HomeMy WebLinkAbout285 21ST ST - Building Permits ADDRESS OFBLIILONO: 285 21ST ST UPIT: CITY OF COSTA MESA — BUILDING PERMIT
OMNERSNMIEwmcsN: CROTEAU, RONALD A PERM NO: P 081708
ADORES& CROTEAU, CAROLYN J
285 21ST ST PERMIT NO: P 081708 PLAN CHECK NO: N GOVT: N SUPP : N
ZOSTA MESA,CA 92627650-3627
APFL.MMUNGADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
ARCNRECT ORE lam GC.NO.: JOB DESCRIPTION : C/O DISHWASHER SQ FT:
ARCA OR ENC.'S ADORESS: WIT:
CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 /
cCNm*CTarsNAME: NOCK PLUMBING ( 714 ) 895-1246
eartRAcroRT
ADDREN0 STAND SEABOARD CIR ***+ME**+TS.t*4*****O *r**************+RErIEEZED BY Er**********rE*rEEERr****+ErrrtrErErErtrE+r*** -rE*�rrrrErEEr***REEert***
ADDRESS: STANTON CA ILCIIO: 707775
90680 LINT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby Slam under penally of perjury that I am rcansel littler provisions of Chapter 9 SETH ACK S
(commencing with Section 7000)d Division S of the Business and Professions Cole.and my Ronne a In full arca and efled.
clrvuc.No.:O5O3 6 .cuss: C-36 LICA . 7 75 EXP: 02 /97 MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dat.: u �1 c...... •-------r
LEFT. FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER ECLARATION:I hereby affirm wider penalty of perjury that I em exempt from the Contractors Liners.Law for the
idbwng reason(Section 2O31.5 Busies+and Proles:ms Cole:Any cry or county which remixes a permit to oonsmct.der.improve. PARKING REQ• PROV; PARCEL: 42621509 ZNE; REF NO:
"-oafish. le h
h.or repelany sanctum,pros issuance.able requires the applicant for such pre to fib a signed statement that he or she PLANNING NOTES>
Mused pursuant to the provision of the CaNracton License Law(Chapter 9(commendng with Section 7000)of Division S of the
,einem and Professions Cods)r that he Or the is exempt therefrom and the basis for the alleged esrnpton.Any violation of Section >
7OSt.S by any applicant for a permit subjects the appruan to a end penally d nm more then Five hundred dollen(MOD. *******************************************************************************
❑ Lesowmdihs pmwrtyormyempmyees with*ages as they sole nnmprmmim,MI dome work.and me structure is not'Mended DEVELOPMENT SERVICES REQUIREMENTS
or offend for sale(Sandon 7044,Business and Professions Code:The Contractors Lice.... not Law does apply tome ownr of property
who bands or in on
roves there .annd who does such work himself or hand or through he or her mei employees,provided that such
improvements are not intended Or offered Is sale.If,however.the building or inrovamer S sold ekhn ono year d completion,the ZONING APPROVED BYDATE:
owner-builder will have the burden d proving he or she dol not bold or improve for the purpose of sale).
❑ I.asownrathe p k•Pm axdusialYrmdmnrowSm'minedcaurars m emmtn msrojad(Benimn TD4+.emihesa awl BUILDING APPROVED BY : DATE:
Professions Code:The Contractors License taw does not apply to en owner of properly who builds or improves thereon and who
contracts for such prajeds with a onnmdrls)named pursuer/to the Contractors Lipase Law).
❑ Iamexempttod-Srlion: B.BP.C..brthis reason: APPLICATION ISSUED BY: 4,0 DATE: 2-z1- 97
*******************************************************************************
Dale: dinar LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
I do hereby candy that I van aware of and understand the requirements of California Health and Ugly Cods Swim 25505,2S533,and
2554.,and that ler any Muss bedding occupera will/will not(&cleo )n°°dmcompy`""'aid mate codes and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a pensee for constuction or modlretion ham the Al Gush yManagement Drones.Residential mn eppfrations are exempt Iran these
provision.. PERMIT 8 , 75
Dona: Apprran: 2 5 2 SMIP/NON—RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby en oder penalty of popsy one of the Mowing dedratiw: ISSUE FEE 22 . 00
❑ Ihave end will maintain aconducts oconsent losdbsrefor en:owecopenmton.earaidedfrbySsdion3700aUI
the BLDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Code, mnaoedwewaklawi rapane +issued.
TOTALS----> 8 . 75 22 . 00 0 . 00 30. 75 30 , 75 . 00
•C1 I have and will malntaih workers'compensation Insurance,as required by Section 3700 of the Labor Code,for the prfonnance of the
X work for which thisne e.MvwranGOLDEN Nf rd policy
ime: EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 30 . 75 OVER/SHORT: . 00
Cana:
Policy Number; NWC. .321141U1 09/01 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
„his section need not be completed I Um parol is for as hundred datere(Stool or Ono) 30 . 75
❑ I certify that in the performance of the work or which this permit is issued.I shall nor employ any person n any manner so es to
become subledtothe 'ccs ant ion laws am
CaEua. II become subjed to the wakens' *************de*****************************************************************
w'"pram'i°niprove'
/sj�e�wci Section d the°l'"°'Cods,l shall ' ply °mvi.nr". INDIVIDUAL F E E BR EAKD OWN
Data: %/ (/‘ Mprram:
Warning:Failure to secure waren canpesadan coverage unlawful,std then reject en employer m criminal penalties QTY DESCR IP T I O .N UNIT COST TOTAL COST
civil Ann hp to one hinted thousand dollars(4100,O00).ht adedon to roe coat of conprt/stlort ds sgee es Provided for In
Secdon42059/IN Labor Code,lmresL endmfomry's fees. PLU 1 DISHWASHER 8 . 75 8 , 75
CONSTRUCTION LENDING AGENCY:I hereby affirm oder parlay of perjury that there is a construction lending agency or the END OF FEES • p
performance of the wok or which the penal u este(Sedion 3097,Cb.C).
LENDER'SpfrII
NAME: '•` ��� I
LENOER'9 ADDRESS:I crWythat I have reel this application and name thin the show information a cared.)agree tocmply with all dry and county crdinrwee E4�Jy\VBS FIRED FEBD 26 1997
and stale laws raking to Wildly contusion and hereby authorize representatives thole city M enter upon the ahem-nnaoned property
forinsPedonPurpamrRON N CK , t DATE 2a - 72
Phar —` / CITY OF COSTA MESA
one:
D
Signature of Owner/ApaWAppfrar a4iada
•
(5151-46.WP) While-Building 8 Safely;Green-File:Canary-Applicant Pink-Revenue:Goldenrod-Assessor \
/'
.CONSTRUCTION AND PLANNING POO SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3, Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd. 57. APPROVAL TO COVE R-GUNITE
. 7. Footings58. Electrical Conduit-Undrgrnd.
'8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 61 Backwash & Receptor-Final
i
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains • 64. Plumbing System - Final
14. Rough Plumbing _ 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final • ,
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace - - _- - APPROVALS '' Permit#
21. Ducts,in Structure • - - . - 70. Underground Hydro
22. Ducts, Ventilating ; - 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough& Test - i 1 ,1 72. Underground Flush
24. Roof Framing - 71 Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) &Monocoat - 75. Dry Chemical .
27. Frame and Flashing , s 76. Dry Standpipe - - -
28. Lathing & Siding - . 77. FIXED SYSTEM FINAL
29. Insulation7,8. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT:REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter•Final 80. FOOD CERTIFICATE ISSUED
•
33. -Final Electric Notes: • -
34. Final Heating& Air Conditioning .
_
35. Final Gas Pipe-Test -
-
36. Hood or Canopy _,
- 37. Final Factory Fireplace •
38. Final Plumbing -
39. Water Service-Final
40. Gas Service-Final - .
41. Solar Domestic-Final - -
42. Backflow Preventer - -
43. Backflow Irrigation - . -
,
44. Landscape Irrigation System _. - '-•
45. Sound Attenuation - -
46. Handicap Regulations - - "- ,r
47. FINAL STRUCTURE & BUILDING �' C.
r .. CJ
48. FINAL PLANNING - c: C
49. Electric Release to Edisonr
r-
cU
50. Gas Release to Southern California Gas Co - V--..--_,-;;.
-___ ' '•
51. CERTIFICATE OF OCCUPANCY I -,•."
No Date
1
•
ADDRESS Of BMLGWO: 285 21ST ST WIT: CITY OF COSTA MESA — BUILDING PERMIT
FIowNERsw°EntoNN, CROTEAU, RONALD A PERM NO: B 073992 26
IlI ADDRESS: CROTEAU, CAROLYN J
285 21ST ST PERMIT NO: B 073992 PLAN CHECK NO: N GOVT: N SUPP : N
COSTA MESA, CA 92627
APDL.MAURO ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
ARCNDECT OR BONER: UC.NO.: JOB DESCRIPTION : T/OFF REROOF W/COMP SHINGLES SQ FT: 2 , 300
MICN.OR MI ADDRESS: WIT:
CLAIM VALUE: 2, 300 . 00 CALC—VALUE: 2, 300 . 00 GROUP OCC : R-3 /M-1
coNmACTOfStU : BEST ROOFING ( 714 ) 557-4040
COITRACTORSMMLRal 765 ST CLAIR COMMENTS : REROOF 2300SF RESIDENCE, SMOKE DETECTORS REQUIRED PER 91UBC
ADDRESS: COSTA MESA CA actio_ 603323AE
********** *iEitst+t*****at*********RP3tRPRt*********** tit***** ************************
92626 WIT: B ZONING REQUIREMENTS SMOKE DETECTOR
LICENSED CONTRACTORS DECLARATION:I hereby dffrm under penalty a perjury that I am Lcensed under previsions a Chapter 9 SETBACKS
(commencing with Section 7000)a Division 3 of the Business and Professions Code,and my license is in lull force and edea. E D
cmuc.No.: 051718 / us
uc.Cs: C-39 UC.No.: 603322 EXP: 09/95 MAIN BUILDING ACCESSORY BUILD
�6 �O r 57 n�4, FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dae: casado LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT : FT IN
OWNER BUILDER DECLARATION:I hereby learn wider penalty Om m I em exempt from the Contractors License Law r«the
following reason lseda
(Section Buenas,and Adm'vu Code:Any esm w
yady Aid.roping*apsrmC to construct.alter.improve. PARKING REQ: PROV: PARCEL : 42621509 ZNE: REF NO:
•ymatih,orrepak any structure,prince as issuance.also requires the Woken!for MCA permit to Me a steediMermea dw he«she PLANNING NOTES>
it licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Seaton 7000)a Divian O d the
'samass and dessions Code)or that he or e is exempt therefrom end the basis r«the alleged exe ption.My violation a Section >
R
031.5byany applicant l«apermit subjects the appTradto a ad penally of not more than fire hundred ddten(SSDOD. **************iE****************************************************************
o I.as owner a the property ormyemployees web wages esthei vole compensation.rel do the wok.and the structure bnot intended D E V E!L OP MENT SERVICES REQUIREMENTS
mattered for sale(Section 7044,B tineas and Professions Code:The Contractors License Law does no.epphy to anowner a propertywho beads or inpraves thereon.andoho does such wok himself or bevel«el through ough cc her own emptes,o)eProvided that such
erAPPROVED- BY
- -
improemtsarerainterdedaofferedlotsale.U.however,thebuildngorinprovementissolwithinoneyea of completion, ZONING APPROVED- BY DATE:
owrw-0mlder will have the burden a pnonq he or she did not build or Mone to the purpose d sale).
o I,as omerof the;roomy.amasth i,*mmnadi Web licensed contractors U3 construct the project(Section 7044.Business and BUILDINGAPPROVED BY : DATE : '
Pra ® de
leos Co :The Contractor,Live Law does not away 10 an pow a emcee/whn
o bolds or Peres thereon and who
coverlets l«such projects with a ma«ao(s)roamed pursuant to the C«Nradors License Law).
❑ Iamexempt under Section: B.AP.C..for this reason: APPLICATION ISSUED BY: DATE:
Date: Owner: LEGALIZATION:N F E E • SUMMARY STRUCTURAL SEGMENT:Y
I do hereby cattily that I am aware a end understand the requirements d California)4eeah and Soley Code Sedism 25505.PActt,and
25504,and that l«any future building omtpem willlwa rw(dccb ane)naed to comply web said meta code,endlh requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit for construction or mediation from the Army nagetted Diarist.Residential conarudion appiatbro are exempt tram these
pnovi ons. PERMIT 54 . 00 . 50
Date: Apptcev: _ SMIP/NON—RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under Niamey a perry one d the following declarations: ISSUE FEE
❑ Ihave end wiimamana certificate acolleen toeeUnar°for workers'compsmmion.aprovidedforwnnof
by Section BUILDING—DIV—> PERMIT ISSUE PLANrCHECK TOTAL PAID DUE
cod.,fmth
performance
ah.wmkr«w:a lspermnelsm .e. TOTALS----> 54 . 50 0 . 00 - ' 0 . 00 54 . 50 54 . 50 . 00
❑ I have end wii maintain workers'compensation Insurance,enquired by Section 0700 a the Labor Code,for the perlonmerra Of the
work for which this penes is sued.My woken'compensation insurance canter and policy number are:
Carrier: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 54 . 50 OVER/SHORT: . 00
Percy Number: 1131512-9S 06/01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC . FIRE SMIP/TOT GRADING PLAN—CHECK
An,section need not be compwed/dm penal is hr one hundred doiars($1oaJ or len) 54 . 001 A . 50
❑ I amity that In the pada/mance of the work for which this permit Is issued.I shall not employ arty person In any manner o as to
compensation eambl*itdp othe workers'thead Section Oct ? b,laws orrisshall.and ag� pry dI provisions.omsubject to the worker,' *************************************$****!E************************************
2 n l1i'µthat ' IND I V IDUAL F E E BR EAKDO 14 N
cera: q •7D•�]) Applicant I`C� � q..f' ,
Warning:Failure to secure workers'compensation covelsgs b unieLtd,and shall r an employer to criminal penalties and TYPE QTY D E S C R I P T I O- N UNIT COST TOTAL COST
civil fines up to one hundred thousand dollars($104000),In addition to Its.cost of marauder;der;damages as provided for In
Sections)aoofMeLaborCods,Interest,andalroma.fees SFR 2300 REROOF BY VALUE RESIDENTIAL/ NOZONE 1 . 00 2 , 300 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty a perjury that there is a commrudbn lending agency for the END i OF FEES
performance of the work for which this permit is issued(Section 3097.Civ.C). t
•
LENDER'S NAME: .
LENDER'S ADDRESS: I
I certify that I have read this application end state that the above information is coned.I agree to comply withal city and county ordinances
and stale laws relatio to Sating construction and hereby authorke representatives a this city to enter upon the abma.memioned properly .'
for inspection purposes. JIM GOULD
•I��� PrintName Cl 001,13:6—.30189327 T$�T 4.5U
,���I Date: 9 36 5 1 ,•l ' , ' DATE: C':.1.);t/S` S
-Onetime a OmedApoUAppiatWContrat« TIDE: p.:�5
I. :.
(5151 de WP) White-Buidap i Sauey:Green-file:Canary-Appicant:Pnk-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING POOL WA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location , ,
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement •
•
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe•Undrgrnd. 60. Backwash Lines, P-Trap, 0 Uodrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final .
12. Sewer Cap _ 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System • Final,'
14. Rough Plumbing 65. Electrical-Final
•
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS F!NAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts,in Structure - 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas 0 Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathingq-7--q5- acc4t' 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing&Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80 FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating& Air Conditioning k„Cr'a' _/? _ s /�_
35. Final Gas Pipe-Test """_] ��T/ t!�/
36. Hood or Canopy / e - Q. •
37. Final Factory Fireplace Gl/
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 47141/5- 6141-
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern Catttornia Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
BI "WING PERMIT PROCESSIILOG
2
EMPLOYEE:
ADDRESS: 2 %S 21 )r St . �
PERMIT NUMBER: £i—y2,9 q L TYPE OF PERMIT: ( -nv` Pel
VALUATION: Z,')p-0 ..v SQUARE FOOTAGE:
PERMIT FEES: q-CiD
DATE: TIME IN TIME OUT ACTIVITY
`� I 30ltir ' In I : .0 PElQ.✓KE7 t<CUkNLE ` Ski-EM
t 1 95. — 7 ; 50 Guam Ater( s1-.-fed - •" f krna¢y
yrsr 547. /).c a-� Cti�
1 -I- 9c /0 ; o S C u1ce �.
(m s,; �- r, - fra® hr4 Y
5 k , o
q-5- R5- 9%oS 9; 35 IC ,,..uc
ONLY ONE ADDRESS PER SHEET—TIME IS TO BE CACULATED TO THE NEAREST 15 MINUTES
PLEASE BE AS SPECIFIC AS POSSIBLE IN RECORDING ACTIVITIES
I
PATIO COVER DETAIL 6/1 /67 - ' �YPICAI� �Jp ® �I igR
f� ® Mesa Building P1/571
STATE—f�-y, '� /'i •:� ., -.-....... ...
SPACING SPAN • ...r' —�"$'��•�. c 9
SIZE =. .
OVERHANG ss7-T 9Y brio a AT TIMES
® /Z Y " THE J; �� IT
.•PRO �.
6"
RAFTERS: NM _ Y'^=• li U7 PREP•
INE NO • 5
STATE LENGTH s----SLOPED FOR DRAIN 3 F DEQ i'
MAXIMUM 1/3 SPAN A J - -- ;.t.,,n,�# ]F A PERM ,p�Rp�
6 a CONTINUOUS f TIFICATIDNS SH, rJOT "= �UN..IRI
• 3/g x 5'Lags 32 /e LEDGER J' P:•iiiI:01IN;PIE:I0VRCQETK
OR AN APPCOvAL OF. 'rI0LA1'Blocking - FOR,il, MAXIMUM Predrill Ledger .4� % 4; PROVISIONS OF iH15 COU•.. NO PERM.L Predrill Existing '/-3Deep Su,,,iE PUTHORIT1' TO VIOLATE Oft CANCELTHEi- ,'� JOIST HANGERIonOVTHISCODE SHALL BE VP.JC, EXCEPTIN SOor other approved methodsNOTE USE REVERSEvK�O�R`"'"��lb'�1TH0I?LANWFOL.
BEAM of su PPurt • tie.
I "1 'x ?"
inc. m„u,J]J` OF ^ Hcn`HT RASED UPON PLANS AND
STATE SIZE 1CATIONS HALL NOT PREVENT THEcC010LNI OF ERRORS
NO I ' A ER, i I+G rNE cu'�j �}
ALL LUMBER DOUGLAS FIR IIV SAID PLANS AND 51 :��"' �,j1� FROM PREVENTING
FOR OPEN EGG CRATE r'O(N Tt� IRdJAIINldEN
y 346x2��-T-STRAP ALUMINUM OR PLASTIC N VIDN OPERA710NS B 1 obhNG - N�W�FNAtl
� � � CONSTRUCTfON' GRAD£ ROOF COVERING IN VIO non OF THIS 0
I
LNG.
MAXIMUM SPAN SIZ.ETHE ITSPACIN,_ _ _. -. .. • ,
X I7. 0" 2x6 12% 15' I "
s 16' 0" 2`x 6' 16-14 13' 3"
POST-BEAM 15' 0 " 7x 6' 24% 10' II"
-r CONNECTION 12' On 2'x 4" 12% 9' II"
• , ^ IV r 0' 2'x 4' I6% 8• 8"
�l POST 10' 0" 7x 4" 24% 7' I"
^* Y x Y' F 67" NOTE: FOR PROPOSED OR FUTURE ROOM,OR WHERE PATIO
.4 SHOW SIZE SHOW SPACING WALLS ARE TO BE BUILT. USE NO. 2 CHART ONLY.
'Ii, SHOW LOCATION ON REVERSE SIDE. WIDER RAFTER- SIZE MAY BE INTERPOLATED FOR
I/4- SPACING ONLY.
PLATS - DROP PATIO FLOOR FOR PROPOSED OR FUTURE ROOM OR WHERE PATIO
f— SLOPE TO DRAIW Z
`'3 ' ` THICK SLAB 4 0:: � WALLS ARE TO BE BUILT SUBMIT COMPLETE )(OUSE
Iii
PUDDLED SAND FILL
w�l%� AND ADDITION PLANS
cx 24 STRAP ' 12 .. Remove Grass And Weeds Down To Natural Grade
CONCRETE MIX 1:3:4 MAXIMUM WATER CONTENT
POST ANCHOR 1'..�-.a'.. 71 GALLONS PER SACK CEMENT.
For Pipe Post.Embed kl2--I Provide 26 Ga G.I. Flashing At Wood Floor Const. COSTA MESA BUILDING DEPT.
Pipe In Footing.
Provide Flange Or Weld Plate Screwed Or Bolted To Frame.
77 FAIR DRIVE 834-5273
FORM BU-40
1 I
e E fro,-- 7C--7�
) .._
0/
/
-4 -Q . 1 -
.t 'cif/mop. /
0231
11) -
e/��
__ __________<1,-- STRUCTURAL APPROVAL ONLY
' / } SEPARATE ITS ARE REQUIRED
FOR ELECTRICAL, PLUMBING,
q % HEATING, VENTILATING AND
w�w�o "' REFRIGERATION WORK
6 'w11 Una •0011101=1114 I ■ Q'.CBBO�# #
r, %W JNlNNVId li
THIS ;UMBER UST ACCOM 'ANY
I 1 /V43W yiSOJ d0 A 13
o
J •
LJ ?��nmV "I / ALI l�SI' C Imo ; ri QU[SIS
/ 417 Qa iOadd fOR BUILDINGS WHERE PERSONS ARE TO-
BE EMPLOYED, WE SUGGEST THAT THE I
STATE OF CALIFORNIA Df6'ISION OF
INDUSTRIAL SAFETY BE CONSULTED FOR
ADDITIONAL REQUIREMENTS.
I
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
F COSTA MESA CON TR UCTI ON PERMIT PjMIT NO. / /// TRACT NO. LOT NO. UNIT NO.
� j �ST cost
m� i •
/'� o7�07Yp LI
Ale Z 9679"12/31/86 • 23.25 TL
oJlic A's Mailingrnt. / / TYPE OF CONSTRUCTION U NEW LI ADD LI ALTERATION U REPAIR
Applicants Pslreu ��• /� ����� .1 � f
,f/ -v ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
Owner's Name �" �� 4±116.: �/ Gl/" Phone sec A.P.# �'� 2 /� Q Zone IC
Address /1 -CO "2"07-
DESCRION F WOR SE OF BLDG./t&.
'G• PJI./-n / t7(1 NDATION ❑ STRUCTURAL S Maio-Beildmg: S/'J•4 Acceaser•Y-8ufkiiw9;ECQt�IO, iENV
Z
Arch/Eng. License No. TYPE OF PERMIT GRADING F T
U Front 3 / „a-- ite* /5te'' ro
Address
111B Rear 3 / ' _O �� / 2 3 '-trh'TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL / N
- 1
io n,/l�d!/ �- 11102 � LI OTHER A
Contractor's Name ,vim ct-s 7- Phone�J ///� C Right �'
��(111 PROJECT DESCRIPTION -3fic'I^C T6cJ OCCUPANCY g 't` / - 0 9 L '—a o N
Address(mailing) y`- / ' ,/ ` CONSTRUCTION TYPE VALUATIONS S Left 2'-a/r /e '- Uq G
City License No. C l�'/ //-- f(Q/t- �1v1 ZONE GRADING CU.YDS. ACRESR
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
I hereby affirm that I am licensed under provisio Charter 9 (ca encing Remarks: Planning Notes: /
with section 7000) of Division 3 of the Busines and Professions Code,and �'/ � •^•� M
my license is in full force and effect. / T
License Class _ License No. S
Date Signature PLUMBING FEES
WORKERS'COMPENSATION DECLARATION Bar Sink Showers
I hereby affirm that I have a certificate of consent to self-Insure or a certificate ELECTRICAL FEES
r Workers' Compensation Insurance, or a certified copy thereof (Section ^
Backflow Preventer Service Sink
100, Lab. C.) Automatic Washer Transformer 0 15-50 KW
relict' No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW
8 Certified copy is hereby furnished.
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date Applicant - -
EXEMPTION FROM WORKERS'COMPENSATION DECLARATIO Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundre.- $100) or
less). Dishwasher Solar Piping. Dryers ❑Gas ❑Electric ' Sub Panel
I certify that in the performance of the work f�ich his p It is issued, I
shall not employ any person in any manne as t• •eco' e subject to the Drinking Fountains Solar Tank Fan
Workers'fpropensry)Ign Laws of Californi. - Motors❑0-1 HP ❑1'h-8
Date "(�/-YJ j-5. Signature � !-_ Floor Drains S a QQ DO
NOTICE: If,after makingthis declare i - P �.+L F.A.U. Inc.Solar ❑9.15 HP ❑1645+
, yo- d become subject to the
Workers' Compensation psivisio." the Labor Code, you must forthwith Floor Sinks Urinal Fixtures •• Microwave comply with such provisions this permit shall be deemed revoked. _
CONSTRUCTION LENDIN• •GENCY Gas Service Outlets . Water ClosetDevice Boxes
1 hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) -
Interceptors Water Heater Outlets
Lender's Name Range
Lender's Address - • Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION - -
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Disposal Garbage
following reason (Section 7031.5 Business and Professional Code: Any city or 9Standing$eitions -
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays Generator ❑0.5 KW❑5-15 KW
any structure, prior.to its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions'of Roof Drains
•
the Contractor's License Law(Chapter 9.(commencing with Section 7000) of '
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section . n/'1 6--, Ci
731.5 by any applicant for a permit subjects the applicant to a civil Fr{/f7sl DO
alty of not more than five hundred dollars($500).
I, as owner of the property • -• .-.- . .. -- . . • Reinspection Fee I $15 Issue Fee $ 3
cpeapewselrp, will do the work,and the structure is not Intended or offered Reinspection Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL -FEES p $15 Issue Fee
.License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own - - DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I '❑
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ • Zoning Approved By Date L
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date! %ate. -
prove for the purpose of sale).
-0 I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat: i77L ,
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a con-
tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration I - BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation incur. Ce should be . ovided to me. PLAN CHECK $ PERMIT
0 I am exempt under Section 'B. & P .for this reason Firepl/Fact.Blt. ICBG# Fire Dampers ISSUANCE $
�f PLUMBING - $ ' •
Date -. -z. Owner ;41rte' — Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have r- •e-his application and state that the above ❑O-100,000 BTU 0100,000BTU— _ GRADING $
information is correct. .grey /+'comp with all city and county ordinances ELECTRICAL $ a
and state laws relati ,o •z t•ing co• traction, and hereby authorize repre-
sentatives pofu this -n[er ..n the above-mentioned property for _ .^ �
•
inspection purpo � ' MECHANICAL $ _ • TOTAL FEE $ `-)�1J
Signature �� '"� Dat Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $
Drivers' Lim e or S
CMF 0865- rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL&SPA
APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector
•
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System' 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains - 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough &Test ,72. Underground Flush
24. Roof Framing .73. Undergrnd.Storage Tank 0 Gas. 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 175. Dry Chemical
27, Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric 6/i9 -i 6,vt Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing t 61411 rsrj
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final •
42. Backflow Preventer •
43. Backf low Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
I
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY, ,
No. _ Date _
CITY OF 1STA MESA
PA FEES Ns 117 .
Fee Payment Receipt
SA.Project Address'L.8'S,'L.89 sir sr. / �.3,t l putt-
.
� Park Area
A. P. No. 118 —14 — 013
Building Permit No.3 l 12-I 3e>
399 3 2, 35
Owner's Name Cue— t-5:3C .S I QC.,
Mailing Address PO -Pio-, 3 7 s � C u Sit u
FEE /I
Single Family * No. of Units 4 @ $455.20 = 18tra. B
Multiple Family ** No. of Units @ $321.32 =
Total Fee 182x.8 0
Planning Department Approval Date .5 —13--) By CA-3 �d1✓
Applicant's Signature // /
* City Ordinance 72.44
** City Ordinance 72-45
*** City Resolution 74.124 I l
White-Planning;Canary-Planning;Pink-Finance;Goldenrod-Applicant CMF 0174-26 C,I ll I �d�tl
; ;(ANLN "'^"r_' LIL/11.11/11./.1.1.3 11•l.• DATE
.. JOB ADDRESS ; • S •- BUILDING PERMIT NO. "
'GENERAL CONTRACTOR Hood & Assoc. DESCRIPTION of WORK Res.w a , ar
ai 9 AD No. 118-11.3-08 LOT TRACT FIRE ZONE VALUE $35,000.00
.j 1 -CTIONS Signature Date TYPE V GROUPI & J ZON ER1
V SOILte...91C 6129-76 SUBCONTRACTOR PERMITS ISSUED
GAS Date
Number Signature
WATER R•o S•- -21-•y •� �'7 Plumbing
ROUGH PLUMBING =, /,< L,^2s7? 'J Y.4Y W—ea. _-�a•7S ` 7vW4./
PROP. SWR. LINE [L'HOUSE CON. d rV [.�' 2S2^ 5, Eaten, v 6-a3-75 614/7----
SPRINKLING
� //----
SPRINKLING SYSTEM J
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING .�5 6 -2. - 7e- .
TEMPORARY SERVICE OR POLE )2..(•G T5-2075
UNDERGROUND 0 POWER ❑
ROUGH WIRING _6,1;1 Heating and Vent.
TRENCHES ❑ FORMS ❑ STEEL REINF. 0 Q ^ z 2.1J 62.„•.;/ ,_2„.,....c... 6,-. 3-75r / /PM 3
FLOOR SYSTEF-M� an- C rJ',-�
BOND BEAM [l STEEL REINFORCE •
SHEATHING � / C ^� 3-7—
FRAME AND FLASHING Iry'�J/ •/ <2 •_. 7_I
LATHING - IN OUT 4-',/i
- -
PLASTER, BROWN COAT °- /3T
ST TURAL, FINAL r iYa3_LD, - ' I�� /
H. ,G, VENT., REFRIG. AND A.C., FINAL IP.• 4 t Y-li- 2jat -erifat:��� -i _2 90/,- Ate--Y
PLUMBING. FINAL ANO GAS TEST [-1r-1S Z sineI;j[,j; ._/C• • -,il. /47 r
lir._ _
39 3993 "av 6 75�M�a00 is9<: **x73.45
-
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
BUILDING •7 `/ 5r Of/T/ RECEI V�D�BV I Dl✓siE RFjCEl7j� DATE ISSUED
ADDRESS n Lr" 'JC ...57)--eco/ /C S^ G .Ir /`// 7
OWNER /� r �v, /��/,-s 1,�,eMAIL A.P.NO. 1tg 143-08 I PERMIT NO.
sr
ADDRESS d. o;U,A' J2 (p BUIDEG �� r �jl%t
/ ADDRESSla La TEL.
,,11x�.6 G. ..
0 U CITY 72/_C t/AC NO.4J6'y3XC RA T Ti' �OT2 BLOCK
CONSTRUCTION / (ADD ALTER (REPAIR (MOVING DFMOLISH
O H LENDER
am
J 7 BRANCH '
J N OWNER -'
mLIJ
J ADDRESS pp.00 /�(�J� n VALUE -CrN AOR HITT T a 41-,, TEL.lS TO.�.J��lr/�S USE Y•-4"•/ .� FYI` $ > 00o
UQ FIRE V _ �/J�
W cc ADDRESS 7��c� y-t, 4��1 ZONE / VPE GROUP l.-Y-�
it W APPROVED /II I
JQ CONTRACTOR o45 dC/�'.' !4 � BY � fEDATE 1/�hi
IL
71
0 yr
JCC ADDRESS ager fj ^)
W(II � TEL -.0135‹
, ZO NO.OF USE OF NEW
ZI- CITY riff 5i,tel) NO.53' 7,.3s‹ PLANS BUILDING w
W O STATE �t CITY YARDS APPROVED YARDS APPROVED tA
to¢ LIC. NO. p2,2 /D b/// LIC.NO. MAIN BUILDING - ACCESSORY BUILDING m
D 0 SIZE y INO.OF BLDGS.
/ (FROM C/L STREET) `�,J
OF LOT , SQ X 2 0 NOW ON LOT ' FRONT Sb FT. FT. nY
USE OF
EXISTING BLDLG/. �/ -/s/, R SIDE S FT. FT.
ZE OF
NO.OF
2 NIEW BLDG. '/ /� �/ ROOMS S STORIES / L.SIDE S FT. FT.
Q EXTERIOR WALL ROOF /fir �•s e l
V COVERING CCO COVERING ( -Qit� Ci _REAR T. �Q FT.
J USE OF BUILDING AND WORK TO BE PERFORMS DISTANCE BET. BET.MAIN&
1
a MAIN BLDGS. ACCESS. BLDGS.
Q .` te / - /��./�/ VAR.. DATE 3-^ -.,S
o ,'/� ,, / / �--2 a C.U.P.# /S-LO APPROVED T
~ APPROVED /3
r
2 H N ' ECIA L REQUIREMENT'_
t~.1 I hereby acknowledge that I have read this application and state ' M
D that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ \-‘7•44.
\ qJ.
I- any person in violation of the workman's compensation laws of
CO the State of California. \ m
— I hereby certify that I am properly licensed as a contractor under SO. FT. o
the State of California Business and Professions Co , ivisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force nd ef'.ct,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
IC
am exempt from the •rov i.ns of the Sta - of C ifornia =usiness
and Professions Cod:, D' Is •n 3,Cpapta •. VALUATION $/ /•�[I- Lrt- N
/ //// PERMIT FEE O
Signature of / /f�" co
Permittee _f/.- $ 3,'J� UUO - PLAN CHECK $ / l - E
Authorized •gent a/5-1 >-/ u
TOTAL FEE $¢
OWNER MARCHIORLATTIT JON DATE 6-13-77
JOB ADDRESS 285 East 21st Street BUILDING PERMIT NO. 44134
GENERAL CONTRACTOR Owner-Builder DESCRIPTION of WORK Patio Cover
AZ,::/). 118-1143-28 LOT TRACT FIRE ZONE VALUE $500.00
ikkiljcTiows Signature Date TYPE V GROUP j ZONE R-1
SOIL)45
PERMITS I5SUD
GAS - SUBCONTRACTOR
Date Number Signature
WATER Plumbing
ROUGH PLUMBING •
PROP: SWR. LINE ❑ HOUSE CON. 0
PRINKLING SYSTEM
• SSS
MISCELLANEOUS _
ROUGH HEATING AND AIR CONDITIONING .
TEMPORARY SERVICE OR POLE
UNDERGROUND 0 POWER 0
ROUGH WIRING Heating and Vent.
YTRENCHES U FORMSU STEEL REINF.
FLOOR SYSTEM
BONO BEAM n 'STEEL REINFORCE n
SHEATHING _
FRAME AND FLASHING
LATHING - IN n OUT n
PLASTER, BROWN COAT
S TURAL, FINAL Elertrie
HL. .NG, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL
BUILDING. FINAL soidIf g ratlir 2 •
•
PAID F 4***n
44139 fug13-77rX�z0015Q6� 5.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely— Use Ink Only `/
ADDRESS �ov REC�4�%FM9R'�- DATE RECEIVED p k IED
BUILDING t-1 /STI / -AWJ� �7 E((/37
F/ /y� qpn /� n�•� A.P.NO. / 7L/S}_ /fir PERMIT NO.
QWNER Jo/v ///ryrt e, �l/�6/T7/� V /r
++ AIL n86 f ^/c7 ' ADBUIDRESS �� /�i_ ��rADDRESS rjS �C '/ ADDRESS
Q,J ?AD /Y—LG`
/+',,�^ �y /� TEL. -.4/�fTR/CTNF/Grr 7ALOTJ/y BLOCK
CITY l..C:5 /9 llfr_s fT NO. 04
CONSTRUCTION NEW ADD ALTER REPAIR MOVING OFMOLISH
LENDER /
BRANCH OWNER tri,---, J1fi /J/ LF(0fl
ADDRESS /moi /) a��r -
//'�/r0 ICDLVALUS d
ORCNITECT TEL. USE CD
OR ENGINEER Na
FIRE
ADDRESS ZONE / TV E i GROUP
CONTRACTOR nnowneR APPROVED / DATE1Y".7-2,2
ADDRESS S/f' V
M TEL. ZONE? / INO.OF USE OF NEW _
CITY C. /7 - NO. ^ PLANS , BUILDING Yd (Lvcc
— STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE INO.OF SLOGS. (FROM C/LSTREET) //
M.. OF LOT NOW ON LOT FRONT�///tilic- CC ALJ FT.
HUSE OF --/
EXISTING BLDG. B.SIDES FZ FT,
/kV f
H Separate permits are required for L.SIDE ria FT. FT.
electric,plumbing and heating work-
CREAR arlFT. FT.
IM 4
H USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN Er
Q /'� /� / MAIN BLDGS. ACCESS. BLDGS.
Q \ / e P/f� ��T�(J rbve ° C.U.P.# f� r/�r--,�!l���� _APPROVEEDD
n%oP. �V ROVED 1-- /1N/' DATE V •/���
L alii- Oxy Tof N/
a
w
a. I hereby acknowledge that I have read this application and state n
p$ that the above information is correct and agree to comply with m
a all laws regulating building construction, and I shall not employ
i
Z any person In violation of the workman's compensation laws of o
the State of California.
I hereby certify that I am properly licensed as a contractor under
SO. FT. ry
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: e
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE a6—, 490e
and Professions Code, Division 3,Chapter 9. J:
0m
Signature of /�N_ ��> 0 Q PLAN CHECK $ / o
Permitto //iM /'�l�t�/�� .l r� . $ 5-o TAX § i 6 d u
Authorize
Permit-toy
TOTAL PAID $ 4 50
0