9 //OW S'O �t
Z
ADDRESS iZ.L.N 4N..t. 3
Ill Ili TEL.
a0 CITY C_osho. \(-:(�.z NOO`L0‘-cic69,_, TRACT 3.5170 I LOT 6 BLOCK
ZCONSTRUCTION NEW ADD ALTEfi REPAIR MOVING DFM-a ISH
OV- LENDER �C��'Q.- Y7q�,
am
J D BRANCH — QQ ,(
OWNER / / 'I L.DGUL�
0_-co
ADDRESS -�
�[�//" VALUE 2 goo
J Q ARCHITECT 0.\--<'2C�.(\CN TEL. USE I $ �/J GG��
OR ENGINEER C.O�C1e Q'C5 ND,�'�Si-CSL\\t ��
O to
Q FIRE y/
W W ADDRESS \ --JS-2 \.,.Q S4y\.�e2�\pNCQN\\c. ZONE YPE • GROUP 2 e.—
a
APPROVED
W Z CONTRACTOR ��QCO\s k. 1C+� BY DATE -(5175
m O 1103
J cc ADDRESS Z 1{ Q(o v3. 'Cac Sc.
LB W TEL. ZONE n NO.OF USE OF NE
ZF CITY C0 `cv "L" Nc TON NO.CL>\O-\f3Q A�/ PLANS BUILDING
tU O STATE CITY YARDS APPROVED YARDS APPROVED
tO Ir LIC. NO. '�t\2\-C') LIG.NO. MAIN BUILDING ACCESSORY BUILDING
D O (FROM C/L STREET)
S1ZE I NO.OF BLOCS.
OF LOT NOW ON LOT \ FRONT FTS FT.
USE OF \ /y
EXISTING BLOG.S\ . \�V`t\. GLS- R SITIF FT
F- SIZE OF NO.OF
Z NEW BLDG. O ROOMS N STORIES \ L,SIDE ..y4\
FT.
Q EXTERIOR WALL„y ROOF p YYY .F�
0 COVERING \JCCO COVERING C.0 < REAR FT. W FT.
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
_ MAIN BLDGS. ACCESS. BLDGS.
QVAR.# DATE
O C 3\QCG\'Q 4.,"0Si cQ 'Q c3<OC tt% C.U.P.# APPROVED
I- YROVEDNDVP �t
V) � O �`QQ\S\C� tu /PJt ABDATE /
" AS -76
Z r t �D l -Le Nrl hnmv. �r�
F TF \
U I hereby acknowledge that I have read this application and state /A `\
that the above Information is correct and agree to comply with lVI
CC all laws regulating building construction, and I shall not employ
I- any person In violation of the workman's compensation laws of
(A the State of California. h
\ u?
-
Z -I hereby certify that I am properly licensed as a contractor under50. FT.
the State of California Business and Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: ¢;
am exempt from the provisions of the State of California Business VALUATION
and Professions Code,Division 3,Chapter 9. m
ad PERMIT FEE $ et
Signature of.,,: � ��qq� __ � � 0/(J
Permittee �C\W �-O` $ �/ '-r OO PLAN CHECK $ f E
C 0
Authorized Agent u
` TOTAL FEE $ 7