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Home My WebLink About1972 KORNAT DR - Building Permits 4`0ln 44-49 CITY OF COSTA MESA _ BUILDING DIVISION r Y , DEVELOPMENT SERVICES DEPARTMENT PE MIT NUMBER Fr :rem 1 DERMIT \/1 06-00422 ape ed. (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1972 KORNAT DR Status: ISSUED Suite: Applied: 03/22/2006 Vicinity: HOUSE AND GARAGE ROOF Issued: 03/22/2006 Primary Occ: R3 Type of Construction: V-N Parcel Number: 13944112 Zoning: R1 Applicant: FRANK MANGISI • Address: PIPELINE LN UNIT �% vV J UNITA Phone: 714-379-8522 ISSUED BY: r HUNTINGTON BEACH,CA Zip: 92649 Owner: HAUSER, ROGER W JR Address 1972 KORNAT DR , Phone: 714-546-9927 COSTA MESA,CA Zip: 92626 Contractor: CONSUMER SERVICES Address: 15201 PIPELINE LN UNIT A Phone: 714-379-8522 HUNTINGTON BEACH,CA Zip: 92649 License: 676090 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT T/O EXISTING WOOD SHAKE ROOF MATERIALS,REPLACE WITH WOOD SHINGLE,CLASS B ROOF OVER EXISTING SKIP SHEATHING ON ATTACHED HOUSE AND GARAGE,APPROX 18 SQUARES.REPAIR AND REPLACE SHEATHING AS NEEDED. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $8,500.00 Permit: $167.25 Claim Valuation: $8,500.00 SMIP Res: $0.85 SMIP Corn: $0.00 Other $0.00 Inspection: $0.00 Total: $168.10 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: 0 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(6/00) DECLARATIONS' 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, ❑ I have and will maintain workers'compensation insurance,as required by section 3700 f the Labor Code,for the performance of the work for which this permit is issued. My worker ' 0 pensation suran carder and policy number are: 4 �./ Carrier:�� G /�'rc, Policy.Number. 35 600 6 (rifts section need not be completed it the permit is valued at one hundred dollars($100)or less.) L�— ❑ 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 workers' compensation laws of alifomia,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply withth= .y' •• _ 1�' . APPIi�i _ �a7`i_ WARNINGI.FAILURE TO SECU'E WORKERS'COM4 SATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVERTO CRIMI L PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOU.ARE(5108000),IN ADDITION TO L 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 I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force.ai�ect.:Ctc:th, (o-qt., 450 �Class_N�, '(2) Conlrac ors.Slg; "V Date' CONSTRUCTION LENDING AGENCY: O 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 properly 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.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property 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). O 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? 0 Yes 0 No (Section 25505 of the Califomia 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,ore 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? 0 Yes 0 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 Califomia 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? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�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? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 Califomia 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. A ignature Of Legal Owner(s) Date A • e' •trthartzed'Applicant..____ Date�� ;ODE 0 If15PECT10N TYPE OAS INITIAL$ CODEI INSPECTION TYPE fAIE INTrTIAL@ 1616 Fixed System Final Fir. • evention • 206 Final Mechanical 1266 Pool Spa Final ' 208 Final Plumbing z 200 Final Re-Root 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 1 co . z . •�`�'��' A��j .f s Twining Laboratories ,uE� = cucf�= � ' inc ?'( . 't .. C. . •- ., '.1 4++,.... P iJ A, . .:7 i, Ca UOAOt :2' 3355 .t't 036.. ISI' 7'4. H2R Rd?2 TESTING .. . -.s r _ . .-.. +•.... •, .. .. July 9, 1979 July 3, 1979 Examination: 5C79-3161 COMPRESSION TESTS ON MITE CYLINDERS My `/ C Mr. Errol F. Heesch M y fl V E �.r, n�rrT ,firQ, 12921 Aspenwood Lane In E :Air' Garden Grove, California 92640 PROJECT Pool for ROGER KAUSEP. JUL 131979 AM PM ADDRESS 1972 Kornet, Costa Mesa 718191100111211120141516 SAMPLE FROM Gunite Swimming Pool & Spa ! ARCr'tECT 0'“;.''. VN Irvine Pools 4 ENG NV p/P4r11 '1 S & A Gunite Co. I SPECIFIED MIX 4z - 1 STRENGTH 2,000 psi DATE CAST 6-12-79 CYLINDER SI.. DATE TESTED 6-22-79 6-22-79 6-22-79 7-2-79 7-7-70 7-2-79 CYLINDER NO 1 2 3 4 � 6 COMPRESSION 10-Day 10-Day 10-Daly 20-Day 20-Day 20-D1Y TOTAL LOAD. LBS 43,000 76,000 95,000 35,500 41,500 88,000 POUNDS PER SO IN 1,520 2,690 3 ,61; 1,640 1,E'1': 3,115 Size: 6"x12i" 6"x122" 54"x12" 54"x12" 3i;"xl?;" 6"x12" COMPLIANCE Average complies with specifications. MADE BY DE. vEVED By RECt .ED JN CYLINDERS Skip Hee.sc:T 6-14-79 DISTRIBUTION E. F. Heeseh - 2 Eosta Mesa Bldg. Dept. Irvine Company 4301 Btrch Street 92664 /„4111,>,(LTwining Laboratoriep,�1fE ElJetn ea<<fonzLa, 9,=c. I. r: L, nc ern Mr-SP 33;0 cup',';\\'z': ' t•1mq „ adAddss P(1 IBn1 '6(ityr9 (% .,tjl CA 90801 ' 12131 .126.3355 12131 6362386 (7111828-6432 TESTING Ir,ANC^OrrICC ;5,40 Nor:', 0,,,.i S s�,r , ::.,., E•192703 ;,:.5317045 JUL 131979 PM /m8191a 10 1112 1121314150 July 3, 1979 t Examination: SC79-3161 COMPRESSION TESTS ON GUNITE CYLINDERS Mr. Errol F. Heesch 12921 Aspenwood Lane Garden Grove, California 92640 y PROJECT Pool for ROGER KAUSER U�/f/V„-1,7 ADDRESS 1972 Kornet, Costa Mesa lyl 11) 4 Y� 1' UUU SAMPLE FROM Gunite Swimming Pool & Spa AK-or,lT CONICet1O✓ Irvine Pools ENOINEN SUBCONI1AC10G S & A Gunite Co. SPECIFIED MIX 4i - 1 STRENGTH 2,000 psi DATE CAST 6-12-79 CYLINDER SIZE 4 - 5,1" X 12" 5 - 54" x 124" DATE TESTED 6-22-79 6-22-79 6-2.2-79 7-2-79 7-2-79 CYLINDER NO. 1 2 3 4 5 COMPRESSION 10-Day 10-Day 10-Day 20-Day 20-Day TOTAL LOAD, LBS. 43,000 76,000 35,000 35,500 41,500 POUNDS PER SO IN. 1,520 2,690 1,615 1,640 1,915 COMPLIANCE MADE BY DEtIVERED By RECEIVED ON CYLINDERS Skip Heesch 6-14-79 DISTRIBUTION E. F. Heesch - 2 'Cotta Mesa Bldg. Dept. Irvine Company 4301 Birch Street 92664 20 2 zTwining Laboratories Of=Suu t,E= da&/o=,2 L2, g,,,. ff ThilOP 33'0 lrcppr, V,,•; N1...1.n9 Alar.•« P O Bn. 47 .nnn 9eeo1 CA 90801 0131426-3355 1213.636-2386 17111 828-6137 TESTING rnr:C,.O: ICE 1514 O•. .•n ...1 .S...... s... _,.. CA _ 1 53. 204N Examination: SC79-3161 COMPRESSION TESTS ON GUNITE CYLINDERS Mr. Errol F. Heesch 12921 Aspenwood Lane Garden Grove, California 92640 dicirB.d1 " PROJECT Pool for ROGER KAUSER /SIJ ADDRESS 1972 Kornet, Costa Mesa I I nr SAMPLE FROM Gunite Swimming Pool & Spa 1 ` A>CNFIECr CQ1,T A I,,, Irvine Pools fNO/Ntt= SOECOra%cUO; S & A Gunite Co. SPECIFIED MIX 4# - 1 STRENGTH 2,000 psi. DATE CAST 6-12-79 CYLINDER SIZE DATE TESTED 6-22-79 6-22-79 6-22-79 CYLINDER NO. 1 2 3 COMPRESSION 10-Day 10-Day 10-Day TOTAL LOAD, LBS. 43,000 76,000 35,000 POUNDS PER SO IN. 1,520 2,690 1,615 COMPLIANCE MADE BY DEIIVEYfD BY RECINED ON CYLINDERS Skip Heesch 6-14-79 DISTRIBUTION E. F. Heesch - 2 osta Mesa Bldg. Dept. .. .. . . ..i.. ,. :. ., . - .I a e....a OWNER SAMAR CONST.CO. DATE NOV 4 1953 JOB ADDRESS '2Konat Erive BUILDING PERMIT NO. 20624 GENERAL CONTRACTOR Santer COnst.CO. VALUE $ 23,61ib.00 AP No. LOTJ TRACT 43 1 FIRE ZONE DESCRIPTION OF WORK Res.w/att.Gar. INSPECTIONS Signature DATE GROUP I & J TYPE V ZONE Rl Soil 't=/1-4--4.z SUBCONTRACTOR PERMITS ISSUED Gas / g /_i 6 DATE NUMBER Water 7)' /2 --177:7;" i - ',` _"� Rough Com. Refrig. 0 Air ond. C] _ Rough Heating /-/= - .• ., /. . , 19F4 �' �W Rough Plumbing i/Q�►' Ir ,:, Nov 2 1 1963 4 t.. ;`� <- a • Miscellaneous Prop. Swr. Line '2 House Con. a St. Swr. 0 ".//. - - Q 'n. rflc\CC nCY' , l-.ln 142 Sprinkling System Q.� �1 b Construction Pole e 2 dPl a Underground f� Power �❑ %�' / Aj� 6 b" Rough Wiring /'YC'., �.•G CY e6)4 (/Di�- /2-/6-e.'l o?/ln/7 Trenches Forms W� Steel Reinf.- Z.ll 53 ' Floor System Z5'1"d� Bond Beam 0 Steel Reinforce 0 Sheathing f( z•/7_- "/ Frame and Flashing „Q z-"7-6 Lathing— In' ' ' Out Pr � 3_4-67 Plaster, brown coat 4i-'L--o- Refrig. PRefrig. ❑ Air Con• ,❑ Final Heating, Final •/� ,4-^7, Plumbing Fixtures, Final ,Qy /y Final Gas Test ,5 e Electric Fixtures, Final a ,/rC,! Building, Final T-' f'A/�47 OCCUPANCY Y . Form BU4-6M-3-63--S-B P 20824 FEE RECEIVED -CC'4lA MESA BUILDING-SAFETY DEPARTMENT OCT 1 7 IyOd P.O.BOX 317 COSTA MESA.CALIFORNIA FINANCE DEPT. �� CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT Tr. 4341 TYPE OR PRINT Lot 87 BUILDING BUILDING For Office Use Only ADDRESS 1972 Kornat Drive RECEIPT NO. $j1r ry COSTA MESA, CALIFORNIA .U(uJ r//�it RECEIVED BY DATE RECK V[D ISSUED OWNER Samar Construction Co. 10 /O%�/ NV 4 1062 BUILDING MAILADDRESS ADDRESS'1653 Minorca Drive FIRE 7E GROUP-O/{� CITY Costa Mesa No11Ci 90395 ZONE TYPE[ / ARCHITECT TEL. AP ARCHITECT DATE 0 MGINEERE. G. Kaltenbach No. PROVED547-8016 AL_..ESS1823 E. 17th St. Santa Ana ZONING ZON[ No.or USE OF NEW sires R1 I PLANS 2 I BUILDING W/at ,gar, CONTRACTOR Same as Owner LEGAL Lot 87, Tr. 4341 ADDRESS DESCRIPTION CITY A.P.NO. (/ 3 ' NOTE: NO EAVE OVERHANG SHALL BE LESS THAN LIC.No . 197838 ry�. 90'TO SIDE a REAR P.L. EAVES SIZE I NO.OF BLDGS.O ALLOWED (U.B.C.REQUIREMENT) OF LOT 75 X 85 NOW On LOT YARDS APPROVED YARDS APPROVED USE OF ___ MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. (FROM C/L STREET1 SETBACK LINE FROM FRONT 41',S--FT. RT. CENTER OP STREET 501 REAR YARD 29 SIDE YARDI LEFT 6 I RIGHT• 7 R.SIDE 7 FT. FT. DESCRIPTION OF WORK . L.SIDE C FT. Fr. F X ALTERATION _ ADDITION REAR '7 FT. FT. DISTANCE BET. BET.MAIN e REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS. - VAR.# DATE BUILDING.,205 sq.ft. ROOMS NO.OF 8 STORIES 2 C.U.P.# _ APPROVED SIZE L \\AA// pp SCLh, 1� R EXTERIOR WALL OOd RI ROOF ShAke Y APPROVI# 11 I - G COVERING tUCCO COVERING J Ing lel BY 11 /IA.A/h DATE 10- 3 USE OF BUILDING AND WORK TO BE PERFORMED Single family residence and attached garage. //jQ PlanI HEREBY RSEDGE THAT I HAVE READ THIS APPLICATION THE/�f HQT BHOWN UNDHO�AY/ �/IS FOR THE ��D D/ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. X O PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION (,.� m BUILDING CONSTRUCTION. PERMIT FEE S / H SIGNATURE OF $C7J / //' ., . 3 'S O ¢ PERMITTE �pnyJl l'� >� P'H✓ f/D Y�(// J g _ AUTHORIZED AGENT _ TOTAL FEE (✓ J . vnncrt f7HU3GKt KUtitK LJMIL 5-11-/`J JOB ADDRESS 1972 Kornat_DriveBUILDING PERMIT No. 48027__ GENERAL CONTRACTOR Irvine Pools DESCRIPTION of WORK private__Swim_Poo1_w/SpaZ-AP No. 139-441-12 LOT 87 TRACT 4341 FIRE ZONE VALUE $ 4 RSD (111 INSPECTIONS I SignatureDate GROUP TYPE ZONE \ RC- �- ?JrPERMITS ISSUED Q.Pool Location I1 � „� 'l9% T SUBCONTRACTOR Date Numbc_[ signature i Forms S - c vi Main Drain Steel Reinforce Electric I Elec. Bond Oqc SL5--e9-2/p M.f{/I4" -04)- 6 -d')7 A456 V ' Approval to Cover Underground Electric cpC ?a-vq'lf' Gas Piping Test /C .. ‘/H19' Plumbing_ � � Lam�,__ -�fQ1,�� b ry/ Filtering System Lines /QC J �-7, 4"hat�Ct •5'i/ Y 6ozd Backwash Lines and Recep. FQCi6/pi? Electrical Final "C. G•96 Heater and Vent Final Filter System Final c S .- .. Backwash and Recep. Final Fencing Final e. i 9/ _eo I ., COSTA ESA BOX BUILDING-SAFETY MESA, DEPARTMENT A 6E6 APPLICATION FolikAmmithix .PERMIT 48.50 TL k IRECEIvEDBY p _"ti5QCKTD For Applicant to Fill in Completely 877 . • pp p y — Use Ink Only / '._- ' BUILDING vii Mc cu „ �p� A.P.NO. 1 31.E ( — !� ADDRESS a. �" \\\pt�V,\ /s--� TENANT NV BUILDING ' 97a lies eh I?j 9 OWNER OR IN I�1 ADDRESS i� `� MAILING SUP NAI ONOR . r� ADDRESS \O(\ a ik hCA NO. LOT A �I BLK. TEL. CITY QiG.]_1� I\Vy c� NO. S� /b- 9Q7 3 y I CI / - C NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION --'-- LENDER pX. BRApsr OWNER at\er� gayseY ADDRESS VALUE USE E ARCHITECT `�.s TEL _ OR ENGINEER tiA NF" NO.,in c/ OeI ADDRESS1 O O Rip cA, C•101"O ZONE 42-1 TYPE GROUP p ^ APPROVED 1 CONTRACTOR 0..PYh� BY DATE — ADDRESS �I 1r-t 1 �s0 f I1 r _ \\ _','al'�CJ" l'slPl TEL CITY F• STATE �`Q `�Q r Al• CITVO SS.J�IO2I APPROVED SETBACKS LIC. NO. 2 I l,c l LIC.NO. togs...5? La SIZE NO.OF BLOCS. Cl. (FROM C`ST9EET) „Esti . OF LOT NOON LOT FRONT ��FT. Cirrei a USE OF ��//T/ u EXISTING BLDG. R.SIDE —I V FJ. - E Separate permits are required for L.SIDE <U FT. Gelectric,plumbing and heating work. REARFT? E-. USE OF BUILDING AND WORK TO BE PERFORMED PLANNIN�TION 1 4.-p, [1 � p 9) (co ..GN sDATE APPROVED B-vP 220___ 0 TE 7 q >-. ..I CC IV a.0 I hereby acknowledge that I have read this application and state n a that the above information Is correct and agree to comply with L all laws regulating building construction, and I shall not employ ti Z any person In violation of the workman's compensation laws of o S - the State of California. co I hereby certify that I am properly licensed as a contractor under SO. FT. N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: - va am exempt from the provisions of the State of California Business VALUATION PERMIT FEE E 3 /1 I and Pr dons Code, Division� 33, Chapter 9. M ��! to PermitteeSignature en o l JVn (-- fy:i4 si--) (� �� Cn�P- XN CHECK S / / r A'1O u or J 7- 77 / I v�y[' l�{lQ U Authorized AB t Data \ TOTAL PAID $ y � r d