Loading...
HomeMy WebLinkAbout2045 MANDARIN DR - Building Permits CITY C F COSTA MESA 4` 9 6g BUILDING DIVISION • ,,,aa I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT � � \./ B04-02167 (714)754-5273 • Fax(714)754-4856 • www.ci,costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2045 MANDARIN DR Status: ISSUED Suite: Applied: 12/29/2004 Vicinity: ROOF Issued: 12/29/2004 Parcel Number: 13953134 Zoning: R1 R1 Applicant: SHULMAN, JOE ISSUED BY: Address: 7721 ETNA CL Phone: (714)536-5116 HUNINGTON BEACH,CA Zip: 92648 Owner GRIGAITIS, PETER A Address 2045 MANDARIN DR Phone: COSTA MESA,CA Zip: 92626 Contractor: SHULMAN ROOFING Address: 7721 ETNA CL Phone: (714)536-5116 HUNINGTON BEACH,CA Zip: 92648 License: 690617 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 30#FELT,7/16 OSB,CERTANTEED PRESIDENTIAL, 50 YEAR COMPOSITION SHINGLES AND REPAIR/REPLACE SHEATHING AS NEEDED.2,800 S.F.FOR S.F.D. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $9,480.00 Permit: $181.25 Claim Valuation: $9,480.00 SMIP Res: $0.95 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $182.20 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left - 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: i0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California 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 180 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 required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46(6/)0) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'coo p satlon I range carder and policy number are: • /J�• /y9 ane,-- not b _ ..L& pt,,,, /'1�� ®2 ' (This section nee not be completed if the permit is valued at one hundred dollars($100)or less.) I� ❑ I certify that in the performan 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 workers' compensation laws of Calif n' ,and agree th�L�f I sho Id become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these prow5i 5 ..�' `:�l Date:.. /2-c/ ''—Os A••i int Signature:,--�- �[/iw� t ©4:6'Ir"c -AILVR O SECUR ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPL tau CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($103, ,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm.that.bam.licensed un er o isions of Chapter 9(commencing with Section 7000)of Division 3 of nesProf the.Busis and Ps' ns Code,and my license is in full forc jg�Mreffect::Cio..a-�-�--'� ���0pi wawa_ - .C. (( Goniracto Signeture:T`-'--"- -----r------- ---- i air' /A- ' `3 Ott CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom 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).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). E l I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes C No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sig if.re Of egalOwner(s) /pp DDate SLI r And/Or A'uthbrized Applicant ',. .-4-,-,;-,:,r--. - •ate ".,-: —Y CODE* INSPECTIONTYPk pATE INTmALS CODE. INSPECTION TYPE DATE INRTIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final /� /I ,� 208 Final Plumbing 200 Final Re-Roof 1-2'`f 9 a/'f[/ 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval _- 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy v VIII Call ClCsait VGSWG DU1IiUGllO, 1111'• LA1Ca r17 vI JOB ADDRESS P045 Mandarin Drive BUILDING PERMIT NO. 26930 GENERAL CONTRACTOR Mesa Verde Bldre. DESCRIPTION OF WORK Residence W/Att. Gar. AP No. LOT 93 TRACT 6,237 FIRE ZONEVALUE $35,338.00 `ECTIONS SiSignazure Date GROUP T & d TYPE V ZONE l s,,.. a—c_, l7c 4.---2_7;, 7 PERMITSISSUED Gas U7°e.,.r r - f en A.1 .- SUBCONTRACTOR Date I Number I Signature Water UF S- Z4 G7 ad - / •-mac Plumbing Rough Pliflnbin C _ r - ! u�.' r c !gr� ,��j��Ij,►fjl� Prop. Swr. Line IA'Fiouse Con. i� age- - �. I�� � ✓,�ii�_, _ �A ii��flA'/� io S rinklin S stem Miscellaneous 'timing . ,4/-4_ 5-5-- -j 4 Or .1-26. 4'7/4. Rough Heating and Air Conditioning /FfG 7_5-G, Temporary Service or Pole Underground 0 Power [7 Rough Wiring ✓, / //JJ Heating d V nt. ' Trenches l� Forms a Steel Reinf. ® fast r-3- 7 j(' 'Ten.• t ''VII�g--eper/ le7y Floor System 404- r-le-67 G/G/ll (('' Bond Beam 0 Steel Reinforce 0 Sheathing Rlilg !-3067 Frame and Flashing /fig- 9-/1- 67 Lathing— In E Out E VW ?_yr-y Plaster, Brown Coat /Llys &-v-67 S' tural, Final ectric 1. .ng, Vent., Refrig. and A.C., F' al IP : _ �77-6J 4"/A0. AU, �-C keR -/e7v17r7o Plumbing, Final and Gas Testa 24 Electric, Final // -LY-V¢ Building, Final t i'ft-9--X6in 269310APP 25.67Pa5AUO1259 *** 15825 9'E COSTA MESA BUILDING-SAFETY DEPARTMENT ..- P.O.BOX 317 COSTA MESA.CALIFORNIA For Applicant to Fill In •Completely APPLICATION FOR PERMIT Lot 53 TYPE OR PRINT Tract 6237 BUILDING For Office Use Only BUILDING .0 .oVs"A4 e AtIaA ADDRESS - RECEIPT NO. fy�+v /'� COSTA MESA. CALIFORNIA rte. �.` '9:110 RECB q�� RECEIVED DATE ISSUED Mesa Verde Builders -`Inc. it �!/t7'� OWNER j*Xd X Xkb:hers ld'. l MABUILDING ADDILRESS 2850 Mesa Verde Drive ADDRESS i b49— FIRE '/ y" CITY Costa Mesa TEL 0395 ZONE TYPE • GROUP y(/// ARCHITECT TEL. `547- APPROVED ARCHITECT DATE OR—.INEER Kaltenbach NO. 8046 ADLnESS 1823 E. 17th St. Santa Ani ZONING ,p� Mesa Verde Builders Inc . zip NO.OF USE OF NEW/�' /,{J/ 65/ I PLANS I BUILDING CONTRACTOR RetatiNX x$¢ iS4TBL'TCSXX �/l LEGAL j-..6-14...t 3 -� /��7 ADDRESS 2850 Mesa Verde Drive DESCRIPTION ���. CITY Costa Mesa A.P.NO. NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STALIC.NO. 18.7318 No' '549-0395 EO"TO SIDE@REAR P.L. . EAVES SIZE 3 v /D gOF LOT /� I NO.or pupas. 0 NOW ON LOT ALLOWED (U.B.C.REQUIREMENT/ YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. (FROM C/�L/STTREET) SETBACK LINE FROM FRONT Ve FT. FT. CENTER OF STREET REAR YARD // SIDE YARD I Len RIGHT R.SIDE (p FT. FT. DESCRIPTION OF WORK L.SIDE 7 FT. PT. 3 NEV X ALTERATION ADDITION REAR '1) FT. FT. DISTANCE BET. BET.MAIN @ REPAIRI MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS. BUILDING NO.OF YAR. DATE SIZE ROOMS ' STORIES _ C.U.P.�SC APPROVED/EXTERIOR WAL -I ROOF Shake APPROVE,,' / () Qt COVERING I�'tuccq COVERING Shingle _ BY /��t.-xry.. DATE// ' USE OF BUILDING AND WORK TO BE PERFORMED New Residence '0 6 '� .... V V 7 SO.FT I HEREBY ACKNOWL GE THAT I HAY READ THIS APPLICATION THE AMOUNT SHO N UNDER VALUATION IS FOR THE F AND STATE THAT THE ABOVE IS COBBECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O BUILDINGPLY CONSTRUCTION. ALL CITY ORDINANCES*110 STATIC LAWS REGULATING VALUATION L c°. m' SIGNATURE OR � w f,'�,N.I(/A„',t.A PERMIT FEE § /�✓�✓ ��� $ 33l 3 PLAN CHECK $ s AUTHORIZED AGENT TOTAL FEE $/38t a 5 URNCK EMERY, M. DAIt 10-19-67 NI, JOB ADDRESS 2045 Mandarin Drive BUILDING PERMIT NO. 27728 <4 GENERAL CONTRACTOR ontine tal Construction DESCRIPTION of WORK Pvt. Block Wall Ae Yo• None LOT 53 TRACT 6237 FIRE ZONE VALUE $ 5 • .00 ',is: tit CTIONS Signature Date GROUP J TYPE 7TI ZONE R-1 SOIL PERMITS ISSUED GAS SUBCONTRACTOR Date I Number I Signature WATER Plumbing ROUGH PLUMBING /PROP. SWR. LINE El HOUSE CON. LI SPRINKLING SYSTEM N�MISCELLANEOUS \ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND El POWER El ROUGH WIRING Heating and Vent. TRENCHES ® FORMS ❑ STEEL REINF. Q !a-i.•-4j FLOOR SYSTEM BOND BEAM n STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING — IN n OUT fl PLASTER, BROWN COAT 5" TURAL, FINAL Electric H, IG, VENT.. REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST r] ELECTRIC, FINAL BUILDING, FINAL I v 4 27728 P;.7F .' OCT 19-67-6,s,0(1 npi, I :.r.:. .::,7 t COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING For Office Use Only BUILDING 2045 Mandarin)p,j g ADDRESS RECEIPT NO. /gRMlppw COSTA MESA, CALIFORNIA .�— L ' I/GJI8 — RECEI ED MY -DA RE VED ,OATS gKU! OWNER Mr. and Mrs. M. Emery ( '.v�7 �Id- /7-G) fU-?fl MAIL 2045 Mandarin ADDRESSNO [YD7'V . 2722,22e442,ZS ADDRESS FIRE \,..7- CITY Costa Mesa NOL 545-0791 ZONE N.- TYPE 7Z-GROUP `. 4ITECT TEL BYPROVgq _p242/5/1_,DATE /0/9 47 ' NGINE!R NO. (G� ZONING ADDRESS Co. ZONE :o.:1):02 US[OP N[W Continental Construction CQ - ( I LAI BUILDING y CONTRACTOLLR11,,,^, V' y- q ADDRESel(.Pi'(1 So. Minnie Street LEGAL .1 i 1L'S3 rrl 60 3 7 CITY Santa Ana A.P.NO. n/NO /V}� STATE TEL. NOTE: SIDE V ROVE POVERHANGSHALL BE LESS THAN LIC.NO. 202487 NO. EAVES SIZE I NO.of SLDGs. ALLOWED (U.B.C.REQUIREMENT) OF LOT NOW ON LOT YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. —, (FROMC/L STREET) SETBACK LINE PROM FRONT Fr. 4-V PT. CENTER OF STREET REAR YARD l " SIDE YARD I LEFT I RIGHT R.SID[ PT. FT. DESCRIPTION OF WORK L.SIDE PT. FT. / d 701 REAR Pr. Pr. I. ALTERATION ADDITION DISTANCE SET. BET.MAIN Q MAIN BLDQS, ACCESS.SLOGS. REPAIR _MOVING DEMOLISH 1 BUILDING NO.OF VAR'# DATE SIZE ROOMS STORIES C.U.P.# APPROVED EXTERIOR WALL ROOF APPROVED COVERING COVERING SU/ __{P AT! (y/ y /4 n USE 01 BUILDINS AND WORKTO BE PERlM D F IL ft. Concrete Block 4iJr . . _ t '___ SQ.FT. X G I HEREBY ACKNOWLEDGE THAT I NAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. F15 PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION $ /`^/� XI BUILDING CONSTRUCTION. PERMIT FEE DO PERMITTEE SIGNATUREOP �-f') E �v. v PLAN CHECK S w / AUTHORIZED AGE 5 /(/�� TOTAL FEE CJ OWNER EMERY, MAtffTOE MYRON DATE 8-25-69 JOB ADDRESS 2045 Mandarin Drive BUILDING PERMIT NO. 30688 •S GENERAL CONTRACTOR Owner-Builder DESCRIPTION of WORK Patio Cover / '0.139-531-34 LOT 53 TRACT 6237 FIRE ZONE LU Signature 700.00 I., ECTIONS Signature Date GROUP 3 TYPE y ZONE R-1 SOIL SUBCONTRACTOR PERMITS ISSUED GAS Date Number Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ❑ ROUGH WIRING /' Heating and Vent. TRENCHES .. FORMS 0 STEEL REINF. n f614L £5,-.7 -67 FLOOR SYSTEM BOND BEAM n STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING — IN n OUT n PLASTER, BROWN COAT S TURAL, FINAL Electric HE...ING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST ri ELECTRIC, FINAL / BUILDING, FINAL 4-A__ G.7 -6.9 • • : 30688 COSTA MESA BUILDING-SAFETY DEPARTMENT AUG 25-69Nsp001033 .4 COSTA P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 For Applicant to Fill in Completely APPLICATION FOR BUILDING PERMIT RECEI D Y 135.y RECEI D D T ISSU DD//' BUILD G ADDRESS.ZO¢S MAVNo w, IN bpR . �y v/, c Z T�/t6-/per MAUR%(r AI Y4't,v !A16 V A.P.NO. / /l'3/J P.'OLs NO 3 OWNER ,f r� f/'/1- AMAIL DDRESSoZO4C MANb,-�I.0 Dip, BUILDING /fa y3)va - J _ •L a ADDRESSp( J Gs.yL�jL� Z �n TRACT 237 LOT L3 BLOCK f- U CITY COJT/'] /1'1 C'S KI NO.3-/'J-OM 7� Z _ NEW ADD-ALTER REPAIR MOVING. nFM01 ISH Z Q CONSTRUCTIONE11/h /t Jam/ O in LENDER !y a m _ID ARANCH OWNER atI/jLGO //4 r a.- ADDRESS — J / �"^�� VALUE USE ''y'^� $ ARCHITECT f' OR ENGINEER _Sect r---. �� __ 4�1NO.UN TEL' 2 Q ZE t GROUP W ADDRESS ZONE TYPE1 ��///) /` ,( CONTRACTOR JCL APPROVED fit)..A.DATE %'l /n 7 W Z '(J / / J O CD Z JCC ADDRESS W W - - - 20Ny�E INO.OFPLANS USE OF NEW 4 Z= CITY NO. /�'- PLANS BUILDING 2E W 0 STATE CITY YARDS APPROVED YARDS APP OVED u,CC LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING U SIZE /A� i NO.OF BLDGS. (FR/,p�gyjLC/��/vq/STET) / OF LOT eS if-/0.3 JNOW ON LOT / FRONT /jF • FT. USE OF EXISTING BLDG.�(�/ 06NG r R.SIDE % FT.Q // FT. I— SIZE OF ,�st / / NO. OF //�� (j i on, Z NEW Bte6.SODF 7X37 ROOMS( 1 STORIES I L.SIDE / Q FT. / FT. �a.1 EXTERIOR WALL ROOF 7 / / / / r/ COVERING COVERING / X 3 REAR % FT. f . FT. U E OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& A'T/D 0 0 F MAIN BLDGS. ACCESS. BLDGS. Q VAR.# DATE O C.V.P.#��// APPROVED ZROVE y�� DATE 69 O lNNr UI hereby acknowledge that I have read this application and state ✓ that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ I-, any person in violation of the workman's compensation laws of Cn the State of California. co Zb I hereby certify that I am properly licensed as a contractor under SO. FT. 6 the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses ere 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 CC VALUATION and Professions Code, Division 3,Chapter 9. t. co PERMIT FEE S 7. Signature of D s�/�/jff�� ra Permittee /�'C +f i $ n0n PLAN CHECKS E Authorized Agent / L{ )-'J #-IV LL ,. TOTAL FEE $ / /