HomeMy WebLinkAbout601 LAKEVIEW LN - Building Permits\, ,
VL//���//� �7 ..
i � �
COSTA MESA BUILDING•SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
z .
W W
a U
Z
Z Q
O v~i
am
J �
J �
Q W
fd J
- p7
J Q
U N
Za
a¢
W
W Z
J �
m Z
J �
W w
O=
zF
w�
fn ¢
70
H
z
Q
U
J
a
a
Q
0
F
N
Z
�
F
U
�
�
H
h
z
ADDRE � _ _
OWNEfi HELTZER ENTERPRISES-BROOK
MA�L
nooaess 740 N. La Brea Avenue
arv Los Angeles, CA 90038 NOL 9
COPSTf7UCT10N United California Bank
I FNfIFR
BRANCH I'ldlil Branch
nooAess Fnn a_ c.,,-t��gt �L.A. 9005
OF ENGINEE Fields & Silverman No`' 653
ADDRESS1�-3 N. SdR Vicente, Beverly
CONTRACTOR George J.�Heltzer
A�DRE55 740 N. La Brea Avenue
TEL.
ciTv Los AnQeles, CA 90038 No� 937
uc No. 3144 �ic�No.
SIZE ' NO.OF BLDGS
OF LOT NOW ON LOT
VSE OF
EXIS7ING BLDG.
SIZE OF NO. OF
EXTERIOR WALL ROOF
COVERING Plaster COVERING Wood
USE OF BVILDING AND WORK TO BE PEFiFORMED
Reside tial
� c/!t%!J`.i , !,l , .
v�.�c i
�,,q o_-,�. . n .., c
i.:. ,,�,;�- „ 523` t.::. iO�.�S
APPLICATION FOR BUILDING PERMIT
TRACTCJZT
FIRE
Hills ZONE
APPROVED
2
]
DATE
F�`C NO.OF I USE OF NEW ;3 (��,y
� S PLANS 2 BUILDING }�
VARDSAPPROVED VARDS APPROVED
MAIN BUILDING ACCESSORV BVILDI
/�
DISTANCE BEf. BEf. MAIN &
MAIN BLDCS. ACCESS. BLDGS.
CURP��—����, qppROVEDO���7-�
APPROVEO r1
I hereby acknowieaae Ihet I �ave reatl t�is application ena nate ,:J� /!
that t�e ebove intormation is correct and aBree to comply wfth
ell bws reBulatin8 builtlinB consttuction, entl 1 shall not employ 7qX
any person in violation of Me workmen's compensation lews of
Me State ot Califomia. � /��� �Q 2
I heraby certity that I om properly licensetl as e conttactor unGer SQ. FT.
Me Stete of Californie Business entl Professions Cotla, Dlvlstcn 3, TME AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, antl Mat wc� lieenses ere In full forca end effoct, or I THE PURPO6E OF ESTABLISHING A VERMR FEE ONLV:
am exempt from Me pr Is ons ot the Stete af California Bucinazs VALUATION �
antl Professions Cotle, on 3, Chapter 9. PERMIT FEE $
Sipnature ot / .l ._ �
Permlttae � $ ��, DDO P�N CHECK $ � �
Authorized Apeni �
TOTAL FEE S
�'S:_ ,
e
0
LL
..
ti
�Jl I
i
��
OJECT ADOHESS: 6 O I LAKEVI EW LN
OWNEH'SNAME:BROOKVIEW CONDOS CONDOS
aooREss:630 PAULARINO
CM„ CA. ,
AflCHIENGINEEP:
AOUNESS:
flEC.NO.:
i�
UNIT:
PEPMITTEE:MESA ROOFING CORPORATION ( 714 ) 598-3012
aooxess: gq3 W. 17TH ST
COSTA MESA CA 92627
UCENSEU CONTflRCTOP OECLANATION: I hereby a��irm �hai I am licensed under Dmvisions ot Chap�er 9(commencing wrth Sec�ion
7000) ol Omision 3 o�ihe Business an� Prolessions Code, an0 m I �NICE'm I.
ciTvuc.:0 5 sTaTeuc.5641 cu�ss:C-3
�ate: -' "�' SignaNre'. � �
WOflN 5' COMPENSRTION OECLABATION: I hereby ' at I have a cetlificate o� consenl to self-insure or a cehihcate of Workers'
Compensallorurysyryiy@,prlapetlll��qqy 1�ereo� (Section 3800. Lab Cf�
�POUCYNO.:YY'1l.Lg b/ V EXP.DATE:O/IO1I94
comeaNr:GOLDEN EAGLE
❑ Cenifietl copy is hereby �Ium+ishe0. � Certified co ' i ee with �he ciry Building Di ''
�ate: � ��— / � qpplic t' ���
E%EMPTION FpOM WOPNEPS' COMPENSRTION OfCLABATI :(This seciian neetl no� be romDleteO if Ih¢ p¢rmit i5 for one hundre0 (5100) Or 1e55�.
I cerlify �hal in Ihe periormance of Ihe work for which t�is permil is issue4 I s�all nol employ any person in any manner so as to became
5u01e�� �o ��e Warkers' Compensalion Laws ol California.
Oate'. SignaWre:
NOTICE: Ii, after making ��is tleclaraiion, you shoultl became SUUject lo lhe Workers' Compensa[ion pmvisions ol ��e La�or
Code. you must �otlhwilh compty wi�h suc� pmvisions or �his permit shall be tleemed revoketl.
CONSTflUCT10N LENOING pGENLY: I here6y affirm that ��ere is a con5�mciion lending agency lor the pedormance oi Ihe work for
wbich Ihls pormit Is lssuetl �Seclion 3097. Civ. CJ.
LENDEN:
aooeess:
OWNEN BOILOEB OECIAflRTION: I hereby a0irm Ihal I am exempt irom �he Contrac�ors' S�a�e License �aw tor the tollowing reason
(Section 7Q31.5 Business an� Pmlessional CqOe'. Any city oi couniy which reQuires a permil �o consimc6 aller, impmve, demolish, or
repair any simcture, prior lo its issuance, also reQuires �he applicant far sucM1 permi� b �ile a signetl s�atemen� Iha� helihe is licensetl
pursuanitolhe provisans olNe Contraclois' Siate License Law�Chapter9(cammencing wi�h Section 7W0) o��ivision 3 oi�he Business
antl Pmlessions CoOe� or Ihal �e/she is exempt Ihere�mm anOl�e basis for the allegetl exemption. Any violation o1 Sectian 703t5 by
any applicanl �or a permi� sublecls Ihe applicant lo a civil penalry oi not more ��an �ive huntlrea tlollars ($5�0�.
I. as owner oi Ne pm0e�y or my employees wiih wages as t�eir sole compensa�ion, will Do Ihe woB, antl the
❑ s�mc�ure is not iniendee or o��eretl �ar sale (Seclion 7044. Business antl Pmlessional Code: The Conirac�ors' S�ate License Law
tloes noi apply �o an owner of a pmpetly who builds or improves t�ereon, antl who tloes such work himselllhersell or Ihwug�
his or her own employees, pmviOeA ��at such impmvements are no� intenUed or offeretl �or sale. II, however Ihe building or
impwvement is sold wilhin ane year o� compleiion. �he owner will have �he burtlen ol pmving he/she did nol builtl or improve
for Ihe purpose ol sale�. .
I, as owner oi lhe Omperty, am e�cWsively canVading with bcensed contracmrs �o cons�md �he pmlec� (Sec�ion 704a, Business
❑ and Profe55ions Code: The CanVaciors' State License law does nm apply Io an owner of pwOeM who builas or impmves �hereon
antl wha conlracis tor suc� pmlects wit� a conirac�or�s�license pur5uani �o t�e CONrador5' $late License Law�. I am aware
Ihat proo� o� Iheir Workefs Campensa�ion insurance shoultl �e pmvided lo me.
� I am exempl un0er Section: B. 8 P. C.
I lor Inis reasan:
Oaie'. Owner.
I Oo �ereby certify ��al l am aware ol an� untlerslantl Ihe reQuiremenls o� Calilomia Heallh anA Safery Gotle Sections 25505, 25533, anA
2559a an0 I�at I or anyfuture bulltlmg occupantwilllwillnoi (clrcle one� neetl Io comply wi�h said s�ate codes andlhe requiremenls fora
peimii for conslmclion or moeJication Imm Ihe Au Oualiry Managemenl DiSUict. Fesitlential mns�mc�ion applicalions are exempt imm
Ihese pravisions.
Oale: ApPlicani:
I here�y cetlify Ihai I have reatl Ihis aOPlicatlon ana state ihatihe a
ordinances and nate laws relaiing Io �uiltling conslmc�ion an0 �ereby
prope/riy �IoiinspeC�ion purpo5¢S.
Dale: / ��� �� Signalur .
Dd�er's ucense or Socia� Securiry v:
ta comply wi�h a0 ciry antl counry
�a enteru0on�he a�ove�mentioneU
t64t�46 White—Builtling: Green—Cotle Enlarcemem: Ganary—Applicant; Pink—Revenue: Goldenmtl—Assessor
CITY OF COSTA MESA — BUZLDING PERMIT
PERMIT NO: 8 064020 PLAN CHECK NO: N
PERM NO: B 064020
GOVT: N SUPP: N
CONSTRUCTION TYPE: �� PERMIT TYPE; STR PURPOSE: OTH
JOB DESCRIPTION : T/OFF, �A3fi S REROOF W/COMP SHINGLES SQ FT: 8,645
CLAIM VALUE: 8,645.00 CALC—VALUE: 8,645.00 GROUP OCC; R-1 /
COMMENTS: REROOF W/COMP SAINGLES, INCLUDED 603-605 LAKVIEW LN
*�r�r****�w****�r�****�r�*�****�*******�r*****��r*****rrr*r�**�**�**�c�*�r*�+r+r***�**��**
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
----------- MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAA: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING RE � PROV; PARCEL: 93405026 ZNE: REF NO;
PLANNING N 'fES>
a4Kif M if it if iF it it ik M if it if ik k k if %!f M if ff if if i! iF iF iF if iF ik if 1f iE 1k 1E f! it fF it 1f if 1F if 1f M it If M 1F M if iF iF iF if iE 41f /f!f K K M%M!F ff 1t K if M If IE i! M M
D E V S 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 APPROVEU BY DATE:
BUILDING APPROVEU BY : DATE:
APPLICATION ISSUED BY: DATE:�''/ � 3
MitiFiFifklFifiFiEMifiElfififiElfklfiF% lfif%1FfEiF%ifikM 1fiF
if iF if it iF it M if ff if 1E if it if if %if k ff fF if it M ft it ff ih if if if it fF %if iF if it iFlF k 1F M if if f! ik M 1t M!f k if if 1k k M if M if k if iE 1t if it ik iF M%1t if if %if it 1t it 1f iF
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL•SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 108.00 8�6
PLAN
ISSUE FEE
SMIP/NON—RES
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL pAID DUE
TOTALS----> 108.86 0.00 0,00 108.86 108.86 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 108,86 OVER/SHORT: 00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
108.00 ,86
ih iF if k fF iF iF'k!f it k ik it M 1F ik ff iF iFlf ih if 1F if iF ik i! if iF if ik it it iF it if iF 1FlF 1f 14 if 1t it if 41f ftM M1f M ft k if it iF 4!F fE if k 1t ik ik 7k iF 1F 1k ik 1f 1f 1FlF it 1! 1E 1t if
I N D I V I D U A L E E E H R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 8645 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 8,645,00
END OF FEES
s������� ������c�W�R
REQUIRED
Y
01, OOt4749?—Cit]14'<SS T u T 308.35
DpiEz 09/23/9"o TT.ME: II:S��
�f
•� t
r CONSTRUCTION AND P1.ANNING POt�� $ SPA Ji
APPROVALS Permit # Date Inspecior APPROVALS Permit # t Date tnspecmr I
�
, 1. Temporary Electrwal Serv;ge or Po�.:�; 52. Pool & Equipment Locat�on
.2�$t�il Pipe-Undr�rnd-� s � _,�p 53. Steei Reinforcement , �
�- m±.;
'�+-�:-Electrical Cond'ufNGtihty-Unc{rgrna^� , 54. Form:: �
_. ,_
-"=��E�yctricai ConduY�t�ndrgrnd. , �,�'� , 55. Electricat Bood:ng ( I �
.-- ,. .. `-i
C.,n:-; teel Reinforcftner,r .- -y>.: 56. Rough Piumb.ng & Pressure Test ,� �
S3K ' '•• a: �,.._
t� �� Electrical UFF�G��d �� 57. APPROVAL Tp CCIVER�GI',.'iTE 'z �
. . •� ��
-�g�oot�ngs ��y; _ � . 58. EleciricalCond�ii�Und��md. � �� i
_�" � ` -
_�,8. FountlaUon SH ' , 59. Gas P,pe, �� Undre�r��,7., Test � �
�?.l. Water Pipe�Un�,grnd. 60. Backwash Lnes, RTrap, -'� l.'ndrg�nd. �
� _� � 1
`�. Structura� Flo� SysYem '� , 67. APPftOVAL TO CEGK _i
L�. PropertySewe��ir�&�Ho�useCor��etion 62. Backc.a>h& Recepto-�Fi�iai '
72. Sewer Cap � ', c, � �-�
63. Heater & Vent�F,nal
:n a � J
13. Roof Oraim �;;; , 64. Pl�mbinq SYstem - F�nal �
74. Rough PlumbiFg ✓ 65. Electrical�Fina� ',
15. Rough Eleccri�i-Conduft � � -~
,� 66. olar System-�:n�l .
16. Rough Eleciri�.`?/Uiring � 67. Fencing & Access Appro:ai �J�
=>77. Rough Winng 3iyn 68. APPRdVED FOfl PLASTEflWG �
...,
•_� -_
78. Rough Eleciric�i-T Bar Ceil�ng 69. POOUSPA SYSTE"ii5 FINAL
79�Rou h Hea2ing &_ Air Conditian�ng FI,RTE C�-P�T. �,[QUIREMEN7 :��� I �
�� J � i f! 1 b'_=�„ J : :,. L l'zy_a r. r -. .
�. _ �-� .
20�yRo�h �:tt TY ���.P!ace � S[^ . S z 5 �. •`•, r i �"�PP� Vlty~'e y,.J,� `�Pe ��it fi r �.. "� I
J r-� r-cc-al?_
... _. -�� . �,:-� i : '7�i''c�.-L � �7= ^�.-i�i � .
2YrDu"or.,s,ik�St:llctdFir`. !.... -+-= j. S c� *+ � S r. .
� '70. �'ihder��"�}`c� H�,_;ro
:�7 .� 1 .S H { t � i-! :1 � 7 �. ' �t � "
22 -0u''s, l+�'nif �Ciri- � '» * S •-: i .. '" -n � t -
r3 � ps» � c, .r •� �c; i;� f•. .t t..77. Produc��iny l��is CDOiI
' r�.y_..�-. ,F .�,.. '4-t-(---�j:-. . =' � . ...D-:. - �
23.•Gas-!'ipe.RoUgh&'ies[ . m� x� [�t c�:; J= t f 72, Under�rovh:3 FIg54.<� ` �-' ��'
> > iy"m rr(' s- -t• ._.:e .: (l - Z A_2+ 4 - --
24:�floof Fr�ning ;x � `�'�" ..` # '' � �'`-,.,; ' �':73yUndernrn'c�. Stor�y�L�nk i ! Gas ;; �il �
TS_-*3.'--9_--..,i 'R- J-^" - � c�....-y._-.uc_.�� - ..
25. Ro� St:?athing �t �., . /( '+� 74�W�erhead Nydre=' �
.. ��Q3 =' _�. x �.-, , _ �-_
26.`T-��?r Ceilin9 (St: aturali &',�;.3coat .. y �J �� r t 75^ -� .:._i �i -^ -
.a. .sU 4 3 J, x s�Y Che��+C�' c�J �: t7
. ♦ � x ^' ��„_�'1 `L��":r_F'S"iT"3:. - _ _ -
27�:Frame �tad Ffashing .�,u;.'r +�. � ?� c;.� 76. Dry Stanr�?;ic FT �+' '' .
',_� - .!� �-� i7.C.-c, z i.: aa_r.� '' --
^28. Lathin i il1 � '✓] ^'a�.7: r Y. � • ••i .K rn �iy -,< Y .
S;�tS�.d �r h.,^:. Ci r � .t � 77.=� FIXED r1'�E17:sFylf�Alxti �-i
� �-L-�'�.. � _-"
y29.� Insu�atio � .3F� ".... �. "' � _y 7E�FIREPREV,FINf��� �`= �. �' .
,_ ...,��. �.. : .: � .. -� ., + - - -- �
'Y30. Drywaii•}:aiing �' ` � j y �J �1LTMt EPT'�fi�Qt71R�iViENT . '
_ � �-, � r E-, � � • S � _. . p . ,
•� �:�--�- , �- ., -�+-� - r -r-c-�- - - - �
ci37. Plasier �.Y,o�^P Cc.^.tt S � P•:' * i I +• 79. FINAL i^'.:s,?'�CTi�iv t �
�a f._s_� �� +-:-�� 1-�� m o-_ti_-- �.= � �
"32�='Eiectnco P�er4;�fit^.G.nai� + c� I 1 >• n t*; � G .�i �--- -
;.�, ,y q;�� � .V � � ;t. ��l �d0�.;F00D CEFTiF,.��A�" i5$�D,i a;
�_: 7T ,v • i i ^' Y ;r. -T5"V" [�-C�:_.-.C-.,..�`-.__X_' _-�; •'"- ____�
�33Sr�rt� ElectriL• ••* t*1 I �1' * i �r r. Ildil;s: -1 '7['1 +�'-7 O NC7 � - �
�i"i- Si-� .�.� a' I-i-i.,.a C � �"'--:q<> ' '-I.i-- -.=.�- �
�,34��ir5r HE`jt�niv& k,�1 �f,,oCu�tidniFg� C` F t' %' �c s ,y�:c r. _' �C+ �,
1'� .� � }` .� 14 i'� {(��.Y /�� *
`' �r:5�..1i'������ i 1 • � \ i� 1��,_���s���--��
� 35�-. in� G�: Pip_•T�oC. f,• .. r r+ i 1 x w0 -7-+ r r.�
a�:-.--.� --r-;.,t�_.r- i -C�l-•-�+t� ` y__-_c:�_-_'_.___ _i
:•36, Hoi,�� or CanoPY�" � � ;*'7 °� * C', � '1, t : �' io x �_�-
'1 - � t '1 � S,,r, !� + _I fi x j . 7 'c `> a t+; '-7. 7
_'V `��-"D':'��TS'C^ h x�; ; i I_ T�-Ci- _.fi.__-,_-T,__.._. _- __ _ �
�-�37..�ina. Faatory Ficep3acr� � r�- . a
_ - u...--a.� � - "_L�-- _'�_Y_ c••------ . �
"38. Finx,l Pl�mbing ��v ^�;u `" •• p < � � � a S •-� * .� :7
t^ _ :0 ':.-K:1 1 :.t { [,, Y H �--�'S Y v;
� ° C'• I � x i �*-� . i �,=�8�-_Q_ _1
39. 4Va%�r Ss;,v�ce;Fi�I� � i � .; .� • i cr �. -� -r, : •
e�--s�---n • cn 1 � � i-,c�_._r.-n-.�a7 _- '
t�a0. Gas Serv_ce-F.inat^ �'t �:�'r� x;:? I x pw �ntu x --I
i. ; . �a �l t� l^ a. � �i k F. . �r� T Y�S
�;41. Soiar Dc...�nes�c-"� ,�1" `. .. ' . '.-x :.�=�-�- -
+'�� � � . � � j,; _ , � -� .o ., T r,
-�^ ey--rt : ?' . �?- -- :' �' r c_
� 42 Backfloiw PrevenIDr :� + I � � a� ,r, •�;-� • :, p ,-, !
-� - ��y +� - s � - .�Q� Y c. .
f .� ' , �f A Cl'.C''Z-�`_ _
43. Backflow Ir;;jaYieiit r s, s a a t ;i •
- � :�' - - -t_� � -
?R4. t_andsca�elFriqati6hSysterr•��n,;� a r;:t r " r.+t � ' N -- ;r,(;� 't �u � �
... _ • -..L`��i 6? . ,.. �:: Qs ? '-, E �D ��C`. fi =� �
^ �-n:F t�' a �. �-. ��� a� ti �-. c^c.i r.- a --�
�45.,Sound Q.tte�atioi} :� .... r •r, m m+ r c c: .=-� �
� -- ' .-fy-'• ' - ' -- - - �
,�46.•HandicaPRegalatic.'�ns �+ ^ � ..-..''� '" `- - � 5 �
�. v - � yi e . _,;ro0 �, ,
.�7���If�.ALSTF`yiCTU�iE&BUILDING. yf / �� : " : .. fI
� • c^ .
48.77ttYA�PLANNWO i�I�, ,: o; � '� . k; ;,j :'-: � a� I
M �i`: ,:� - . .
�49��IeC�ric.�hel�seto��:dison � ;, i. � � : ' .. I
� � � � -
� � `. � �:
�'SO,:Y.ias�Rel2ase to Sou!hern Califio�tr'a Gas Co ' � � a:- --� c� �:.�n7 r 7 •
. �r - o ;; i tU �
�5}, C£itiIFICATE0Fi0CCUPANCY ' ' *�' �� ��-' `�---^ � �j
No. Data �
Fjuuo�/Y/.#7
� .• =i. 1 �
' � V-
2 .
a cWj
�- Z
ZQ
O v~i
d m
J �
J U1
Q W
m J
m
J Q
U N
Za
W ¢
aW
W Z
J �
m Z
J �
W W
o=
z F-
w�
N �
�O
F
z
a
U
J
a
a
Q
�
r
N
Z
O
H
U
�
�
F
y
z
OWNER HELTZER ENTERPRISES-BROOK
MAIL
ADDRESS 740 N. La Brea Avenue
cirv Los Angeles, CA 90038 NOL 9
CONSTRUCTION United California Bank
AIf1LQ
BRANCH Main riranch
nooaess FOl1 c_ S=,-;„�cr �L.A. S
ARCHITECT Fields & Silverman TEL.
OR ENGINEER NO
nooaess113 N. San Vicente, Bevei
coHrRacroR George J. He2tzer
ADDRESS 740 N. La Brea Avenue
;:5� i a-7�;P"�° 105.49
r i 00 523 } +� � *
:NT
!s
APPLICATION FOR BUILDING PERMIT
R O TE EC V DATEISSUED
PER
.EW A.P.NO. �O3-� " . .
BUILDING
ADDRESS I � —�j
—z1J1 TRACI�'JZi LOT BLOCK
D P
OWNER
�"�$ a,�`��r
-0160 �
FIRE
H111S ZONE TVPE GROUP
APPROVED
CITV Los Angeles, CA 90038 No�� 937-21
LIC No. 3144 LICyNO.
51 Z E I NO. OF BLOGS.
OF LOT NOW ON LOT NO
VSE OF
E%ISTING BLDG.
SIZE OF NO.OF Z
NEW BLOG. ROOMS STORIES
EMERIOR WALL ROOF
COVERING Plaster COVERING Wood
USE OF BUILDING AND WORK TO BE PERFORMED
Resid tial
� C/!L✓!J`S . .u' ,flU
��C NO.OF USE OF NEW ;
� PLANS Z BUILOING
VARDSAPPROVED VARDSAPP
MAIN BUILDING ACCESSORV
DI5TANCE BET,
MAIN 8LOG5.
VAR. �W
C.U.P. qW� — ���
APPROVED
I hereby ecknowledge that I hava reatl this application antl state
ihat Ne ebova intormetion is correct antl agree to comply with
all laws ragulating builtlin8 �onstruction, antl I shall not amploy
any person in violation of the workmen's compensation lews of
the Stata of Calitornia.
I hereby certify that I am properly licensed as a cootractor untler �$Q. FL
the Scate ot Calitornin Business end Professions Code, Divisicn 3, THE AMOUNT SI
Chapter 9, antl that such licenses are in full torce antl effact, or I THE PVFPpSE OF
am ezampt trom the pr Is'ons of the Stete of Calitornia Businecs VALUATION
antl Professions Cotle, i i on 3, Chapter 9.
SiO�ature of (/ �
Permktee $ %1 �,ODD "
U
Aut�orizatl ABent
FT.
J
DATE (�_����
APPROVED O
Tq)(
Q �
9 VALUATION IS FOR
i A PERMIT FEE ONLV:
E
`o
LL