HomeMy WebLinkAbout617 LAKEVIEW LN - Building Permits�
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PflOJECT AOOflE55: 6 S 7 LAKEVI EW LN
OWNEpO flESS: PASCO MANAGEMENT CO�
P.O,HOX 2966 1
COSTA MESA, CA 92628
AHCHIENGINEEfl: 6 4 1— 0 5 9 3
aooAess:
flEG.NO.:
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UNIT: ��
uwT:
PEPMITTEE: ORION CONSTRUCTION ( 714 ) 363-0727 �i
nooeess: Zg OAStCLIFF DR
LILENSEO CONTpACTOP o�cuAniioN: N I GU�Em ina� � am �icensee urwer prmwa�ns���bap�r 9(cammencinp wi�� Section
7000� oi Division 3 0l ��e Business ana Pm�ess�ons Co�tle. an0 my license is �n lull lorce an0 ellecl.
ciTr uc.: 0 4 10 srare uc.: 4 S S 4 5 9�- �u55' H��y�
�aie: � Signaiure: /����•s� - - --
WOHHEBS' OMPEN RTIONOECIABATION: I�ereCyall twveacenificateal�nsentla�n5urearacertilicateofWorkers'
CAmoenulion Insurance. or a mrtilie0 wpy t�ereol I�c 380U. LdE. q.
Poucrxo.: 046-93UNIT03554 E%P.DRTE: OSIOLI94
•omraxr: STATE FUN�
� Certilie0 mpy is �ere0y fumisAed. Cerlifie0 wpy B/iIN wiN t�e dty BuiWinq Di '�
Da�e:._lLl. 7'�' APVlkant: � �.
EXEMPfIONFXOM WOH ENS'�OELUN�TION: secipn neeE mt Oe mmpki i� Ne pcml ¢ are �unCreO (5100) a leu�.
I t¢rii�y IIWI in Ihe performarrce 0� Itle w0A lot wNth iks p¢rmit i5 icv�eG. I LWI n0i Cmp�ay any person in y manner so a5 io �ecome
subject Io ine workers' CAmoe�sation Laws of Calilomia.
oale: SipnaWre:
xonce: u. aner �wny mrs aecw�arw, rou snome oecome swcen m me wwkers Compemation DrOvisions ol Ihe Lahor
COEe. you musl IOrthwifll comDN �^�� SUCh prov5i0n5 or I!>5 pGrmi SIWII be OL¢me0 revOk¢G.
CONSTflUCTION LEx01NG �GENCY: I here�y aflirm inat Ihe2 is a COnstmction IenEolg agenty lor Itre pehormance ot tAe vrork for
w�it� I�iS Dl�mi� i5 i55uM (5¢Ciion �497, Gv. C�.
LENOEN:
ROOflESS:
OWNEB BUILOEP OECLAMTION: I nem0y allirm Ilut 1 am eKemp� Imm tAe Canvactars' SUte lkerae Law lor the IOlbwinA �eamn
�Section 709L5 Business anJ Prolessional CWe: My dty al counry whic� reQuira a permii �o comiruct. alter, improve, OemolisR or
re0aii any siructure. p�io� lo its iSSuance, al5o repuires t�e applipnt for suctl permil to lile a siAneO sWtemenl tliai �U5t1e 6 licenud
pursuam to ine Orovisions ol ine Comractors' State Lkense Law (CluOter 91�mmendnp witn Section 7000) al ONision 3 0l Ine Buvness
an0 Piolessions Coae) ar I�al tM/s�e is exemD� ��e�etrom an0 t�e EasS lor I�e alleOeA eaempiion. Any violalion ol Seclion 7031.5 Gy
dny dppllWoi �Ol d pCf11Gi $uGitCtt I�E ippOG�i IO ] GW pCNliy 01 MI IMrE 111d� �Iv! 111111EfEC OW13R ($.)00�.
I, as owner of tice Dropeny ar my emqoyees witn wapes az ineir sde wmpe�ation, witl ao tne work. anE ��e
❑ simcmre is not imenGed or olhrea for sale (SecUon 70aa, Business ana Pmiessional CoAe: IDe Caniractors' State Licensa Law
Eoes nol aoDM �o an Ovmet ol a pwpiny wtn OWOs or imw�'es ��erCM, anA wM a0M suth woA �im5ell/Icersell or Inrouph
Ais Or ber own emDlpyees, proviEeO Ilui Such imD��'em¢nis 2re n01 inl¢ntlea Or 0��¢r¢4 �or sale. II, hOw¢v¢f I�e Ovilainp or
impmvemem is 5oW wit�in one year ol camDletion, t�e owner vM tuve t�e GurEen ol D�0 ��s�e Ei0 not CWPo or improve
�Or Ih¢ Durpose 0� Shce).
I, as owne� ol Ihe pmperty, am eMGusivery coniractinp rritn IiunuO coniractors to consirutl tne project (Section 70a4, Busineu
❑ an0 Prolessians CaOe: Tho Cootrxtors' State Lite�Se Law Gce5 nOt aDON �o an wmer ol D�VeM'�0 Cud05 or ImprOVC51A¢tton
d00 Wh0 COIIIIdCIS IOf SY[11 OfOjtCIS wilA d COIIIIdCI0l�5) IICEf15! pUfSUdIII 10 111! LOOIIdC�0�5 61ate Liwnse Law). I am aware
inai O�ool ol t�eir Worker's Campensation insurance shoNO Oe provi0e0 to me.
�� 1 am e�empt uMer Seciion: B. 8 P. C.
I br Inis rea5on:
Dale: Pmer.
I eo hereGy cenily Ihat 1 am awart ol an0 uMerslana ine repuiremm6 of Cdlibmu Mplih an0 Salety CoAe SettPons 25505, 25539, an0
2557a antlt�at I or any lulure �uilEing o[cupan�wilVvrillnol (cirUe on¢) ne¢dlo camply wilh SaiG state wtles antlthe reQuiremenis lora
permil loi cans�mtlion or moEtl¢alion Imm I�e Air Ouahiy Manapemeni USMci. NesiOeniul constru[tion appliaiions are exempt imm
Ihese D�ovisions.
Date: pODlicanl:
I hereDy certily I�al I �ave reae Ihis ap0�icaGon an0 slate tlut t�e above inlormation 6 correCt. I agree to compty wii� ail Gty antl county
ortlinances an0 statelaw5relatinglo �uildinp cons�mction anG �ereEy aW�orrzerep�esen�alivesolt0is cityio¢n�eruponille a�ove-menlionetl
O�oOe��Y �or inspe lian pur0o5¢5. /y ��
Or �cr/ �
Oa�e: o SiAnawre: N��✓"^—
Oriver's License or Social Secmity M: ��-� � �
�6Ab<6 Whne—Bulltling; Grom—CODa EnbrcomenC Canary—Applicant: Pink—Ravenue; Goldonme—Assessor
CITY OF COSTA MESA – BUILDING PERMIT PERM NO: B 06366
PERMIT NO: B 063662 PLAN CHECK NO: N GOVT: N SUPP; N
CONSTRUCTION TYPE: 5–N PERMIT TYPE: STR PURPOSE: REP
JOB DESCRIPTION ; AEPLACE SIDING NEA#224 UNITS 617 6 619 SQ FT; 4,200
CLAIM VALUE; 4,200,00 CALC–VALUE: 9,200,00 GROUP OCC; R-1 /
COMMENTS; REMOVE SIDING REPLACE W/STUCCO UNIT 621
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Z O N Z N G R E(J U I R E M E N T S
5 E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ• PROV: PARCEL: 93405012 2NE: REF NO;
PLANNING Nt31'ES>
7
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D E V E L O P M E N T S E R V I C E S R E(j U I R E M E N T S
20NING APPROVED BY DATE:
BUILDING APPROVED BY ; DATE:
APPLICATION ISSUED BY• DATE; �i Z� �
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�f if 1f if if �tiF if if iF4 iF iF 1f k iF if it if �F if iE k if if if if k if iF iE iF iF k iF k iF if 1f k 1f k if M 1f M ik 3f 1k 1f M!f it iF ff M if k k �t if ik i! if k iF ik if iF ff k if ff 1f k �t �F iF if
LEGALIZATION:N F E E S U M M A R Y STAUCTURAL SEGMENT;Y
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 72.00 50
' ' . SMIP/NON–RES
PLAN
ISSUE FEE
BUILDING–DIV–> PERMIT ISSUE PLAN–CHECK
TOTALS----> 72,50 0.00 0,00
REVENUE DIVISION TOTALS--> COLLECTED;
BLDG PMT PLUMBING ELECTRIC MECHANIC
72.00
TOTAL PAID DUE
72.50 72,50 .00
72.50 OVER/SHORT: .00
FIRE SMIP/TOO GRADING PLAN–CHECK
kifkifMlkkkM4ifkiFlkMlfiflfk�flFkikkifkifikifiliflFlfMifiFMk�flfifMififiFlElFiFiFMMkifkifiFkiFifkkiFkikiFifklfiFiFkifMififklfiFk
I N D I V I D U A L F E E B 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 4200 ALTER BY VALUE RESIDENTIAL NOZONE 1,00 9,200,00
END OF FEES
s
01 00145734-001457g,�, T C�'Y 72.Sp
DaTE: 0?/26/?3 TIflE: 13:43
CONSTRUCTION AND PLANNING PC & SPA
APPROVALS Permit # Date Inspector APPROVAI.S Permit # Date inspector
1. Temporary Eiectrical ServiCe or Pole 52. Pool & Equipment Location
�
2. Soil Pipe•Undrgrnd. �� ^ 53. Steel Reinforcement
,�3:��EJettrical Conduit UdLty-Undrgmd; 54. Forms
4.�Electrical ConduR�U�drgmd. � 55. Electrital Bonding
S. Stpel Re;^farcement � 56. Rough Plumbing & Pressure Tesi "
�.�� E�eFtncal UFEF�fp�pd. ` 57. APPflOVAL TO COVER•GUNITE .: �
� d. Gaotirgs •� - � - 58. Electrical Conduit-Undrgrnd. �
' 3;� Fo�ndaUon ' ' 59. Gas Pipe, � Undrgrnd., Test '
-�
-.3. Weter Pipe�Undrp:r.d. 60. Backwash Lines, P-Trap, O Undrgmd.
16. Strvctural Ffoor System ` 61. APPROVAL TO DECK
1'. Property Sewer LinQ & Ho�,se ConneCtion 62. Backwash & Recepior•Finai
12. Sewer CaP - . 63. Heater & Vent�Final
13. Roof Drains - 64. Plumbing System � Final
14. Rough Plumbinq 65. Electrical�Final
75. Rough Electrical_Conduit • 66. Solar System-Final
16. Rough Electric Wiring ' 67. Fencing & Access Approval
17. Rough Wiring Sjgn 68. APPROVED FOR PLASTERING
18. Rough ElectriWl•T Bar Ceiling 69. POO VSPA SYSTEMS FINAL
19 Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT
20..Rougt� Fqatory� Fi�Place � cni a�7 n O c, �pw ��' � J'ItiWI � �:: � i- r.•
WPPRONAL-S�: � Perr[rIt # �• n'
.� ' C y. - �-. ��. . ..tr � ti x 7.
21. � uCi?, iq $tr�G�ur��•. �(-(.• HS :u � r '; y c. '� �`7 f M y M
� � t � 0. �dergrouQ,d��}lyry�O
22. bucul Ventilating •a. � nS r. � � s �L� * 77. Producc FiSLfrig Q'6a'3 D Od
23.`Gas�PlPe�tioug &'T�st ' '� i � � •�� • -•., � "�' • r-', '�'
1\ � � .,;ti �,�,t r.� .y �,}. �.�i2. Underground�Flu�tti��. �. ,.i
) e , . . ., .. . . .
24.�800 .Framing•• i r�[ • -�r. - � �_� s Y. .�3.,�lndergmcL:�StorageTartk �Gas ❑Ot['
25. Roo She^athing ' �: v� � � � :�� ^ • , : ,F �: - ,.
�. * a �, � . � �/4.,;F?�verhead Hydro :, �
26.. •BaiiCeiling (StrucWral) & [vtonoeoat . 'n i_ *��n < 75. Drq Chemical � - � � _
27. Frame and Flashing' � ` L '� - �6. �d?� Standpi� e, J'` '~ '��
-� ,,:.-. =•s r m. R -r• i��
' .. . �'I # .�;rt.' � "
�2�8. Lat� Siding � ,. rn • td � ., � (.C'.Q�• � 77. 1FIXED SY-ST.EM'F.I7VAL � �
- - � -
�29. Insulatiort ' � "' ' - , 78„FIRE PREV, fINA� rt _ �
n'i0. Drywall Nailiag �� ��� x� �-� HEALTH QEPT.�FGEQUIRENJENT
'31. Pla:ter B,XQwrUCoat y ` � ,., :� � , �.79.'FINAL INSpECTIQ�I � �-' � �-.',
� Ht M
'�2. rElectrira� Power Meter��inal , > �, { . ,8:0. iF00D CE � IFIQqTE ISSt1E0 � ,/�
33. ninal Electric _ "' � I�lote : '� �,tF/�-/
. . ' , . � . ;. m . ` ,� l,lsu-i-; 61;r; G:4�fv�, ;rhr.i /l �
-�4. �F,inal Heat.ing & A15 Coi4ditiorjin�;� � " S �L7r93 �;�` ' ` �7 ' �
35. Fin�i Ga5 PipO.Test '^ '7 ` ^ �1 �1 . ��
.. x H ^O -• rr
� F
36. �Ioo$or CanoPY � � -• , ,�, ' � � •
. �. (�1 ' ? �. i� J 'r T.
37. Eina�FaGtory Firepfece � � i '� �� - �� ' �
i - � . � �+
�38. Final�Plum6ing `..� �� �� ; � ' � } � : . '
c39. Wate� Service-Finaf � � .. x �'� v•: � r '
o• '�
�0. Gas Service�Final , '= � F _`" . , ' ,
v r r g �t ;r, < � ::�„' 'l:p
41. Solar pomestia-Final •- c � � �- A-z S `- ��
> ' ; n � .� .�
�42. $ackflow Preventer ' 4 � � � ^ `+ '�� �.' ^
. � • .t. _ . r7
43. Backflow Irriyation � ��S : � X � l. o i
44. Landscape Irr.jgatiorj System �`�; r r, L y ` � '_�;, ;�. ' j�
:45. ��$ound Aftenuation r�-- i�' n s ' � - y F�C x^ .
.46. `Handicap.RegulatioAs - �, `� ' - � ! "-� ••'" �
i L.
47. F,INQL STRUCTURE & BU�LDING � � _._.>�; �
48. FINALPLANNING ' " ` " T � "
.� r .
,49..Electric Releaze to Edison � - ; : � � a _ -
.r �.
50. Gas Release ro Soutqem California Gas Co e � s _ "' ; '_
� . r
51. CER IFICATE OF OCCUPANCY' :i: ,; , ;;� ., , f , .
No. Date
PflQIECTROUPESS: 61'� LAKEVIEW LN
OWNEfl'S NFME: �jASCO MANAGEMENT CO
nooRess: P O.HOX 2968
COSTA MESA, CA 92628
AfltH/ENCINEFP: 6 4 1— 0 5 9 3
RODPE55:
AEG.NO.:
UNIT:
uxiT:
PEHMITTEE: ORION CONSTRUCTION ( 714 ) 363-0727
aoosess: Zg OAICCLIFF DR
LAGUNA NIGUEL CA 92677
UCENSEO CONTRACTOB OECIABATION: I hereby aflirm that I am IicenseA under pmvisions ol Chapler 9(commen[ing with $ection
7000) ol �ivision 3 0l I�e Business and Professions CoOe. antl my license is in full torce an0 et�ect.
CITY LIC.: 4 1 0 O STATE LIC.: 4 S S 4 S p�� CLA55' H
-Da�e: � SigreWre: %�'t�'i•—�
WOXKEfl C MPENSpTION �ECLABATION: I hereby a��ir have a certibca�e o onsen� ta SelfAtl ure or a certifica�e ol Workers'
Compensa�ion Insurance, or a cenifieU copy ihereol (Sec�ian 3800. Lab. C). ✓
eoucvNo.: 046-93UNIT03554 E%P.OFTE: OLIOSI94
coMvaxr: STATE FUN�
� Cetlitied copy is �ereby lumished Certifietl copy is �ile0 wi�h ihe ciry Building �ivision.
��
�ale: 3 � pPPlican�:
E%EMPTION FflOM OPKEBS' COMPENSRTION UECIABATION: s seciion need no� be com ete0 il ihe Oe is �or ane hUndretl ($11q) ar less�.
I cenily ihat in I�e Oedormance of �he work for whicA Ihis permi� is issued, I shall no� employ any pers in any manner so as �0 6ecome
subleci Io the Workers' Campensation Laws a� Califomia.
Oate: Signamre'.
NOTICE: II. aller making Ihis Oeclaration, yau s�oultl become sublec� ta the Warkers' ComDensa�ion provisions of lhe labor
CoOe. you mu5i lorl�with compty wilh such provisions or I�is permii shall 6e Oeemetl revoketl.
LONSTPUCTION IENDING AGENCY: I �ere�y affirm that there is a tonsimction IenAinA agency for ihe peAormance of ihe work for
w�ic� Ihis permii is issued (Section 3097. Civ. C�.
LENUEfl:
PODPE55:
. OWNEH BUILDEN OEClAXR710N: I here6y aifirm t�at I am exemPt imm ihe Contractors' State License Law for t�e iollowing reason
�� (Section 703L5 Business and Pmfessional CoOe: Fny ciiy oi coun�y which reQuires a Oermit to consimct, al�er, impmve, demoliSA, o�
repair any stmclure, prior to its issuance, also reQuires �he ap0licani for such permfl �o lile a signetl s�a�emen� iha� helshe is licensetl
pursuanllo �he pmvisions of the Contraclors' State License Law (Chapter 9(commencing wilh Section 7000) of Division 3 oi Ihe Business
and Protessions Code) or �ha� helshe is e�emp� thereiwm antl �he basis �or Ihe alleged exempiion Fny viola�ion ot $ec�ian 703t5 by
any ap0licant tor a permit sublec�s Ihe applicant to a civil penalry o� no� more �han �ive huntlretl tlollars (E500).
I, as owner o� Ihe DmDeMY or my employees vAih wages as ineir sole com0ensation, vnli do t�e work, an0 Ihe
❑ 9mcNre is no1 m�en0ea or offere0 for sale (Section 70aa. Business anU Professional Cotle: T�e Contractors' S�a�e License Law
does noi appty to an owner oi a pmperty who builtls or impmves �hereon. antl w�o tloes such woB himsel�/hersel� or ��mugh
his or her own employees, pmvitle0 Ihat suc� impmvemenis are no� in�entleA or o��eretl for sale. I�, however the 6uiltling or
impmvemenl is solJ vnthin one year ol completion, the owner vnl� have Ihe 6urtlen ol pmving �e/she did no� �uild or impmve
for ihe pmDose af sale). .
I, as owner of Ihe propetly, am exclusively conirac�ing wi�h licensee contracmrs m constmc� �he Dmlect (Sec�ian 7044, Business
❑ antl Pmfessions CoOe: T�e Convactors' State License Law Uoes not apply to an owner oi pmDerty who huilOs or imD�oves thereon
anA who ConVac�S �Or SUCh projetis wi�� a tonVac�or(5) liten5e pursuan� IO Ih¢ ConVattors' Sia�e License law). lam aware
t�at D�oof of roeir Worker's Compensation insurance should be pmvi0ed lo me.
� I am eremp� untler Sec�ian: B. 8 P. C.
for ihis reason:
�a�e'. Owner.
I ao hereby cehily �hat I am aware of ana un0e¢land Ihe requirements of Califomia Heal�h antl Sa�ery Coae Sec�ions 25505, 25533, and
2553A antl Nai I or any iNure Dwltling accupani will/will no� (circle one) neea �a comply wii� said slale co0es antl �he reQuiremenls for a
permil far canslmction or motldica��an Imm ��e Air Oualiry Management DisVicl. Re5i0ential consimclion applica�ions are exempi imm
�hese provisions.
Date: NpPlicanl:
I hereUy cer�ity IAat I have reaU �his apPlicaiion ana slate that the a�ove in�ormaiion is corteci. I agree to comply wi�� all city antl counry
ortlinances antl slalelawsrelalinglo builtling constmction and hereby authanzerepresen�atives ol�his ci�ylo enleruponihe a6ove-men�ione0
pmp¢rry lar inspection purposes /�—� `/'7�7� �
�Oate: a L3 Signaiure� /"Y✓1"^�--� �fA-"*—�-M�1�
�nver's Llcense or Social Security x: *�.� �� � �
164La6 Whi�e-6uil0inq: Green—CoOe EnforcemenC Canary—AoolicanC Pink—Revenue: GOltlenraC—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: H 06379
PERMIT NO: B 063792 PLAN CHECK NO: N GOVT: N SUPP; N
CONSTRUCTION TYPE: S—N PERMIT TYPE: STR PURPOSE: REP
JOB DESCRIPTION ; REPLACE SIDING NER#229 UNITS 610 6 612 SQ FT: 6,200
CLAIM VALUE: 6,200,00 CALC—VALUE: 6,200,00 GROUP OCC; R-1 /
COMMENTS; REMOVE SIDING REPLACE W/STUCCO UNIT 619
�t*****��e***����t�t�r�r***�***�r�rx�*�r�*+r+r+r**�+�**rr�r*�� ��r**�r+�*�r***�r�rx �***�r***�t*******� **
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 REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV: PARCEL: 93905012 ZNE: REF NO:
PLANNING NCSTES>
i
*****����r*�e��e����e****,�*���**+�*x�*+�**�**�e,r�***,�+��r,�,r�**�**��*�r*��*�e�*��;�*��r��**�*�r
D E V E 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; "
HUILDING APPROVED BY :
APPLICATION ISSUED BY:
DATE ;"
r
IE 3Eaf 1E iF �IE iE 1F iF 3f jE iE if iE if 4 i(� 3F iE jf if if iE if if iE *�E �!E 3E iFiF'3F{�iE iE
iEiEiEiEiEiEiEiEiElFiElEiElEiEikkiliElElEitiEiElE�EiFiEiElFifiElEiEi!!ElEiflEiElEiEiE iEifiElEiFaE3E1FiEiE1FiE1EiEiEiEikiEikiFiElEiFlEiEiE3E�f1EiEiE
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 90,00 62
SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECR TOTAL PAID DUE
TOTALS----> 90,62 0.00 0.00 90.62 90.62 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 90.62 OVER/SHORT; ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
90.00 _62
1f if 1f k iE iE iE if 3k iE iE if ik �k �f 1E iE iE iE i! ff it iE 3E iF if if if if 1f if iE �F �E �E if 3E if iE iEiE if if iF il�lEiEiflk if i! 1! 1E iE 1Eif 1E iE if if 1Elf iE if iE iF iE iE iE 7E iE 1E iF iE iE iE k 1F iF
I N D I V I D U A L F E E B R E A R D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 6200 ALTER BY VALUE RESIDENTIAL NOZONE 1,00 6,200.00
END OF FEES
O1 C014b313—D014d319 T�] 7 9d.ti2
DATk: 09lC!,3,�93 TItIE: 09:14
CONSTRUCTION ANp PLANNWG PG & SPA �
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location
2. Soil Pipe�Undrgrnd. � 53. Steel Reinfortement
„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 COVEfi�GUNITE
7. Footings 58. Electrical Cqnduit�Undrgrnd.
S'. Foundetion � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P�Trap, O Undrgrnd.
70. Structural Floor System , 61. APPROVA� TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor�Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Piumbing System - Final
14. Rough Plumbing 65. Electrical-Finai
15. Rough Electrica6Conduit 66. Solar System-Final
16. Fiough Etectric Wiring 67. Fencing & Access App�oval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
78. Rough Electrical�T Ba� Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
� ,
20. Rough Factory Fireplace i�. � r��� � ' - APPROVA�LS�- ��Permit# ��'
i - i *
21. •Ducis, in Structure;` � F , ` � �" � l � �
� . . �: � i ::. ,. 70. Undergrciund }iYdro -
22.�Ducts,Venti�ating � � �� �� �t - �y�, producLPipirlgO�ias ❑Oil
23. `Gas�Pipe-Rou h &'Tes� ' � �
„ 9 � x �� , .. i72. Under9round,Flush�;i, ,
. . ,, i �
24.iRoof Framing• . � � i r� •�t *-• � V3.� Undergmd?StorageTank OGas ❑Oil
25. RoofSheathing � '" ' �-' " '.7q..Overhead Hydro �
26. T�Bar. Ceiling iStructu�al) & Monocoat - - 75. �Dry Chemical -- ��
27.�Frameand Plashing , � , 76. DryStandpipe � � '
i28.'Lattiing&Siding �� � �. -• 77,�,'FIXEDSYSTEM�FINAL �
29. Insulation ' " ' � � I. _ 78„FIRE PREV. FIf�AL � - �
i:30. Drywall Nailing � � I � � HEALTH DEPT: REQUfREMENT
'�37. Plaster Brown Coat ,� � j ' 79.' FINAL INSPECTION ' ,,
i32.�Electrical Power MeterFinal ��� � � � 80.. FOOD CERT CATE ISSUED
33. Finai Electric' • r ' ' � Notes: �' �� � ' , ,
34., Final Heating & Air.Conditioning . . ' �, � , ' � } ,
35. Finai Gas Pipe-TesT � , � � � ' :, � ' . �
36. Hood or CanoPY , . - � � � F r � .
i -
�37. Final�FactoryFireplaCe � � I i � �'
�
38. Final Plum6ing .� . � I . . -
i39. Watec Service�Final i I ' . . , " ' �
'40. Gas Service-Final . � . I � _ . �
41. Solar pomesticFinal �
Y
42. 8ackflow Preventer ' - � � . �
I I I•
43. Backflow Irrigation ' • ' -
a
:44. Landscape Irripation System ' . ., • - ', r � . , .
45. �ound Attenuation ' � • �
� 'r�
46. Handicap Regulations .� / _ L _ I ... ..-
47. FINALSTRUCTUR�&BUILDING J//:2y/O� ' •
! /�
48. FtNALPLANNWG , �
:49. Electric Release to Edison � � � ��
50. Gas Release to Southern California Gas Co � -
51. CERTIFICATE OP OCCUPANCY , . ,
No. Date
�
acc�i oosess: 617 LAKEVIEW LN
OWNEP'SNAME:HROOKVIEW CONDOS CONDOS
AOONESS:(73O PAULARINO
CM., CA.,
APCHIENGINEEfl:
ROOFlESS:
flEG.NO.:
UNIT:
UNIT:
PEflMITTEE:MESA ROOFING CORPORATION (714)548-3012
aooncss: gq3 W. 17TH ST
COSTA MESA CA 92627
LILENSEU CONTBACTOB DECLIBATION: I hereEy aliirm ��a� I am licensed u ' Chapler 9(cammencing wi�� Secfion
7000� ol Oivsion 3 of IOe Business ana Pmtessions CaOe. an is m lull laae an0 e ec .
QTY UC.: ^�J� STATE U4�j 6 4� CIAr . —
Daie: _ � Signapu . — ¢g
WOflNEBS'COMPENSATIONDECLINATION: 1�ere�y irmihatlhave ¢ateofconsemtoselbinsureoracenifiwteaiworkers'
Compensa�iorLnSyrbn�.pr1ape�I��o,Qy tnereof (Sectian 3800. La� Cj�
i POLICV NO.:YWI. 9 b V E%P. OATE: O/ I O S � 9 4
comvaxr:GOLDEN EAGLE
� C¢riiliea copy is herehy Wmis�etl. � Cehilietl cop '' i IAe ciiy Builtlin rvi
IOate: /' � J / � qppli�L �—��i /�
E%EMPTION FflOM WOPREBS' COMPENSATION OECUflATIOtI (ihi55ec�eA noI De campletetl iI lAe permil i5lorone hunGreO (511p) or less�.
I cen0y tnal in Ihe Detlo�mance ot I�e work tor whic� I�is permi� is issued. I s�all not employ any DQ«n in any manner so as Io �ecome
subje[I la I�e Worker5' Compensatinn Laws ol Cablomia.
Oare: Signaiure:
NOTILE: II, ailer making t�is Jeclaration, you S�oWC become SUUlect �o Ihe WOBers' ComDenSaiion O�a�isions ol ��e LaUor
Cade. you mUSi lort�wil� comDly wii� sut� Omvisions ar IhiS Dermi� Shall be aeemeU revoketl.
CONSTflOLTION LENOING PGENCY: I hereGy aflirm Itwi t�ere iS a canstmc�ion IenGing ap¢ncy for ihe p¢tlormance ol Ille wark lor
whic� ��is De�mi� is issuea �Seciion 3097. Civ. C�.
LENOEfl:
R�OHESS:
OWNEN BUILOEH UECUHATION: I �ert0y a��itm Itu� I am exemp� Irom l�e CAntratlar5' State License Law for the lollowinp reason
(Section 7Q3L5 Business an� Pml¢ssional CoOe: Any ciiy of wunry whic� repuires a permil Io con5imcl, alter, improve. Aemoli50. or
reoair any slmcture. prior lo Rs issuance, also requires ine apolicanl lor sucn permit ta file a signea statemenl lnat he/sne is licensea
pur5uani lo Ihe O�ovisions ol lhe Conlratlors' Staie Licenre law (C�aO�er 9(commencing vnih Sec�ion 7000) o� Oivision 3 oi Ihe Business
antl Pro�esvons fAde) or t�al ne/sne is enemo� iherefmm antl t�e Easo lor I�e allegetl exemption. Pny violation ol Section 7031.5 Dy
any applicanl for a permit sublecis Ih¢ appliwni Io a ciWl p¢nalty al noi rtwre I�an INe �unGred Uollars (5500).
I, as owner ol Ine pmpeny or rtry employees wil� wages as �Aeir 5ole compensation, will Ga Ihe work, an0 Ihe
❑ slmclure is noi inieneed oi o��ered for sale (Seclion 70aa. Business antl Pro�essional Code: The ConlracmrY Slale License Law
Ooes noI apply to an ownei ol a pmpe�y who builGs or imOroves lhereon, anG wAo Ooes such work �imseli/hersell or thmugh
�is ar hei awn employe¢5. pwvitled Ihai Sut� impmv¢meni5 are noi inlenE¢G Or oif¢reU lOr uie. II, however I�e Ouil�ing or
imo�ovemen� is sald wii�in one year of com0letion, ihe owner vrill �ave ��e GurGen oi Dwving �e/she GiG no� �uild or im0��'e
foi ine purpose ol salel.
I, as owne� ol Ihe pmpetly, am exclusively contraciing wiih licensetl conVanors to conslmn �he pmlec� (Seclion 70C4, Business
❑ and Professions CoEe: The Contrac�ors' State License Law Ooes nat app1Y �o an owner of pmpeny who �mlds o� improves Ihereon
antl who coniracis lor suc� pmlecis vnl� a conVactoqs�license Dursuant to t�¢ Coniractors' Slaie Lit¢n5e Law�. I am awar¢
I�a� pmol ol I�eir Wo�ker'S Compensalian insurance s�oultl �e Omvitled lo me.
� I am exemp� under Seciion: B. 8 P. C.
for �Ais reason:
Date: Q�vner.
I Oo hereGy cetlify Ihal I am aware ol ana unAerslana ��e requiremenls ol Calilomia Healt� anA Safely Code Seclions 255U5. 25533, antl
2553A and iha� I ar any IUWre buildinp occupan� willlwill nol (circle one) need to comply wi�� saia Slaie co0e5 an0lhe reQuiremenis lor a
permii for canstmclion or motlificaiion Imm �he Air Ouali�y Managemeni Di5lricL Resitlential canslmc�ion apDlications are eKemp� Imm
IhQSP O�Ovi5i0�5.
Da�e'. ApPlicanC
I hereby cerlity�hai I �ave rea01hi5 apPlication anA sla�e Ihat��e above
ortlinances an0 statelaws rela�ing�o builtling consimclion and
o�operlV lorinsoec�ion purooses.
oate'. ���� Signat —
I agree lo complY wi�� all cily antl coun�y
Wit ciry to en�et upon Ihe above�menlione0
�river's License oi Socia� Sewrity a:
164La6 White-0uil0ing: Green—Cotle Enlo¢emen�: Canary—App�ican�t Pink—Ravenue; CaolCanraC—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 064022
PERMIT NO: B 064022 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: �� PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : T/OFF,-sii�I 6 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 SHINGLES, INCLUDED 619-621-623 LAKVIEW LN
*�r******r**+c*�r*�r**+t****w*�r***+t�r****+t�r��*+r*it*rir**�*rr***�rx�+t**********+tr*�c�+t*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 HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN ERNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT: ET IN RGHT: FT IN
PAAKING REQ• PROV; PARCEL: 93405012 ZNE: REF NO:
PLANNING NdTES>
i
�titr****��tr�trr�rxrfr�x��r�r**wr*it*i�itx*ie�r*�efr*x*+r+rwr******x�*«*+r�r*�e�e+t+t**r*�r�r*+r*�irx+ritr�r
D E V E L O P M E N T S E R V I C E S A E Q U I R E M E N T,S
ZONING APPROVED BY .
BUILDING APPROVED BY :
APPLICATION ISSUED BY;
ff ff if 1f ff M ik M M 1f M M M!t!t * M iF M!t!! ft
kMMMffMfflFffMMifMMltMffMMffMMfflfMlkMMklflfltffMkk4lFiflFffltlFMlfffllkMifiFfFIF
LEGALI2ATION:N F E E S U M H A R Y
BLDG PNT PLUMBING ELECTRIC MECHANIC
PERMIT 108.00
DATE:
DATE ;�
DATE:
M k if f1lk if k 1f 1f 1f 1f /f 1F M iF 1tiF M M� if 1t 1f M k
STRUCTURAL SEGMENT:Y
FIRE SMIP/RES GRADING
86
SMIP/NON—RES
PLAN
ISSUE FEE
HUILDING—DIV—> PERMIT ZSSUE 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 PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
108,00 ,86
M1tiFkitikMkiFifitlkifMlfltiFikifMlfkMMlkMMlFifkllftfFMMiflfiEiEMitiFitMMiFlFiFlflfkiFMMkifltMffMikMMMiEMIkMitiFft7FffMM%iFiflf
I N D I V Z D U A L F E E B 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
snnoK� a����CTOR
REQUIRED
�Ji 00:47k98-00147499 T O T
`vATE: Ui/2�/93 T1IiE: 11�46
�CONSTRUCTION ANO PLANNING
APPROVALS Permit �
� -
7. Temporary Elecvical Serv.�e or Poie;�,;
r "�
.�,_SQilPipe-Undr�rnd. ,`_� '��?
S,-'_ iv �'r-�-^_.,='rl-'
i� �Electrcal Con�'a?�aiihty�Undrgmct:'�
_ �' .:y._-__.
� �`,�I�ctricai Cond��'-�idry�nd. � ry�
-=?��� ., � -`'i"J-_
q;7. Sbsel Reintorc@�crh :� y;.
.:'? � V -� .-
;r..��E!ectricat UGEF.4`�,frd a
,��.�Foot�ngs ' ----T'-�-
r-- 4 i.. '
,y�. Fou�dat�on �r
tq^. V:ater Pipe�Un �grnd.
-, C' �3
�. St�ucturai Plo�ji System �
" i '
'tU. Prape ty Sev�eT:Lirj: R Ha�se CarrEction
:.. -,��"'--
12. Sewer Cap �, :� .�
J
13. Root Dra�ns _ �
- --"c-%o
14. Raugh PlumGirig
75. Rough Electri�i•Condurt �
16. Rough Elect���Niring
I
17. Ro�gilV�.nng�lgn
�---
18. Rougt Elee[rir,y6T Bar CeiLr.q
19. Ra�v� lieatir.q & A�r Cor.d�t o^
22SDu�'(s. '1=int�:tir�.{ r , '" :
r-¢, �.
23�GarPipt,4ca"]'Jh&�es; -=�S
S t ^ r_ �.0
24'tflG� Ff�min'g my ' �'F, .. j
--ti
'I Z5. Rea! 515:a�;-L thin3 J* -�Z �
�, m ��i .�
26�`?�U�r Ceiling (Stynrturall Br�A�!?;acoat
J "'�-:i'�-
27:.iFrame:�nd FL.shinu �xx
- u7_..�t�
'"28. Lathin,t��e S�3in;w;. y '�Q'C ,r
y.r J
r, -n �-;-rJ--cr•. ..--�r
29. In;ulation • Nx S ••
� - y �- n
`' 30. DrywalEl�la�ting �y ,,, i
1(T-'tj`_fT+----r-
:31. P:m•: �� �o��f'f Ca�a 5 -n;P
i^' -��w^-<� ' "a�i>---
...
�� ^�32. ^Eledric�l Pq.�eri'c}%ter'�E�nal�
I r� cj ��-.i-__�� _-�,-
�33�'r.'tr, EIecV � r i C
�34• � rH N�4t�n'�&,4�!�C�t'Si:idi�:;• m
'��.��� # � �-��
I•'s5n„_ � a Gc� PiF. Tr;, p; ••
1�-�•-tr - - -:si-e-- c- - - -
a36�Ha?�.f o�,;Canopvr` �'- i �� -�
� �i
�+ -�� � .. S.T_LL_
,-y37..F�n�. Fawto�Y Fir�'+acea; i .- �-- ^
- - �� ..�-
�,"38. Firy Ple`tnbing ' � '� '''
. . � �
�a�« i �i'_
;'39.�LVaicr 5¢�.vicri�Fi •'
sWO. Gas Seri»te-F1nal''� � ^� CTT:T =
a: _; • cn v � � �..-. ?]
�At. Sola� D��1,nesY;cRinal� R. ��
� ..._�_�„�r:__-
42. Bachflos'u PrzventEn N
i�-�S 7 N_�l �-a -1
43. 8ad�.flow Ir��atPiki;. j;""
YD. JUll1�U r(.lIC�+Yoi��-� � .. ..
,?161•Hani�ca�Res�lat�c�is -+ �
r i ^.. ••
47=r IIc�L STRCICTU�fE � BU1iDING
t-n'i-�--
48�;�fAL PLANiUIN[f i i-�-
,,, • . ..�. w i
�49:'�ler�ric.f�eleaseto�dison �
�- �
�0'•+.�a:CRelease to Souzhern Calif �i�a Gas
Dare
Date � Inspector
P(. & SPA
APPROVhLS Permit;'.=
52. Pool & Equ�pment Locatlon
53. Steel Reinforceinent
54. Form,
55. Electrital Bord�ng
56. Rauqh Plumh:ng & Pressure Test
57. APPP,OVt�!. TQ CvVF9�Gl'��.�'F
58. Elr+ct.ca' Corc,r�t�U�tlrnn�.
59. Gc; P�pe, . �1�!..c•.�d.. Trst
u0. Bar:.r.�sh L��.a-, P.Tr�P, �o�y�nd
61. AFFFC'.VAL TCl DECK
62. Bacc.._;h ;4 Frczrtr� � , :ai
63. H:.;tr 26 VenbF.nai
G4. Plumn;�g Systcm � F���al
G5. Electrical�F nal
66. Solar�SVstem�l=in�.
67. Frnr.in� & Accass APn�o�a!
68. AGPROVkD FOR P: �STERING
G9. POOIiSPASYSTEAlSFWAL
i
i
Date I InsAtctu�� �
� I
---� _,FI �E[�F°T.PxEQUTA4P(�7�:.�T I I - -
> �1 S� C' r. i r . N '
'.(. l: _t :^ f i ,� �7,1.�7 Q lj Y: j„ .
5 -� C. 1� PPY,'�iV��y-n3-�c.Pee::�i[ ,'+_#-':`-�."-I I
{ ' ' ?--rt-a'Ki-F'__5-�"7'Q ?--�--^�3-�
t � 1 ' t> H70. �'ind��•[+fpy,v F:�.o i.
� ` ��= F V) =r� ,I ��i�p'- ,
� � v. ;; , � s IQ71. Produc�r'{��a�c ,.: C=ys ��Oi;
--rr.-' -�"_'-�. �,-7�-i-�r.-x+-r -- - -
.. � :. i.` J+ ♦..72. L'iiU��rq�oe71: c �57�. : i F- ., � i
�_'C�G�_�'- -_•t__ � 'a-� '-a' - - - - - -
�� n p T x r �_ m '- �-� m� � c . � �
. � Ir� ��-r�.J3-�Undurnm4.Storcirp^ki,�G:.s , G,I�
�--`U� � --i3-. - - -v-- .= r-- - -
74�'Ell,.r.�ad i:v..a'' r.
�� _�',- � -� - - -- - ' -. _ .
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.' . r 75E �; Y Cherr+c�J •_. � c t�i
n �J----[+7o--J�--+'-S-.,r,-x- - -- ---
� �� k r. 76. Dry 5!anS"..,ca� :.a; ♦ ;� 1
�,.. ; s_- �Sr_,--'�'==-`'�-'a- -- --
..�t'} 77yFIXED��EC�:�WAIfi;., �, `n i
fK-� -- , -
! I+�� 7&rFIHEPREV_FI,"'•� �.> � �' . -_- -
_.."7_ �' i � _ "
� F � `�'.�4LTFi�iJEPT�: ii�QT11Rj�.-,,fViENT ; � ' .
i -Y _�_' __iJ_.•_-_4._ y....�___ -._-r-1-__ . -^ s ._. i
I; . ,79. F',';P� I'�ix�C`:x'< >, ~ :
_ �k - _ '_n] Q - _-N_ - ' _i_.�= �:r+ I 1 .
y-_
� .F * 'd0��F00DCE-H"I'F�,.h�[ I��tiFDti � I
k-x- �r--- --�- -'72�--v----�;�---- - -- '
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; � 5 !l:: K S ti� -- - - - '
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�.i-- - .'s_ ';-'- --'-�`%---_`-.
� l S T C� 7 I *.`, ":'
-I'_ fiI Tl -T`�'__-_ K'r1 '�''7 _-
-}ti ^Y_ _ __'�-_ -_ CO' _ _ _ _ '
fR � Y (�
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> i � r. * c' �� -r .. �
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r
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'_ - _ '_ '�
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X
-4 _ _____. _ _..
S
T _ _. _
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r �
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�__ __"_
. �
JOB ADDRESS
GENERAL CON
A P N�-
INSPECTIONS
sm�
GPS
WRiER. [d"���•
ROUGH PLUMBING
R CON�ITIONING
UNDERGROUND LJ POWER
ROUGH WIRING
BON� BEAM [] STEEL REINFORCE
SHEATHING
FRAME NN� FLASHING
IATHING — IN OUT
PLASTER.BROWN COAT
HEATING. VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AN� GAS TEST
ELECTRIC. FINAI
DATE.NYV s 1974
BUILDING PERMIT
VALU
SUBCONTRACTOR
�itD/�lj �'3
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applic�n[ to Fill in Cc�r�pletely . _
ADDRESS
OWNER HELTZER ENTERPRISES-BROOKVIEW
MAIL
ADDRESS 740 N. La Brea Avenue
ac"'i arv Los An eles CA 90038 No�937-2
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Z Q CONSTRUCTION
o N LENOER United California Bank
� � BRANCH Main Branch
J N
m � ADDRESS 600 S. S rin St. L.A 0
m ARCHITECT Fields & Silverman TEL.6S3—O
J a OR ENGINEER N
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w Q aooaess 113 N. San Vicente Beverl H
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� � CONTRACTOR Geor e J. Heltzer
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�� ADDRESS 740 N. La Brea Avenue
� W TEL.
z F CITV Los An eles CA 90038 No• 937-2
— � STATE CITV
�� uc. No. 3144 LIC. NO.
� � SIZE NO.OF BLDGS.
OF lOT NOW ON LOT '
USE OF
EXISTING BLOG.
PAIo
"rR 1R-74�,.S.00 518� x*'.��ZS.�o
APPLICATION FOR BUILDING PERMIT
FE 6V TE ECEV D DATEISSUED
PERMII`[J�' �
A.P.NO. 'b� �O3 `'��'��
BUILDING +
ADDRES
TRACT�j�C. LOT BLOCK
W D P
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OWNER
LUE (` /
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FIRE
20NE TVPE GROUP
APPROVED
sv onre
Z E NO.OF USE OF NEW LF �.pNOO
'3 PLAFS ,2 BUILOING G A
VAROSAPPROVED VAqDSAPPFOVED
MAIN BUILDING ACCESSORV BUILDING
F SIZE OF NO. OF }
Z NEW BLDG. ROOMS ' STORIES 2 L SIDE FT
EMERIOR WALL ROOF
V COVERING Plaster COVERING WOOC1 FEAR � FT
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET.
a Residentia MAIN BLDGS.
a �/ y.
O C/ ��[. 1/ � C VRP.9W� �
� APPROVED
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U1 �ereby ackhowlatlpe fha[ I have reatl t�is aOPlica[ion antl sta[e
� that tha above information is corract and agree to comply with
� all laws regulatinB builtlinB consttuction, antl I shall not employ
F any person ih violation ot ihe workman's compensation laws ot
y Ma S[eie of Calitornia. �
ZI hereby certify Mut I am properly licensed as a contrector under � �O SQ. F"
ihe State of Californie Business entl Professions Coda, Divisicn 3, THE AMOUNT:
Chapter 9, a�tl thet such licenses are In full forca antl effect, or 1 THE PURP06E O
am ezempt from the provisions of the Stete ot CalHornia Business
antl Protessions Cade, (` ton 3, Chepter�
VALUATION
Signat�re ot — � �/�'' ��D
Permlttee /ir � $ �%
Authorizetl F�gent
BEf. MAIN &
zo �3
�R2 - m
0
ER VALUATION IS FOR
NG A PERMR F�EE wONLV: m
FEE $ ✓W �
m
HECK $ � / � � E
e
LL
FEE $