The URL can be used to link to this page

Home My WebLink About492 TRAVERSE DR - Building Permits(714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ,lab Address: 492 TRAVERSE DR Suite No Vicinity: Parcel Nunmber: 41803112 Applicant: TOAN NGUYEN Address: 8263 TOMMY DR SAN DIEGO, CA Owner: KUNST, NANCY N TR Address 492 TRAVERSE DR COSTA MESA, CA PLUMBING PERMIT Phone: 619-726-5119 Zip: 92119 Phone: Zip: 92626-3115 Contractor: PINPOINT LEAK DETECTION AND PLUMBING Address: 8263 TOMMY DR � Arch / Eng : Address: ISSUE FEE BackFlow irrigation BackFlow Prevenler Bathtub Clanfier System Connect (Ice,Soda,etc) Denlal Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Phone: 619-726-5119 SAN DIEGO, CA Zip: 92119 License: 795928 Phone: Zip: License: SCOPE OF PERMIT WATER RE-PIPE (COPPER PIPING) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 FEE SUMMARY QTY AMT Laundry Tub / Washer $0.00 0 Landscape Irrigation $0.00 0 P-Trap $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors $0.00 0 Septic Tank $0.00 0 Sewer Cap for Demo $0.00 0 Sewer Connect $0.00 0 Sewer Private Line $0.00 0 Shower $0.00 0 Sink, bar $0.00 0 Sink, commeicial $0.00 0 Sink, Floor $0.00 �TY 0 0 0 0 0 0 0 0 0 0 0 D 0 0 Status: ISSUED Applied: 11/23/2004 Issued: 7 i/23/2004 ISSUED BY: SumpPump Swimming Pool Trap Pnmer Urinal Vacuum Brkr Bktlow(1-4) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closel (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 1 0 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiremenis 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 7 BO days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply wlth ell appllcable codes, and all requlred inapeetlona and final epproval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaae.ae �flroo� WORKERS' COMPENSATION DECLARATION: . , I hereby eXirm under penalty ol perjury one ot Ihe tollowing declarBlionS: ' � • � ❑ I have end will maintain e certificate ot consent to sell-Insure lar workers' compensetlon, es proNded for by section 3700 of tha Labor Code, for ihe pertortnance o} Ihe work for which lhis permii i5 issued. wlll one by section 3700 of Ihe Lebor Code, tor the parfortnance ot the work lor which Ihis pertnil is or ❑ I certify thet In the peAormence of the ork for which Ihis permit is issuetl, I shall not employ eny person in eny menner so es to become suhject to the workers' compensation laws of C ytpmia, entl gree that tl I should become sub�ect to Ihe workers' wmpensetion prodsions ol5actian 3700 of the Labor Cod 1 shell forthwith compNwit v ions. J �/� �Jiwm�Slgnature: - ✓' ' Date: �� WMNW(3�'fAIL E OSEC EWORKERS'COAIP SATION OVERAGEISUNLAWFIILANDSMALLSUBJECTANEMPL�OYEA�CRIMINPLPENALTIE DGWLFlNESUPTOONEHUNDRED FfiOUSANDDOLLAiiE(5100,0OO�.INADDITIIXJTOTH WSTOFCOMPENSATION,OAMAGESASPROVIDEDFORINSECTIdJ3]080FTHELABOflCODE,IMEREST,ANOATTORNEY'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm that I am lica of Chepter 9(commencing wilh Section 7000) of Dlvlslon 3 of the Busine essions Code, and my license Is in full focce.andefteM-ldc�q� � ass�g' s�-....-: ConVedtots Signawre: . �_ Date•.�t ,.�s'•- -, , _ . , � CONSTRUCTION LENDING AGENCY: ❑ I �ereDy attirtn that there is a constructlon lending egenry far Ihe pertartnance of the work for which Ihis pertnit is issued. (Sec. 3097, Civil Cotle). Lendef9 Name: Lender's Atltlress: SignaNre: OWNER-BUILDER DECLARATIONS: Date: I hereby attirm that untler Oenelry ot per�ury thet I em EXEMPT FHOM 7HE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, 8uslness end Professions Code: Any ciry or counry which requires a permit to consiruct, alter, improve, tlemolis�, or repeir eny structure, prior to its issuance, also requires the flpplicant for such pertnit ro tile e signed stetement that he or she is Ilcensed pursuent b the provislons at t�e Contrectors LJcense Lew (Chepter 9(commencing with Sedion 7000) of Division 3 of the Business end Professions Code) or that he or she is exempt therefrom and Ne basis br the ellegetl exemption. Any vloletlon of Section 7031.5 by any epplicent lor a permit subjects the applicant to a civil penalry of not more than five hundred tlollars ($500).): ❑ I, as owner ot Ihe property, or my employaes wl�h weges es iheir sole compensaiion, WILL DO TME WORK, and ihe structure Is not Intended or atieretl tor sale (Sec. 7044, Business antl Professions Code: The Coniractors License Lew tloes not ap01y to en owner ol properry who builds or improves thereon, antl who does such work himself or herself or through his or her own employees, provided ihat such Improvements are not Intended or ottered for sale. If, haxever, Ihe builtling or improvement is sold within one year of completion, the owner-builtler will have ihe Durden of proving that he or she did not builtl or improve for Ourpose of sale.). ' ❑ I, as owner ol the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Profassions Code: The contrectors License Law tloes not apply to en owner of propetly who bulltls or Improves thereon, and who contracis for such project wlth a contractor(5) license pursuent to the Contrectors License Lews.). ❑ I em exempt under sec. Signatura: Owner ID ventietl by tlriver5liCenSe. ❑ Ves ❑ No Business and Professions Code for 1�is reeson: Venficatlon of Ownership by (type ol document, i.e. � property tas blll or tleetl): DIVISION OF INDUSTRIAL SAFETV VERMIT CERTIFICATION: Dnvers LitenSe No. Date: Expires: ❑ I hereby certlty ihat no excavetion five (5) or more feet in depth into which a person Is requiretl to tlescend, wllt be made in connection with work euthorized by Ihis permit, and Ihet no building strucWre, scattoltling, falsework, or tlemo0tion or dismemling ihereof, will be more Ihan thirty-sla (36) feet high. (Chap. 32, Grp 2, An 2, Sec. 341, Title B, Celifornia Atlministrative Cotle). ❑ As ownerbullder, I will not employ enyone to tlo work which would require e permi� trom Ihe Division of Industrial Selery, as natetl ebove, unless such person hes e pertnit to do such work Irom tha division. Signeture: Date: Division of Industrial Safety Permit Number.• CERTIFlCATE OF COMPLIANCE AND AIfTHORIZATION OF ENfAV: I certity under penalty ol perjury thet I have read this aOD��ion and state that Ihe infortnation given is correct. I egrae to compty wlih all state laws antl ciry ortlinences relating to bulltling construction, and authonza representatives of Ihe Clry of Coste Mesa to emer upon the ebove-tlescnbetl property for inspection purposes. I egree not to occupy or allaw occupancy of any building auihorized by this permit until finel inspection. cooe �. ixsveenoxrvve 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Root 201 Final Block/Retaininp Wall 202 Final Factory Fire Place 203 Finel Sign 204 Final Demolition ��7\I�I:IIII/d41 eooe� ir+svecnoxTrve 206 Final Mechanicel 208 Final Plumbing 210 Final Electncal 212 Final Fire Prevention 220 Final Plenning Approval 222 Final Site 250 Finel Building/Occupenq PAIF. 1�64 � (714) 754-5273 • Fax (714) 754-4856 • vnvw.ci.costa-mesa. BUILDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 ..� , �•, : ,. � x; i"'ti �,:a . ),;''1. t,.:s'�-�.••�:• i �- �ob Address: 492 TRAVERSE DR Status: �SSUED �. Suite: Applied: 04/21/2005 Vicinity: REAR OF SFD Issued: 04/21/2005 Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Construction: V-N Parcel Number. 41803112 �� Zoning: R1 f^..� i�� .� p . � S . t• -�-.-'� \,�T9-f�: -,?i E i� I' Applicant: JOSE GORINA ��ISSUED BY: Address: 10395 SLUSHER DR SANTA FE SPRINGS, CA Owner: KUNST, NANCY N TR Address 492 TRAVERSE DR Phone: 800-807-9889 Zip: 90670 Phone: COSTA MESA, CA Zip: 9262G3115 Contractor: SEARS HOME IMPROVEMENT PRODUCTS INC Address: 10395 SLUSHER DR SANTA FE SPRINGS, CA Zip: 90670 Arch : Address: Phone: 800-807-9889 License: 721379 Eng: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT INSTALL VINYL SIDING TO REAR WALL OF S.F.D., ICBO #ER1478 Plan Check: $0.00 Permit: $83.25 SMIP Res: $0.50 SMIP Com: $0.00 Other. $0.00 Inspection: $0.00 Total: $83.75 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existinq: o NOTES: ,`� ^ � tt r t.�'�I� `� 1 Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Lefl 0- 0 Proposed: 0 Calc Valuation: Claim Valuation Right 0- 0 Riqht 0- 0 $3,000.00 $3,000.00 ..i �•S'f5' J� � � NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Orcl. No. 92-28, § 1, 12-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order tor ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspectiona and flnal approval mus� be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � WORKERS' COMPENSA710N OECLARATION: I herehy eHi�m untler penelty of perjury one ot the tollowing decleretlons: ❑ I heve end will meintein e cenitice�e ot consenl lo selbinsure lor workers' compensetion, as provitlad for by saction 3700 of the Lebor Code, br Ihe pertormence ol ihe work for whic� t�is pertnit is issusa. ❑ 1 hava end will maintein workere' c�pensetlon Insurence, es required by sectlon 3700 oi the Labor Cotle, tor ihe peAortnance of the work for which this petmit is issued. My workers' pc�ompensetlon Insurence cerdar end pallcy number ere: �r ��oOO Cartier: )'C�/ PolicyNumber: � (This sec7on need not be cromplefed if Me pertnif is velued ef one hundred dallers ($ f00) or lessJ ❑ I certity that in the pedortnance ol Ihe work for which thls permit is issued, I shell not employ any person in eny manner 5o as to becnme Subject to the workaro' compensation law9 0l Califomie, dntl egree Ihet il I should become sub�ac� �o Ihe workers' compensa�ion provisions oi Section 3700 oi �M1e Lebor Code, I shell forthwlt� cromply with these pravisions. /y�. �Q-7�� /J� • AppliCant Signature: / 1 � � " � � Date: �' /'7 � V � WARNING: FAILUPE TO SEWRE WOiiKE �S' �PENSATION EPAOE IS UNLAWFUL AND SNALL SUBIECr AN EMPLOYER TO CRIMINAL PENALTIES AN� pVIL FlNES UP TOONE HUNDFED Tl1IX15AND DOIURE (St00.ODp), IN ADDITIO �O THE COST OF WAIPENSATON, DAMAGES AS PiKNIOEU FOR IN SECTION 3)O6 pF THE LABOR COpE.IMEFE$i, AND ATTOqNE1^S FEES. LICENSED CONTAACTORS DECLARATION: I hereby atfirtn that I am licensed torce and ettecL Lic. e Contracbr'S Signature: CONSTRUCTON LENDING AGENCV; C�apler 9(commencing wilh Sectlon 7000) ot Division 3 0l ihe Businesgentl Professions Cotle, and my IicenSe is in full Cless w � Date: •L • OS ❑ I hareby affirm ihat Ihere is a construction lending egency for Iha peAormance of the work tor which this permit is issued. (Sec. 3097. Civil Cotle). Lender s Name: Lentler's Atltlress: Signeiure: OWNER•BUILDER DECLARATONS: Date: I hereby ettirtn that untler penalry ol perjury that I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for the lollowing reason (Sec. 7031.5, Business and Professlons Cotle: Any ciry or county which require9 e pertnil to constmct, eltor, Improve, demolish, or repair any stmcture, prior to its issuance, also requires the aDP�icant lor such permll to file a signed statemenl ihet he or sh9 Is Ilcensed pursuant lo Ihe provlslons of the Contrectors License Lew (Cheptar 9(commencing with SecNon 7000) of Dlvislon 3 of ihe Busine5s end Protessions Coda) or tha� he or she is exempt iherelrom end iha 6esls lor Ihe ellegetl eaemption. Any violation ot Section 7031.5 hy any aOPlicent for a pertnil sublects the epplicaN to e civil penelry o� �ot more then five hundred dollers ($500)J: ❑ I, es owner oi the proparry, or my employees wlth weges es lhelr sole compensetion, WILL DO THE WORK, antl ihe struciure is noi intendetl or otterea tor sale (Sec. 70dd, Business antl Professions Code: The Contractors License law does not epply to an owner ol property who 6uilds or im0�o�es thereoq and who tloes such work himself or herself or through his of her own employeas, providetl ihet such improvemenis ere not intentletl or oflered tor sale. H, �owever, ihe building or improvement is 5old within one yoar ol Complelion, iha owner-builder will hava Iho burden of pwving Ihat he or she did not builtl oi improvo lor purpose ot sale.). � I, es owner ot the pmperty, am EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRAC70R5 to constmct the project (Sec. 7044, Business antl Pmfessions Code: The contrectors License Lew tloes not epply to en owner ol property who 6uilds or improves Ihereon, and who contracts for such project with a contractor(s) license pursuani Io Ihe Conlractors Licanse Laws.). ❑ 1 em exempi untler sec. Business and Protessions Code �or this reason: Signeture: Owner ID venfieA by tlnvers license. ❑ Yes ❑ No Dnver's License No. Venficetion of Ownership Ey (type ol tloCument, i.e. - property taz bill ar tleed): DIVISION OF INDUSTRIAL SAFETV VERMIT CERTIFICA710N: Date: Expires: ❑ 1 hereby certify ihat no e:wvation ��e (5) or more teet in depth inb which a Oerson is required to descend, will be matle in connection with work authonzed by this permit, and ihat no builtlinq swdq�e, ScaHoldinp, talsework, or demWition or disman0inq ihereot, will be more �han lhirty-six (3fi) feet �igh. (C�ap. 32. Grp 2, AR 2. Sec. 341, Title B, Califomle Admini5lr8iive Code). ❑ As owner-builtler, I will not employ enyone �o do work which wauld require e permit from Ihe Division of Intlusinal Sefery, as noted above, unless such person has a pertnit to tlo suc� wark from the di�ision. Signature: Date: Division of Industnal Sefery Pertni� Num6er: CERTIFlCATE OF COMPLIANCE AND A�ORVA710N OF EMAV: I certity unAer penalry ot perjury that I heve read this epplication and state that lhe intorma�ion given is wrrec�. I agree to comply with ell stele lews an0 ciiy or0lnances relating to building construaion, entl authorize representatives ot Ihe City ol Cas�a Mesa to emer upon Ihe above�descnbed property lor in5pettion Purposes. I egree not to occupy or allow acupency of any builtling eut�orixed by this permil uniil linal inspection. PAIF ixrrzu�s 1676 FizeU Sys�em Final Fire Preven��on 1266 Pool SOa Finel 200 Final Re-Roof 201 Flnel BIocWReialning Well 202 Flnal Factory Firo Place 203 Final Sign 20d Final DemoliUon � �I.�ate Date COOE I INSVECTION TYPE 206 Final Mechanical 208 Final PlumDing 210 Final Eleclrical 212 Final Fire Prevention 220 Final Planning Approval 222 250 Finel Si1e Finel BuildinryOccupancy PZH ,m . 7 OWNER KUNST, PETER F. Q JOB ADDRESS 92 Traverse Drive AP No.41ti-031-12 LOT ] INSPECTIONS P soi� 1� c�s � �Y W�TER � ROUGM PLUMBING � PROP. SWR. LINE HOt15E COX. SGRINKIING SVSTEM MISCELLAN[OUS HOUGN MEnTING ANO �IP CONOITIOHING TEMPORRRV SERVICE OR POLE UNOERGROUNO � POWER � ROUGH WIRING TRENCMES U FORMS U STEEL REINF. FLOOft SYSTEM BONO BEFM n STEEL R�INFORCE � SHEATHING FRAME ANO FLRSHING LATNING - IN ❑ OUT (� PLASTER,BqOWN CO�T STRUCTUR��, FIN�I HERTING. VQNT.. REFRIG. �NO A.C.. FINAL DA7E 6-27-77 SUBCONTRACTOR � � 4-j#� � � �UP) ?.7-77Pa��OO4��29'� ¢�*-:6F.5E COSTA MESA BUILDING-SAFETV DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFOHNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant [o Fill in Completely — Use Ink Only n /��y� nn RECEI DATE RECEIVED D E JSSLEp ADIDRESS / G J/�AV`.C�F ///� ' 7 OWNER �� NS � A.I BU MAIL C�.� C q� ADDRESS � CITY ST/1 %�i � �'1 NE Q-tpO=I CANSTRqCiION R<}PCL��s ��hv� �C BFANCH j• (�J/�{J/V(/ ADDRESS S�//J /7y� ARCNITECT //�� O�y� NOL OR ENGINEER /T�/ ADDFESS S Ii'/':'� E RE ED � P �ATE (� AODFESS ZONE' NO.OF USE OFNE TEL, p�qryg� BUILDING, / CITV N�. F STATE CITV PPqOv VARDS APPF � LIC. NO. LIC. NO. MA1 ILDING 1YGCGCCGG'i' F {r� SIZE NO.OF BLDCS. IFR ( TiiEEi a. OF LOT NOW ON LOT � RO FT. a USE OF /�� `� 'n/ .�., EXISTING BLDG. r7(/ � G I G��FT � � � Separate permits are required for L. SIDE FT. T Qelectric, plumbing and heating work. REAR FT. (( FT W USE OF BUIIDING AND WORK TO BE PEFFORMED F OISTANCE,BET. BEf. MAIN & �Q MAIN BLDGS. ACCESS. BLDCaS. 6 /!�(/(/ D� % `��/ C URP.9y+ qP ROVED � � X 2 ' � APPROVED ,�`] r �� .� a w � I hereby acknawlatl8a t�at I have reatl this aOPlicetion entl smto y� thet tha ebove ��ormatlon is correct nntl egreo to comply with �+ ell laws regulat�np bulltllnB connrucNon, and 1 shall not employ z eny person In ��oletion of ihe workmnn's compensatlon Inws of ��„ iha State ot Ca��fornie. 3 I heroby certlfy ffiet I am properly Iicensetl es e eontroctor antler S�. FT. t�e Steta ot Ca��torn(a eusiness entl Profesaiona Cotla, Dlvislon 3, THE AMOVNT SHOWN UNDER VALUAT Chapter 9, ontl that such Iicenses ore In full }orce end effect, or I THE PURPOSE OF ESTABLISHING /� PERMIT em Bxempt tforn provlsions of the State ot Callfornie Businacs VALUATION PERMIT FEE E ontl Professlons e, Ivision 3 Cho ier 9 B O PLAN CHECK E sie�et�re o+ r` '� Pormittae $ �� TAX S Authorizetl AAe�t TOTAL PA�D E (1 L /3A� // � m i Y m N OR m _V: " e � O N m a o LL % � U OWNER M, JOB ADDRESS GENERAL COt AP No. 418-i INSPECTIONS SOIL GAS WATER ROUGH PLl1MBINf PROP. SWR. IINF SPRINKLING SYS' MISCELLANEOUS ROUGH HEATING _i� LOT a� T NOUSE CON. TEMPORARV SERVICE OR POL UNOERGROUND I-I POWER STEEI REINF. � I'U'/A� . I�! ��4 -TC FLOOR SVSTEM BOND BEAM n STEEL PEINFORCE �J SHEATHING FRAME ANO FLASHING LATHING - IN n OUT n PLASTER, BROWN COAT STRl1CTURAI., FINNL HEATING, VENT., REFRIG. FN� A.C., FINAL PLUMBING FINAL ANO GAS TEST n ELECTRIC, FINAL DATE � BUILDING SUBCONTRACTOR i�cna - - ' � 31599 Z . W W 4- U Z ZQ � N am J � J V1 Q W CO J m J Q U N Z a W � aw W2 J Q m Z J � W w � ZH w� N K �O COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 ,4PR-8-70cns�OO 441 0+�****5.00 ForApplicant to Fillin Completely APPLICATION FOR BUILDING PERMIT RECEI EDBY DATE ECEIVED D 7�4SSVED BUILDING �q2 T U�2A �. 1�Y- � - � 'a'7� ADDRE55 } OWNEF �U � � A.P.NO. � 'O✓ ��a P MI BUILDING �9iJ ��µQ�� ,• MAIL �+ [� � ADDRE55 /oc ti`i��-we— ADORESS `�-\ � UQ�S e !/ �jry TEL. TRACTU E�/d LOT BLOCK CITV �Q � NO. CONSTRUCTION W AD A P LENDER �/ /\ BRANCH OWNER C' ADDRESS 'ALUE /7 ARCNITECT TEI. S $ - - /U OR ENGINEER N FIRE ADDRESS ZONE TVPE GFOUP CONTRACYOR � �- ByPR VED CDATE ��- -/V ADDRESS TEL. ZONE NO.OF USE OF NEW �L� CITV ' NO. ��-- � P�NS a BUILDING STATE CITY 1'ARDSAPPROVED YAqDSAPPROVED LIC. NO. LIC. NO. MAIN BUIL�ING ACCESSORV BUILDING SIZE NO.OFBLDGS. (F/R fiE OF LOT Q� �,3/ X//3, q7 NOW ON LOT q FT. - USE OF f E%ISTING BLDG. �D F F7 SIZE OF NO. OF �i � NEWBLDG. ROOMS STORIES L.SIDE 6 FT. FT. EXTEFIOfi WALL ROOF T COVERING COVERING REAIi �� FT. �T. USE OF BUILOING AND WORK TO BE PERFORMED OIS7ANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BL S. �� VAR.# DATE C.V.P.#'- APPROVED - APPROVED O I hereby acknowlstlge that I have reatl this epplicetion antl stace that the above in40rmation is correct antl apree t0 tamply with all lews re8uletin9 builtling construction, antl I shall noi employ any person in violation ot the workman's comp¢nsation laws ot the State of Calitarnia. ' I hereby certity that I am prOperly licensetl as a contractor untlar SQ. FT. iho Stata of Calitornio Business antl Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that s�ch licens¢s are In full force antl etfett, or I THE PVRPO6E OF ESTABl6NING A PERMIT FEE ONLY: am ezempt f�om Ne provisions of the Stata of Callfprnia Business VALUATION entl Prote55ions Cotle, Division 3, Chapta� . ' PEFMIT FEE 5 • dO SlBnetura t /� L� � Parmittea�lA �} y� nn C l�rJ 5�DO � PLAN CHECK 5 " Authorizetl Agent TOTAL FEE S�' �� J �"1 27968 COSTA MESA BUILDINGSAFETY DEPARTMENT P.O. BO1C 13W � COSTA ME9A, CALIFORNIA Y2l2E oEcz7-67m 00 92�• *•:*90.00